[Clinical heterogeneity in elderly patients with diabetes mellitus]

There is considerable heterogeneity in elderly patients with diabetes mellitus. It is of clinical importance to assess such heterogeneous features in each elderly patient, because this would lead to a better setting of target glucose level in the management of diabetes. In the present study, diabetic subjects were clinically investigated from three different aspects; past, current and future. First, the "past" aspect represents how long and how high the hyperglycemia the patient has had. Our cross-sectional investigation showed a broad range of duration of diabetes as well as of degree of hyperglycemia, and as a consequence, diabetic complications were diverse. Second, the "current" aspect implies the degree of insulin deficiency and its resistance. According to our observation, elderly patients had diverse degrees of impaired insulin secretion, together with age-related resistance to insulin. Third, "future" aspect refers to the expected length of life, which largely depends on the current age. The complication status (not limited to diabetic complications), however, also affects clinical course and death rates, indicating diversity of life expectancies due to complications besides current age. Thus, the present analysis showed that elderly individuals with diabetes mellitus exhibit a remarkable heterogeneity. The present study also indicated the clinical merit of assessment with the three aspects; past, current and future, in assessing clinical diversity of elder patients with diabetes.