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Current Diabetes Reports

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01-05-2020 | Affective Disorder | Psychosocial Aspects (SS Jaser, Section Editor)

Novel Challenges in Aging with Type 1 Diabetes

Authors: Jeoffrey A. Bispham, Allyson S. Hughes, Kimberly A. Driscoll, Alicia H. McAuliffe-Fogarty

Published in: Current Diabetes Reports | Issue 5/2020

Abstract

Purpose of Review

Due to treatment advancements, individuals with type 1 diabetes (T1D) are living longer, presenting a unique understudied population with advanced complex needs. This article is a review of the aging literature in T1D and identifies existing gaps while serving as a call to the research community.

Recent Findings

Recent studies have identified an association between cognitive impairment and glycemic variability, as well as increased risk and frequency of hypoglycemia in older adults with T1D. However, limited research exists about additional physical and mental health conditions and barrier to successful treatment in this population.

Summary

Older adults may experience both age- and diabetes-related barriers to diabetes management. Due to the scarcity of aging T1D research, current treatment guidelines for this age group are based on type 2 diabetes research. There is a critical need to further investigate the physical and mental effects of T1D and aging as well as public health policy; insurance challenges; and needs for support and interventions for older adults with T1D.

Imperatore G, Boyle JP, Thompson TJ, et al. Projections of type 1 and type 2 diabetes burden in the U.S. population aged <20 years through 2050. Diabetes Care. 2012;35(12):2515 LP - 2520. https://doi.org/10.2337/dc12-0669.CrossRefPubMedPubMedCentral

Dabelea D, Mayer-Davis EJ, Saydah S, Imperatore G, Linder B, Divers J, et al. Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001 to 2009. JAMA. 2014;311(17):1778–86. https://doi.org/10.1001/jama.2014.3201.CrossRefPubMedPubMedCentral

Miller RG, Secrest AM, Sharma RK, Songer TJ, Orchard TJ. Improvements in the life expectancy of type 1 diabetes: the Pittsburgh epidemiology of diabetes complications study cohort. Diabetes. 2012;61(11):2987–92. https://doi.org/10.2337/db11-1625.CrossRefPubMedPubMedCentral

Huo L, Harding JL, Peeters A, Shaw JE, Magliano DJ. Life expectancy of type 1 diabetic patients during 1997–2010: a national Australian registry-based cohort study. Diabetologia. 2016;59(6):1177–85. https://doi.org/10.1007/s00125-015-3857-4.CrossRefPubMed

American Diabetes Association. 12. Older adults: standards of medical care in diabetes—2020. Diabetes Care. 2020;43(Supplement 1):S152–62. https://doi.org/10.2337/dc20-S012.CrossRef

American Diabetes Association. 6. Glycemic targets: standards of medical care in diabetes—2020. Diabetes Care. 2020;43(Supplement 1):S66–76. https://doi.org/10.2337/dc20-S006.CrossRef

Kirkman MS, Briscoe VJ, Clark N, Florez H, Haas LB, Halter JB, et al. Diabetes in older adults: a consensus report. J Am Geriatr Soc. 2012;60(12):2342–56. https://doi.org/10.1111/jgs.12035.CrossRefPubMedPubMedCentral

Beverly EA, Ritholz MD, Shepherd C, Weinger K. The psychosocial challenges and care of older adults with diabetes: “can’t do what I used to do; can’t be who I once was”. Curr Diab Rep. 2016;16(6):48. https://doi.org/10.1007/s11892-016-0741-7.CrossRefPubMedPubMedCentral

Young-Hyman D, de Groot M, Hill-Briggs F, Gonzalez JS, Hood K, Peyrot M. Psychosocial care for people with diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2016;39(12):2126–40. https://doi.org/10.2337/dc16-2053.CrossRefPubMedPubMedCentral

10.

Dhaliwal R, Weinstock RS. Management of type 1 diabetes in older adults. Diabetes Spectr. 2014;27(1):9–20. https://doi.org/10.2337/diaspect.27.1.9.CrossRefPubMedPubMedCentral

11.

Hautala N, Siiskonen M, Hannula V, Järvinen K, Falck A. Early glycaemic control for maintaining visual function in type 1 diabetes: the Oulu cohort study of diabetic retinopathy. Eur J Ophthalmol. 2018;28(6):684–9. https://doi.org/10.1177/1120672117750053.CrossRefPubMed

12.

Fong DS, Aiello L, Gardner TW, et al. Retinopathy in diabetes. Diabetes Care. 2004;27(Suppl. 1):S84–7. https://doi.org/10.2337/diacare.27.2007.S84.CrossRefPubMed

13.

