INFLUENCES OF AGE AND EXERCISE ON GLUCOSE-METABOLISM - IMPLICATIONS FOR MANAGEMENT OF OLDER DIABETICS

The well-characterized decline in glucose tolerance during aping is du e primarily to impaired insulin-mediated glucose uptake in peripheral tissues. Elderly persons with reduced insulin sensitivity are predispo sed to the development of noninsulin-dependent diabetes mellitus (NIDD M), which is common in the geriatric population. Numerous studies sugg est that exercise and physical training increase insulin sensitivity i n young adult and middle-aged nondiabetics, older subjects with impair ed glucose tolerance, and middle-aged persons with NIDDM. These invest igations provide presumptive evidence that elderly persons with NIDDM may benefit from exercise training, although no published studies have specifically addressed the effects of exercise in older diabetics. Ph ysical activity may also be effective in preventing the development of NIDDM. In addition, exercise training improves several cardiovascular risk factors, such as plasma lipid abnormalities, hypertension, and o besity. The risks of exercise in older diabetics include hypoglycemia in insulin-treated patients, exacerbation of preexisting cardiovascula r disease, and worsening of long-term diabetic complications. Any exer cise prescription in the older diabetic must be individualized to the patient's physical capabilities, limitations, and preferences.