Burden of diabetes in an aging population: prevalence, incidence, mortality, characteristics and quality of care

The purpose of this work is to review the recent publications on prevalence, incidence, mortality, characteristics and quality of care related to diabetes in the elderly population. In France, the prevalence of drug-treated diabetes peaks at 14% by age 75-79 years, and at least one million people aged over 65 years have diabetes. Incidence rates for Northern Europeans rank between 3 and 7 per 1,000 person-years. The World Health Organization expects prevalent cases to further increase, due to better case ascertainment, better survival of people with diabetes, increase in obesity leading to a true increase in diabetes incidence, and, in developed countries, the important impact of population aging. The burden of diabetes in the elderly population is already high. Even in the oldest age-groups, excess mortality risks associated with diabetes are significant and mostly related to cardiovascular disease, accounting for the loss of 3 to 6 years of life. The cardiovascular risk of elderly people with diabetes is poorly controlled, increasing risks of diabetes complications, loss of cognitive functions and mobility, and dependency. Screening for lipid abnormalities and diabetes complications to prevent further damage is insufficient, and antihypertensive and hypolipidemic treatments are, in this population, underused, as in other countries. Specific adjustments of medical nutrition therapy are lacking. In long-term care facilities where the prevalence of diabetes is especially high (8 to 25%), quality of diabetes care is often poorer. As the burden of diabetes is becoming heavier, specific monitoring of the health, quality of care and needs of elderly people with diabetes is required for adequate public health planning.