Khan MI, Barlow RB, Weinstock RS. Acute hypoglycemia decreases central retinal function in the human eye. Vis Res. 2011;51(14):1623–6. https://doi.org/10.1016/j.visres.2011.05.003.CrossRefPubMed

14.

Kimbro LB, Mangione CM, Steers WN, Duru OK, McEwen L, Karter A, et al. Depression and all-cause mortality in persons with diabetes mellitus: are older adults at higher risk? Results from the translating research into action for diabetes study. J Am Geriatr Soc. 2014;62(6):1017–22. https://doi.org/10.1111/jgs.12833.CrossRefPubMedPubMedCentral

15.

Laiteerapong N, Karter A, Liu J, Moffet HH, Sudore R, Schillinger D, et al. Correlates of quality of life in older adults with diabetes. The Diabetes & Aging Study. Diabetes Care. 2011;34(8):1749–53. https://doi.org/10.2337/dc10-2424.CrossRefPubMedPubMedCentral

16.

Sozen T, Calik Basaran N, Tinazli M, Ozisik L. Musculoskeletal problems in diabetes mellitus. Eur J Rheumatol. 2018;5(4):258–65. https://doi.org/10.5152/eurjrheum.2018.18044.CrossRefPubMedPubMedCentral

17.

Koh S, Nakamura S, Hattori T, Hirata H. Trigger digits in diabetes: their incidence and characteristics. J Hand Surg Eur Vol. 2010;35(4):302–5. https://doi.org/10.1177/1753193409341103.CrossRefPubMed

18.

Pfützner J, Hellhammer J, Musholt P, Pfützner AH, Böhnke J, Torsten H, et al. Evaluation of dexterity in insulin-treated patients with type 1 and type 2 diabetes mellitus. J Diabetes Sci Technol. 2011;5(1):158–65. https://doi.org/10.1177/193229681100500122.CrossRefPubMedPubMedCentral

19.

Shah VN, Wu M, Foster N, Dhaliwal R, Al Mukaddam M. Severe hypoglycemia is associated with high risk for falls in adults with type 1 diabetes. Arch Osteoporos. 2018;13(1):66. https://doi.org/10.1007/s11657-018-0475-z.CrossRefPubMed

20.

Foster NC, Beck RW, Miller KM, Clements MA, Rickels MR, DiMeglio L, et al. State of type 1 diabetes management and outcomes from the T1D Exchange in 2016–2018. Diabetes Technol Ther. 2019;21(2):66–72. https://doi.org/10.1089/dia.2018.0384.CrossRefPubMedPubMedCentral

21.

Ryan CM, Klein BEK, Lee KE, Cruickshanks KJ, Klein R. Associations between recent severe hypoglycemia, retinal vessel diameters, and cognition in adults with type 1 diabetes. J Diabetes Complicat. 2016;30(8):1513–8. https://doi.org/10.1016/j.jdiacomp.2016.08.010.CrossRefPubMedPubMedCentral

22.

Talley M, Pryor E, Wadley V, Crowe M, Morrison S, Vance D. The physiological mechanisms of diabetes and aging on brain health and cognition. J Neurosci Nurs. 2015;47(5):E12–22. https://doi.org/10.1097/JNN.0000000000000156.CrossRefPubMed

23.

Munshi MN. Cognitive dysfunction in older adults with diabetes: what a clinician needs to know. Diabetes Care. 2017;40(4):461–7. https://doi.org/10.2337/dc16-1229.CrossRefPubMed

24.

Lacy ME, Gilsanz P, Karter AJ, Quesenberry CP, Pletcher MJ, Whitmer RA. Long-term glycemic control and dementia risk in type 1 diabetes. Diabetes Care. 2018;41(11):2339–45. https://doi.org/10.2337/dc18-0073.CrossRefPubMedPubMedCentral

25.

•• Gilsanz P, Schnaider Beeri M, Karter AJ, Quesenberry CP, Adams AS, Whitmer RA. Depression in type 1 diabetes and risk of dementia. Aging Ment Health. 2019;23(7):880–6. https://doi.org/10.1080/13607863.2018.1455167This study provides evidence that risk of dementia is significantly increased with the occurrence of depression in adults with type 1 diabetes aged ≥ 50. CrossRefPubMed

26.

Markowitz SM, Gonzalez JS, Wilkinson JL, Safren SA. A review of treating depression in diabetes: emerging findings. Psychosomatics. 2011;52(1):1–18. https://doi.org/10.1016/j.psym.2010.11.007.CrossRefPubMedPubMedCentral

27.

Trief PM, Xing D, Foster NC, Maahs DM, Kittelsrud JM, Olson BA, et al. Depression in adults in the T1D Exchange clinic registry. Diabetes Care. 2014;37(6):1563–72. https://doi.org/10.2337/dc13-1867.CrossRefPubMed

28.

de Groot M, Golden SH, Wagner J. Psychological conditions in adults with diabetes. Am Psychol. 2016;71(7):552–62. https://doi.org/10.1037/a0040408.CrossRefPubMedPubMedCentral

29.

