Diabetes in the elderly population

Type 2 diabetes mellitus has emerged as an important condition of older pat ients in which both microvascular and macrovascular complications are a com mon cause of morbidity and mortality. In contrast to type 1 diabetes mellit us, this endocrinopathy is clustered in minority populations and has both s trong genetic and environmental factors that influence disease manifestatio n. A number of physiological alterations of glucose metabolism including he patic overproduction of glucose, and reduced glucose utilization by periphe ral tissues as a result of insulin resistance contribute to the development of the metabolic manifestations of this disease. Ultimately pancreatic fai lure and reduced insulin secretion lead to hyperglycemia and the diabetic s tate. Frequently, many of these metabolic manifestations, or what has been termed Syndrome X, antecede the development of overt diabetes by many years . This syndrome is manifest clinically by such cardiovascular risk factors as hypertension, dyslipidemia, and coagulation abnormalities. This abnormal metabolic milieu contributes to the high prevalence of macrovascular compl ications including coronary artery disease as well as more generalized athe rosclerosis. Microvascular complications have only more recently been recog nized as an important and frequent complication of type 2 diabetes. Among t he elderly and minority populations, this has become the single most import ant cause of end-stage renal failure that necessitates renal replacement th erapies. The outcome for these patients on hemodialysis, the modality most frequently selected, is poor, with the majority of these patients dying of cardiovascular causes. Unfortunately, interventional strategies to reduce o r prevent the microvascular and macrovascular complications have only recen tly received the needed attention and will require considerable effort and resources to improve the clinical outcomes and life expectancies for these patients. (C) 2000 by the National Kidney Foundation, Inc.