Increasing Prevalence of T1D Calls for Age-Specific Clinical Guidelines of Management

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Clinical recommendations for the management of type 1 diabetes (T1D) in older adults are urgently needed as the global population ages and as improved diabetes care and management of complications have extended the life expectancy of the patient population.

The global prevalence of type 1 diabetes (T1D) in people 65 years of age and older increased between 1990 and 2019, while mortality rates associated with the disease decreased substantially during the same period, according to research published in BMJ.1

Older adult with diabetes / (JLco) Julia Amaral - stock.adobe.com

Older adult with diabetes / (JLco) Julia Amaral - stock.adobe.com

Current clinical guidelines lack targeted recommendations for the management of T1D in older adults. However, these recommendations are urgently needed as the global population ages and as improved diabetes care and management of complications have extended the life expectancy of those with the condition.

Key Takeaways

  • The number of people over 65 with T1D has nearly tripled in the last 3 decades, highlighting a growing public health concern as the global population ages.
  • While overall mortality rates for T1D have decreased substantially, the benefits are not shared equally across gender, region, or age group.
  • Current clinical guidelines lack specific recommendations for managing T1D in older adults. The rise in T1D prevalence and the potential of diabetes technology to improve outcomes emphasize the need for updated guidelines and educational materials for clinicians and caregivers.

To fill this gap in clinical literature and raise the standard of care for the patient population, investigators assessed T1D-associated prevalence, mortality, and disability adjusted life years (DALYs) in adults aged 65 years and older at global, regional, and national levels between 1990 and 2009.

Using the Global Burden of Disease and Risk Factors Study 2019, investigators assessed data from adults aged 65 years and older with T1D across 21 regions and 24 countries and territories during the 30-year study period. Information on location, age, and sex specific prevalence; mortality; numbers and rates for DALYs; and DALYs attributable to each risk factor were gleaned for the patient population.

Sociodemographic indexes were calculated for each region from 0.005 to 1, with 1 indicating the highest education level, highest per capita income, and lowest fertility rate.

The number of people over 65 years of age with T1D nearly tripled between 1990 and 2019, increasing from 1.3 to 3.7 million. The age standardized prevalence rate of T1D increased from 400 per 100,000 population in 1990 to 514 per 100,000 population in 2019, translating to a year-over-year change of 0.86%.

Concomitantly, the age standardized mortality of T1D decreased substantially from 4.7 per 100,000 population in 1990 to 3.5 per 100,000 population in 2019, with an average annual trend of −1.00%. Age standardized DALYs also decreased from 113 per 100,000 population to 103 per 100,000 population, with an average annual trend of −0.33%.

Investigators noted that while the overall global mortality and DALYs of T1D decreased, the benefit was not equally distributed. Women, people living in countries with a higher sociodemographic index, and those under 79 years of age all experienced a greater decrease in mortality and DALYs than men, people living in countries with a low-middle sociodemographic index—where mortality decreased 13 times slower than in countries with a high sociodemographic index—and those over 79 years of age.

READ MORE: Increased CGM Utilization, Education Needed for Low-Income Communities

The highest risk factor for DALYs in older adults during the study period was high fasting plasma glucose levels.

Regarding their findings, investigators wrote, “Our study found that in 2019, possibly owing to notable advances in medicine, mortality from T1D significantly decreased and the life expectancy of affected people improved. These findings may be related to recent achievements in development goals aimed at improving accessibility and coverage of health care services, as well as progress in economic growth, reduced poverty, and social protection efforts.”

This improved accessibility and coverage of health care services likely encompasses advancements in diabetes technology, such as continuous glucose monitors (CGMs) and insulin pumps, which have become effective management strategies for older adults with T1D. An estimate by Grand View Research has anticipated the global diabetes devices market to grow at a compounded annual growth rate of 7.45% from 2024 to 2030, demonstrating the increasing consumer demand of the industry.2

Diabetes technology empowers older adults with T1D to manage their condition more effectively in several ways. These tools streamline daily management, such as by automating insulin delivery. This eliminates the need for finger pricking, which may be a challenge for older adults with dexterity limitations. Additionally, the continuous flow of blood glucose information allows for better and more precise glycemic control, demonstrably leading to improved patient outcomes.3

Beyond streamlining management, diabetes technology also enhances safety and security for users. CGMs can send alerts to patients or caregivers about potential hypoglycemia events, allowing for prompt intervention, and some devices have features that prevent accidental insulin overdoses. These affordances are especially beneficial for older adults experiencing age-related comorbidities such as cognitive and physical decline.4

As the population continues to age, the diabetes technology market continues to expand, and the global burden of T1D in adults aged 65 years and older continues to rise, clinical guidelines are needed to target management of the condition in the patient population. Educational material for clinicians and caregivers may benefit treatment as well, and changes in disease prevalence across various sociodemographic factors should be considered.3

READ MORE: Diabetes Resource Center

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References
1. Yang K, Yang X, Jin C, et al. Global burden of type 1 diabetes in adults aged 65 years and older, 1990-2019: population based study. BMJ. 2024;385:e078432. doi:10.1136/bmj-2023-078432
2. Diabetes devices market size, share & trends analysis report by type (blood glucose monitoring devices, insulin delivery devices), by distribution channel (hospital pharmacies, retail pharmacies), by end-use, by region, and segment forecasts, 2024-2030. Report. Grand View Research. Accessed June 17, 2024. https://www.grandviewresearch.com/industry-analysis/diabetes-devices-market
3. Toschi E, Munshi MN. Benefits and challenges of diabetes technology use in older adults. Endocrinol Metab Clin North Am. 2020;49(1):57-67. doi:10.1016/j.ecl.2019.10.001
4. Ruedy KJ, Parkin CG, Riddlesworth TD, Graham C. DIAMOND study group. Continuous glucose monitoring in older adults With type 1 and type 2 diabetes using multiple daily injections of insulin: Results from the DIAMOND trial. J Diabetes Sci Technol. 2017;11(6):1138-1146. doi:10.1177/1932296817704445
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