Reddy J, Wilhelm K, Campbell L. Putting PAID to diabetes-related distress: the potential utility of the problem areas in diabetes (PAID) scale in patients with diabetes. Psychosomatics. 2013;54(1):44–51. https://doi.org/10.1016/j.psym.2012.08.004.CrossRefPubMed

30.

Sturt J, Dennick K, Due-Christensen M, McCarthy K. The detection and management of diabetes distress in people with type 1 diabetes. Curr Diab Rep. 2015;15(11):101. https://doi.org/10.1007/s11892-015-0660-z.CrossRefPubMed

31.

Hessler DM, Fisher L, Polonsky WH, Masharani U, Strycker LA, Peters AL, et al. Diabetes distress is linked with worsening diabetes management over time in adults with type 1 diabetes. Diabet Med. 2017;34(9):1228–34. https://doi.org/10.1111/dme.13381.CrossRefPubMedPubMedCentral

32.

Smith KJ, Béland M, Clyde M, Gariépy G, Pagé V, Badawi G, et al. Association of diabetes with anxiety: a systematic review and meta-analysis. J Psychosom Res. 2013;74(2):89–99. https://doi.org/10.1016/j.jpsychores.2012.11.013.CrossRefPubMed

33.

Martyn-Nemeth P, Schwarz Farabi S, Mihailescu D, Nemeth J, Quinn L. Fear of hypoglycemia in adults with type 1 diabetes: impact of therapeutic advances and strategies for prevention - a review. J Diabetes Complicat. 2016;30(1):167–77. https://doi.org/10.1016/j.jdiacomp.2015.09.003.CrossRefPubMed

34.

Böhme P, Bertin E, Cosson E, Chevalier N, GEODE group. Fear of hypoglycaemia in patients with type 1 diabetes: do patients and diabetologists feel the same way? Diabetes Metab. 2013;39(1):63–70. https://doi.org/10.1016/j.diabet.2012.10.006.CrossRefPubMed

35.

Anderbro T, Amsberg S, Wredling R, Lins PE, Adamson U, Lisspers J, et al. Psychometric evaluation of the Swedish version of the Hypoglycaemia Fear Survey. Patient Educ Couns. 2008;73(1):127–31. https://doi.org/10.1016/j.pec.2008.03.022.CrossRefPubMed

36.

Argento NB, Liu J, Hughes AS, McAuliffe-Fogarty AH. Impact of Medicare continuous subcutaneous insulin infusion policies in patients with type 1 diabetes. J Diabetes Sci Technol. 2019;193229681983829. https://doi.org/10.1177/1932296819838292.

37.

Caspersen CJ, Thomas GD, Boseman LA, Beckles GLA, Albright AL. Aging, diabetes, and the public health system in the United States. Am J Public Health. 2012;102(8):1482–97. https://doi.org/10.2105/AJPH.2011.300616.CrossRefPubMedPubMedCentral

38.

Peron EP, Ogbonna KC, Donohoe KL. Antidiabetic medications and polypharmacy. Clin Geriatr Med. 2015;31(1):17–27. https://doi.org/10.1016/j.cger.2014.08.017.CrossRefPubMed

39.

Bauer S, Nauck MA. Polypharmacy in people with type 1 and type 2 diabetes is justified by current guidelines-a comprehensive assessment of drug prescriptions in patients needing inpatient treatment for diabetes-associated problems. Diabet Med. 2014;31(9):1078–85. https://doi.org/10.1111/dme.12497.CrossRefPubMed

40.

Dhalwani NN, Fahami R, Sathanapally H, Seidu S, Davies MJ, Khunti K. Association between polypharmacy and falls in older adults: a longitudinal study from England. BMJ Open. 2017;7(10):e016358. https://doi.org/10.1136/bmjopen-2017-016358.CrossRefPubMedPubMedCentral

41.

Grant RW, Devita NG, Singer DE, Meigs JB. Polypharmacy and medication adherence in patients with type 2 diabetes. Diabetes Care. 2003;26(5):1408–12. https://doi.org/10.2337/diacare.26.5.1408.CrossRefPubMed

42.

Roussel R, Moutairou A, Riveline J-P, Gautier J-F, Potier L. 1091-P: association between mild and severe hypoglycemia in people with T1 and T2 diabetes enrolled in randomized controlled trials for assessing insulin therapy. Diabetes. 2019;68(Suppl. 1):1091. https://doi.org/10.2337/db19-1091-P.CrossRef

43.

