Preparing to Meet the Needs of a Growing Older Adult Population with Type 1 Diabetes: A Narrative Review.

The prevalence of diabetes is rising among older adults. While most diabetes cases in older adults are type 2 diabetes mellitus (T2D), advances in type 1 diabetes mellitus (T1D) management and rising rates of adult-onset T1D have translated into a growing number of individuals with T1D living into older adulthood. This narrative review integrates existing evidence on management of T1D in older adults with expert opinions to provide practical guidance for generalists increasingly encountering the unique challenges and complexities of this growing population. The profound heterogeneity in clinical presentation, pathobiology, and disease progression across the older adult population can make it challenging to differentiate older adults with T1D from those with insulin treated T2D, particularly in adult-onset cases. However, timely diagnosis is critical to minimize exposure to hyperglycemia and reduce the risk for complications, as individuals with T1D rely entirely on exogenous insulin and require intensive self-management to prevent acute complications like hypoglycemia and ketoacidosis. Self-management of T1D in older adults presents unique challenges, including a high risk of hypoglycemia that must be mitigated in the setting of a lifelong requirement for insulin and evolving mismatches between intensive self-management demands and an older person's capacity for self-care. The growing number of older adults with T1D underscores a lack of access to specialized care and limited training and resources for evidence-based management in primary care and post-acute/long-term care settings, as well as the dearth of high-quality clinical evidence specific to this population to inform care. Research to support changes across healthcare systems and at the policy level, in combination with education and multi-specialty collaboration, will ensure that healthcare providers and health systems are equipped and prepared to better meet the needs of the growing population of older adults with T1D.

Duke Scholars

Author Anastasia Stefania Alexopoulos Medicine, Endocrinology, Metabolism, and Nutrition