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Rates of Complications and Mortality in Older Patients With Diabetes Mellitus: The Diabetes and Aging Study

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Huang, Elbert S., Laiteerapong, Neda, Liu, Jennifer Y., John, Priya M., Moffet, Howard H., Karter, Andrew J.·2014·JAMA Internal Medicine
DOI 10.1001/jamainternmed.2013.12956PMC PMC3950338
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Abstract

IMPORTANCE: In the coming decades, the population of older adults with type 2 diabetes mellitus is expected to grow substantially. Understanding the clinical course of diabetes in this population is critical for establishing evidence-based clinical practice recommendations, identifying research priorities, allocating resources, and setting health care policies. OBJECTIVE To contrast the rates of diabetes complications and mortality across age and diabetes duration categories. DESIGN, SETTING, AND PARTICIPANTS: This cohort study (2004-2010) included 72,310 older (≥ 60 years) patients with type 2 diabetes enrolled in a large, integrated health care delivery system. Incidence densities (events per 1000 person-years) were calculated for each age category (60-69, 70-79, and ≥ 80 years) and duration of diabetes (shorter [0-9 years] vs longer [≥ 10 years]). MAIN OUTCOMES AND MEASURES: Incident acute hyperglycemic events, acute hypoglycemic events (hypoglycemia), microvascular complications (end-stage renal disease, peripheral vascular disease, lower limb amputation, and diabetic eye disease), cardiovascular complications (coronary artery disease, cerebrovascular disease, and congestive heart failure), and all-cause mortality. RESULTS: Among older adults with diabetes of short duration, cardiovascular complications followed by hypoglycemia were the most common nonfatal complications. For example, among individuals aged 70 to 79 years with a short duration of diabetes, coronary artery disease and hypoglycemia rates were higher (11.47 per 1000 person-years and 5.03 per 1000 person-years, respectively) compared with end-stage renal disease (2.60 per 1000 person-years), lower limb amputation (1.28 per 1000 person-years), and acute hyperglycemic events (0.82 per 1000 person-years). We observed a similar pattern among patients in the same age group with a long duration of diabetes, with some of the highest incidence rates in coronary artery disease and hypoglycemia (18.98 per 1000 person-years and 15.88 per 1000 person-years, respectively) compared with end-stage renal disease (7.64 per 1000 person-years), lower limb amputation (4.26 per 1000 person-years), and acute hyperglycemic events (1.76 per 1000 person-years). For a given age group, the rates of each outcome, particularly hypoglycemia and microvascular complications, increased dramatically with longer duration of the disease. However, for a given duration of diabetes, rates of hypoglycemia, cardiovascular complications, and mortality increased steeply with advancing age, and rates of microvascular complications remained stable or declined. CONCLUSIONS AND RELEVANCE: Duration of diabetes and advancing age independently predict diabetes morbidity and mortality rates. As long-term survivorship with diabetes increases and as the population ages, more research and public health efforts to reduce hypoglycemia will be needed to complement ongoing efforts to reduce cardiovascular and microvascular complications.

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  • Individuals with advanced diabetes complications, life-limiting comorbid illnesses, frailty, or substantial cognitive or functional impairments are more likely to suffer serious adverse effects of therapeutics, such as hypoglycemia.

    “These individuals are also more likely to suffer serious adverse effects of therapeutics, such as hypoglycemia (65).”

    From 13. Older Adults: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [65]

    The Discussion (page not provided) identifies functional limitations as likely determinants of hypoglycemia risk and describes insulin, sulfonylureas, and intensive treatment as possible contributors. It does not establish that people with advanced complications, life-limiting comorbidities, frailty, or cognitive impairment specifically are more likely to suffer treatment-related adverse effects. (LLM, conf=0.85)

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  • Individuals with advanced diabetes complications, life-limiting comorbid illnesses, frailty, or substantial cognitive or functional impairments are more likely to experience serious adverse effects of therapeutics, such as hypoglycemia.

    “These individuals are also more likely to experience serious adverse effects of therapeutics, such as hypoglycemia (67).”

    From 13. Older Adults: Standards of Care in Diabetes—2025 (2025) · cites this paper as [67]

    The Discussion (page not specified) says functional limitations are likely determinants of hypoglycemia risk and that insulin, sulfonylureas, and intensive treatment may increase that risk. It does not establish increased therapeutic-adverse-effect risk specifically for people with advanced diabetes complications, life-limiting comorbid illness, frailty, or cognitive impairment. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Individuals with complex or intermediate health may not derive benefit from intensive glucose lowering and are more likely to experience serious adverse effects of treatment, such as hypoglycemia.

    “These individuals may not only not derive benefit from intensive glucose lowering but are also more likely to experience serious adverse effects of treatment, such as hypoglycemia”

    From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [73]

    The Discussion (page not provided) says very intensive glucose control appears to offer no significant cardiovascular benefit in older patients, especially those with or at high risk for heart disease, and that intensive treatment may increase hypoglycemia risk. It does not establish those findings specifically for people classified as having complex or intermediate health. (LLM, conf=0.85)

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Research works printed but not linked: 22

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Authors
Huang, E. S., Laiteerapong, N., Liu, J. Y., John, P. M., Moffet, H. H., & Karter, A. J.
Affiliations
  • University of Chicago (US)
  • Kaiser Permanente (US)
ORCID
Venue
JAMA Internal Medicine
Publisher
American Medical Association (AMA)
Published
2014-02-01
Volume
174
Issue
2
Pages
251
ISSN
2168-6106 (ISSN-L)
DOI
10.1001/jamainternmed.2013.12956
PMC
PMC3950338
OpenAlex
W2046621583
Cited by
501
References
10
Citations by year
2026: 20 · 2025: 40 · 2024: 40 · 2023: 36 · 2022: 33 · 2021: 36 · 2020: 55 · 2019: 44 · 2018: 45 · 2017: 46 · 2016: 47 · 2015: 45 · 2014: 14
FWCI
27.85
Type
journal article
Language
en
Open access
Locations
  • JAMA Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Diabetes and Digestive and Kidney Diseases (R01-DK65664, DK092949, R01DK081796, K23DK097283, R01DK065664, P30DK092949, P30DK092924)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
type 2 diabetes, older adults, diabetes complications, mortality, diabetes duration, age differences, hypoglycemia, hyperglycemia, cardiovascular complications, coronary artery disease, cerebrovascular disease, congestive heart failure, end-stage renal disease, microvascular complications, lower limb amputation, diabetic eye disease, peripheral vascular disease, incidence rates, integrated care delivery
MeSH terms
Age Factors, Aged, Aged, 80 and over, Aging, Female, Follow-Up Studies, Humans, Male, Middle Aged, Retrospective Studies, Risk Factors, United States, Incidence, Survival Rate, Risk Assessment, Diabetes Complications

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