Yeoh E, Choudhary P, Nwokolo M, Ayis S, Amiel SA. Interventions that restore awareness of hypoglycemia in adults with type 1 diabetes: a systematic review and meta-analysis. Diabetes Care. 2015;38(8):1592–609. https://doi.org/10.2337/dc15-0102.CrossRefPubMed

44.

Donnelly LA, Morris AD, Frier BM, Ellis JD, Donnan PT, Durrant R, et al. Frequency and predictors of hypoglycaemia in type 1 and insulin-treated type 2 diabetes: a population-based study. Diabet Med. 2005;22(6):749–55. https://doi.org/10.1111/j.1464-5491.2005.01501.x.CrossRefPubMed

45.

Weinstock RS, Xing D, Maahs DM, Michels A, Rickels MR, Peters AL, et al. Severe hypoglycemia and diabetic ketoacidosis in adults with type 1 diabetes: results from the T1D Exchange clinic registry. J Clin Endocrinol Metab. 2013;98(8):3411–9. https://doi.org/10.1210/jc.2013-1589.CrossRefPubMed

46.

Weinstock RS, DuBose SN, Bergenstal RM, Chaytor NS, Peterson C, Olson BA, et al. Risk factors associated with severe hypoglycemia in older adults with type 1 diabetes. Diabetes Care. 2016;39(4):603–10. https://doi.org/10.2337/dc15-1426.CrossRefPubMed

47.

DuBose SN, Weinstock RS, Beck RW, Peters AL, Aleppo G, Bergenstal RM, et al. Hypoglycemia in older adults with type 1 diabetes. Diabetes Technol Ther. 2016;18(12):765–71. https://doi.org/10.1089/dia.2016.0268.CrossRefPubMed

48.

•• Chaytor NS, Barbosa-Leiker C, Ryan CM, Germine LT, Hirsch IB, Weinstock RS. Clinically significant cognitive impairment in older adults with type 1 diabetes. J Diabetes Complicat. 2019;33(1):91–7. https://doi.org/10.1016/j.jdiacomp.2018.04.003This study identified the prevalence of clinically significant cognitive impairment in older adults with type 1 diabetes and diabetes-related factors correlated with impairment. CrossRefPubMed

49.

Mattishent K, Richardson K, Dhatariya K, Savva GM, Fox C, Loke YK. The effects of hypoglycaemia and dementia on cardiovascular events, falls and fractures and all-cause mortality in older individuals: a retrospective cohort study. Diabetes Obes Metab. 2019:1–10. https://doi.org/10.1111/dom.13769.

50.

Roy T, Lloyd CE. Epidemiology of depression and diabetes: a systematic review. J Affect Disord. 2012;142(Suppl):S8–21. https://doi.org/10.1016/S0165-0327(12)70004-6.CrossRefPubMed

51.

Bădescu SV, Tătaru C, Kobylinska L, Georgescu EL, Zahiu DM, Zăgrean AM, et al. The association between diabetes mellitus and depression. J Med Life. 2016;9(2):120–5 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4863499/.PubMedPubMedCentral

52.

Administration SA and MHS. Key substance use and mental health indicators in the United States: results from the 2017 National Survey on Drug Use and Health. Rockville, MD; 2018. https://www.samhsa.gov/data/. Accessed 10 Feb 2020.

53.

Hagger V, Hendrieckx C, Sturt J, Skinner TC, Speight J. Diabetes distress among adolescents with type 1 diabetes: a systematic review. Curr Diab Rep. 2016;16(1):9. https://doi.org/10.1007/s11892-015-0694-2.CrossRefPubMed

54.

Munshi MN, Florez H, Huang ES, Kalyani RR, Mupanomunda M, Pandya N, et al. Management of diabetes in long-term care and skilled nursing facilities: a position statement of the American Diabetes Association. Diabetes Care. 2016;39(2):308–18. https://doi.org/10.2337/dc15-2512.CrossRefPubMedPubMedCentral

55.

Polonsky WH, Peters AL, Hessler D. The impact of real-time continuous glucose monitoring in patients 65 years and older. J Diabetes Sci Technol. 2016;10(4):892–7. https://doi.org/10.1177/1932296816643542.CrossRefPubMedPubMedCentral

Title: Novel Challenges in Aging with Type 1 Diabetes
Authors: Jeoffrey A. Bispham
Allyson S. Hughes
Kimberly A. Driscoll
Alicia H. McAuliffe-Fogarty
Publication date: 01-05-2020
Publisher: Springer US
Keywords: Affective Disorder
Affective Disorder
Hypoglycemia
Type 1 Diabetes
Type 2 Diabetes
Published in: Current Diabetes Reports / Issue 5/2020
Print ISSN: 1534-4827
Electronic ISSN: 1539-0829
DOI: https://doi.org/10.1007/s11892-020-01298-9

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