Causes and complications
The cause of type 1 diabetes is unknown, although it is believed to result from genetic predisposition and environmental factors. Type 2 diabetes also has a strong genetic component, and is more likely to affect people with a family history of the condition. Certain lifestyle risk factors also increase the risk of developing this condition, such as a high body mass index (BMI) and high blood pressure, and this risk increases with age [9]. Further information on the prevalence of some of the main lifestyle risk factors in the older population is given in Healthy ageing.
Diabetes can result in a number of acute and chronic health conditions, including heart attack and stroke, kidney damage, vision loss, nerve damage (neuropathy) and delayed wound healing, which can lead also to lower limb amputation. Early and intensive management of blood sugar levels can delay the onset or slow the progression of these complications [10].
Type 2 diabetes pharmacological management in older people
Management of type 2 diabetes in older people using medication is more complex. For older people, the benefits of intensive glucose control need to be weighed against the associated risks, such as the impact of medications on the kidneys and the risk of interaction with other medicines used for managing multiple conditions (polypharmacy) [7].
In 2012, the pharmacological management of type 2 diabetes in a concessional population of people aged 65 and over was examined, and the following key findings were made [7]:
- 8 in 10 (85%) were supplied with glucose lowering medicines
- 2 in 10 (20%) were supplied with insulin
- 4 in 10 (40%) were supplied with medicines as a monotherapy (a single medication)
- 3 in 10 (33%) were supplied with dual therapy
- 1 in 10 (11%) were supplied with triple therapy.
Hospitalisations
Diabetes was recorded as a diagnosis for over 1 million hospitalisations in 2015– 16—representing 10% of all hospitalisations that year. There were 59,900 hospitalisations related to type 1 diabetes, and 980,000 hospitalisations related to type 2 diabetes [8].
Hospitalisation rates for type 2 diabetes increased with age, with the majority (87%) of hospitalisations recorded in people aged 55 and over. The hospitalisation rate is highest in people aged 75–84, at 22,500 per 100,000 population (Figure 3).