Increasing Prevalence and Improved Outcomes of Type 1 Diabetes Among Older Adults Globally

Core Concepts

The prevalence of type 1 diabetes (T1D) among people aged 65 and older has increased significantly globally, while mortality and disability-adjusted life years (DALYs) have decreased over the past three decades, suggesting improvements in medical care for this population.

Abstract

The study examined the global trends in the prevalence, mortality, and disability-adjusted life years (DALYs) of type 1 diabetes (T1D) among people aged 65 and older from 1990 to 2019. Key findings include:

The global prevalence of T1D among people aged 65+ increased by 180%, from 1.3 million in 1990 to 3.7 million in 2019. The proportion of older people with T1D increased from 12% of all T1D cases in 1990 to 17% in 2019.

Age-standardized mortality from T1D among the 65+ age group decreased significantly by 25%, from 4.7 per 100,000 population in 1990 to 3.5 per 100,000 in 2019.

The increase in T1D prevalence was more rapid among men compared to women (average annual percent change of 1.00% vs. 0.74%).

T1D prevalence at least tripled in every age subgroup of those aged 65+, and even increased five- to six-fold for those aged 90-95 and 95+ years.

The three primary risk factors associated with DALYs for T1D among the 65+ population were high fasting plasma glucose levels, low temperature, and high temperature.
The authors conclude that T1D is no longer a major contributor to decreased life expectancy in older adults due to improvements in medical care over the past three decades. However, management of high fasting plasma glucose levels remains a significant challenge for this population, and targeted clinical guidelines are needed.

Stats

The global prevalence of type 1 diabetes among people aged 65 and older increased from 1.3 million in 1990 to 3.7 million in 2019, a 180% increase.
Age-standardized mortality from type 1 diabetes among the 65+ age group decreased by 25%, from 4.7 per 100,000 population in 1990 to 3.5 per 100,000 in 2019.
The increase in type 1 diabetes prevalence was more rapid among men compared to women, with an average annual percent change of 1.00% vs. 0.74%.
The three primary risk factors associated with disability-adjusted life years for type 1 diabetes among the 65+ population were high fasting plasma glucose levels (103 DALYs per 100,000 people), low temperature (3 DALYs per 100,000 people), and high temperature (1 DALY per 100,000 people) in 2019.

Quotes

"The results suggest that T1DM is no longer a contributory factor in decreased life expectancy owing to improvements in medical care over the three decades."
"Management of high fasting plasma glucose levels remains a major challenge for older people with T1D, and targeted clinical guidelines are needed."

Key Insights Distilled From

More and More Are Living With Type 1 Diabetes Into Old Age

by Miriam E. Tu... at www.medscape.com 06-19-2024

https://www.medscape.com/viewarticle/more-and-more-are-living-type-1-diabetes-old-age-2024a1000bej

Deeper Inquiries

What specific medical care improvements have contributed to the decreased mortality and disability among older adults with type 1 diabetes?

The decreased mortality and disability among older adults with type 1 diabetes can be attributed to several medical care improvements over the past few decades. Firstly, advancements in insulin therapy, including the development of long-acting insulins and insulin delivery systems, have significantly improved glycemic control in older adults with type 1 diabetes, reducing the risk of complications and mortality. Additionally, the widespread adoption of continuous glucose monitoring (CGM) systems has allowed for real-time monitoring of blood glucose levels, enabling better management of diabetes and prevention of hypoglycemic episodes. Moreover, the emphasis on personalized diabetes management plans, including diet and exercise regimens tailored to individual needs, has played a crucial role in improving outcomes for older adults with type 1 diabetes. Overall, these medical care improvements have contributed to the decreased mortality and disability seen in this population.

How can healthcare systems and providers better address the challenge of managing high fasting plasma glucose levels in older adults with type 1 diabetes?

To better address the challenge of managing high fasting plasma glucose levels in older adults with type 1 diabetes, healthcare systems and providers can implement several strategies. Firstly, there should be a focus on individualized treatment plans that take into account the unique needs and circumstances of older adults, including comorbidities and cognitive function. Regular monitoring of blood glucose levels, including fasting plasma glucose, is essential to identify trends and make timely adjustments to treatment regimens. Healthcare providers should also prioritize patient education and empowerment, ensuring that older adults with type 1 diabetes understand the importance of lifestyle modifications, medication adherence, and regular follow-ups. Additionally, the integration of telemedicine and remote monitoring technologies can facilitate ongoing management and support for older adults with type 1 diabetes, especially in cases where frequent in-person visits may not be feasible. By adopting a holistic and patient-centered approach, healthcare systems and providers can better address the challenge of managing high fasting plasma glucose levels in this population.

What implications do the increasing prevalence and improved outcomes of type 1 diabetes in older adults have for the design and delivery of healthcare services and resources in the future?

The increasing prevalence and improved outcomes of type 1 diabetes in older adults have significant implications for the design and delivery of healthcare services and resources in the future. Healthcare systems will need to adapt to the growing population of older adults with type 1 diabetes by developing specialized care programs that address the unique needs of this demographic. This may include establishing multidisciplinary care teams that consist of endocrinologists, geriatric specialists, dietitians, and mental health professionals to provide comprehensive and integrated care. Furthermore, there will be a greater emphasis on preventive care and early intervention strategies to mitigate the long-term complications associated with type 1 diabetes in older adults. Healthcare resources will need to be allocated efficiently to support the increasing demand for diabetes management services, including access to advanced technologies such as CGM systems and insulin pumps. Overall, the design and delivery of healthcare services for older adults with type 1 diabetes will need to evolve to ensure quality care, improved outcomes, and enhanced quality of life for this growing population.