The diagnostic and control criteria for diabetes mellitus in the elderly

Abstract

In order to define the diagnostic criteria for diabetes mellitus in the elderly and to clarify how to manage the elderly diabetic patients, we examined risk factors for the development of diabetic retinopathy or ischemic heart disease in diabetics over 60 years old. Among 381 elderly diabetics, there were 127 patients with retinopathy at the first visit. Univariate analysis showed that the initial fasting plasma glucose (FPG) levels and the estimated duration of diabetes of patients with diabetic retinopathy were significantly higher than those of patients without diabetic retinopathy. The author studied 179 patients who were free of diabetic retinopathy on their first visit and were followed for at least 5 years in order to examine the relationships between the initial glucose levels and subsequent development of retinopathy. Eighty-one of the subjects developed diabetic retinopathy during follow-up period. The development of retinopathy was more common in patients with higher FPG (> 140 mg/dl), HbA1 (> 9%) or 2-h postload plasma glucose levels (> 280 mg/dl). Not only the initial FPG but also the mean FPG levels during the follow-up period were higher in subjects who developed retinopathy. These results indicate that 140 mg/dl or more of fasting plasma glucose levels in an adequate criterion for diabetes mellitus in the elderly, as well as in young and middle age subjects. In elderly diabetic patients, not only diabetic retinopathy but also ischemic heart disease developed so frequently that the quality of life in those patients is often disturbed.(ABSTRACT TRUNCATED AT 250 WORDS)