The average age of people with diabetes is 65. One-quarter (26%) of people with diabetes are 75 years of age or older. Given the aging of the French population, the number of older adults with diabetes will increase in the coming years, which is likely to have an impact on the healthcare system. In addition, older adults often have other associated conditions that can complicate their medical care. Specific analyses were therefore conducted among older adults with diabetes, based on the 2001 and 2007 ENTRED studies.

Diabetes in Older Adults in the 2001 and 2007 ENTRED Studies

The quality of care received by older adults treated for type 2 diabetes was analyzed using data from the ENTRED 2001 and 2007 studies [1]. For this purpose, the ENTRED 2007 data were weighted based on the sampling frame and response rate. No weighting was performed in the 2001 ENTRED study. To compare ENTRED 2001 with ENTRED 2007, the data were standardized by age, since the sampling methods, response rates, and age distributions differed between the two studies (people aged 65 or older with type 2 diabetes: n=1,801 in 2001 and n=1,766 in 2007). Among people aged 65 or older treated for type 2 diabetes, the prevalence of obesity has increased since 2001 (35% in 2007, +7 percentage points compared to 2001), while dietary counseling was prescribed less frequently (59%, -6 percentage points). The mean values for HbA1c (7.1%, -0.2% compared to 2001), blood pressure (135/76 mmHg, -4/-3 mmHg), and LDL cholesterol (1.04 g/L, -0.21 g/L) have decreased. At the same time, the frequency of drug treatments increased: at least two oral antidiabetics in 34% of cases (+4 percentage points compared to 2001), a combination of oral antidiabetics and insulin in 10% of cases (+4 percentage points), antihypertensive treatment in 83% of cases (+4 percentage points), and statins in 48% of cases (+26 percentage points). Severe hypoglycemia remained common (10% of people reported at least one episode of severe hypoglycemia in the year and 4% reported at least three). The overall prevalence of self-reported complications increased between 2001 and 2007, likely due to intensified screening practices (e.g., fundus examination: +13 percentage points) and treatments (coronary revascularization: +7 percentage points). Renal complications were not adequately controlled (missing values for albuminuria: 42%, -4.5 percentage points compared to 2001, unknown glomerular filtration rate (GFR): 13%, +6.5 points), 46% of individuals with GFR < 60 ml/min/1.73 m² were treated with metformin.The quality of care and control of most cardiovascular risk factors in older adults with type 2 diabetes improved between 2001 and 2007. Nevertheless, further progress is still needed, particularly regarding monitoring of renal function, screening for complications, and control of blood pressure and blood glucose levels, but according to a reasonable therapeutic strategy appropriate for this age group.

Reference: [1] Pornet C, Bourdel-Marchasson I, Lecomte P, Eschwège E, Romon I, Fosse S, Assogba F, Roudier C, Fagot-Campagna A, for the ENTRED Scientific Committee.Trends in the quality of care for elderly people with type 2 diabetes: The need for improvements in safety and quality (the 2001 and 2007 ENTRED Surveys). Diabetes Metab. 2011 Apr, 37(2):152-161.

Learn more:

• Bourdel-Marchasson I, Doucet J, Bauduceau B, Berrut G, Blickle JF, Brocker P, Constans T, Fagot-Campagna A, Kaloustian E, Lassmann-Vague V, Lecomte P, Simon D, Tessier D, Verny C, Vischer UM, for the ALFEDiam. Key priorities in managing glucose control in older people with diabetes. The Journal of Nutrition, Health & Aging 2009 (Oct), 13(8): 685-691.

• Slideshow: Characteristics of diabetes in older adults based on data from the Entred 2001 study. [ppt - 549 KB]

• Névanen S, Sobngwi-Tambekou J, Fosse S, Simon D, Weill A, Varroud-Vial M, Lecomte P, Fagot-Campagna A. Characteristics and health status of older people with diabetes and their medical care. Entred 2001 Study. Bull Epidemiol Hebd 2005, 12-13:51-52.

• Pornet C, Bourdel-Marchasson I, Lecomte P, Eschwège E, Romon I, Fosse S, Assogba F, Roudier C, Fagot-Campagna A for the ENTRED Scientific Committee. Diabetes in the elderly: health status, quality of medical care, and outlook (based on the ENTRED studies). La Revue de Gériatrie 2011, 36: 601-608