Hewitt, Jonathan;
(2007)
Diabetes in the older person.
PhD thesis, London School of Hygiene & Tropical Medicine.
DOI: https://doi.org/10.17037/PUBS.00682360
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Background.
More people are being diagnosed and treated for diabetes who are aged
over 75 years. Compared to younger diabetic populations there is less
published evidence available in the older person. At the extremes of old
age the evidence base is even smaller.
Aim.
To examine several aspects of diabetic epidemiology in the older person
in order to expand the evidence base for practice and policy.
Methods
People with diabetes were identified from a representative community
based sample of 15095 people aged at least 75 years old. Associations
between diabetes and its end points were identified. Admission to hospital
and death were assessed in an older diabetic population.
Results.
There were 1177 people identified with type 2 diabetes giving a
prevalence of 7.80% (95% Cl, 7.11-8.47). The prevalence of diabetic
complications of poor vision, proteinuria, raised creatinine, angina,
myocardial infarction, cerebrovdscular accident and foot ulceration were
all increased in the diabetic population. Older diabetic people
demonstrated a good uptake of diabetic services including regular eye
examination, annual chiropody and dietician attendance. However, the
understanding of daily diabetic management was poor with a high
prevalence of cognitive impairment (22.5%) in the diabetic population. The
rate of admission to hospital and length of hospital stay were increased in
the older diabetic person compared to the non diabetic person; rate ratio
for admission, 1.31 (95% Cl, 1.23-1.39) and the length of stay 13.9 days versus 12.4 days, p<0.001. Finally, the risk of death among people with
diabetes was higher than for people without diabetes, hazard ratio 1.50
(95% Cl, 1.38-1.65), p<0.001. The hazard ratio was similarly raised in both
men and women with diabetes across the age ranges studied.
Conclusion
This thesis presents the largest community based study in the older
diabetic person. Diabetes was shown to contribute to morbidity and
mortality until the extremes of old age.