Background: Adults with type 1 diabetes (T1D) are aging more successfully than ever. However, in this older, heterogeneous population, diabetes duration can vary widely, as people may have been diagnosed many decades ago in early childhood or as recently as late adulthood. There is little information about the impact of diabetes duration on psychosocial factors and functional status as patients with T1D age.
Methods: We evaluated a cohort of older adults (age≥65 years) with T1D. All participants completed surveys regarding demographics, medical history, overall health (Short Form 36; SF-36), hypoglycemia awareness (Clarke Score), and hypoglycemia fear (HFSII). Laboratory A1C was measured, and Montreal Cognitive Assessment (MoCA) was performed to assess cognitive function.
Results: We evaluated 148 older adults, mean age 71 ± 5 years, 55% female, 97% white, mean A1C 7.4 ± 0.9%, mean diabetes duration 39 ± 17 years, with 20% of participants living alone. The participants were divided into tertiles of diabetes duration; ≤30 years (n=48), 31-49 years (n=54) years, and ≥50 years (n=46). Comparison of the shortest and longest tertiles of diabetes duration showed that participants of the group with the shortest duration had significantly less depression (35% vs. 59%; p=0.02), less hypoglycemia unawareness (31% vs. 61%; p=0.008), fewer recent falls in the prior 6 months (5 vs. 12; p=0.05), fewer daily medications (9 vs. 11; p=0.02), and fewer comorbidities (8 vs. 9; p=0.05). Additionally, the overall health survey (SF-36) showed that the group with longer duration reported more difficulty and limitation in daily activities due to physical health. The two groups did not differ in age, A1C, cognitive dysfunction (MoCA score <26), or hypoglycemia fear.
Conclusion: In older adults with T1D, duration of diabetes impacts clinical and functional status, and should be kept in consideration when developing management strategies for maximum safety and success.
M. Munshi: Consultant; Self; Eli Lilly and Company, Sanofi. C. Slyne: None. K. Sifre: None. R. O’Donnell: None. A. Atakov-Castillo: None. E. Toschi: None.
National Institutes of Health (1DP3DK112214-01)