Insulin-dependent diabetic patients with macrovascular complications suffer from many geriatric conditions

Current diabetic care guidelines focus mainly on managing metabolic control and macro- and microvascular comorbidities. This focus may be too narrow given the number of geriatric conditions present in these often aged patients.

We studied the prevalence of multimorbidity, (undiagnosed) geriatric conditions and disabilities in diabetic patients with macrovascular complications.

One hundred forty-three community dwelling, insulin-dependent diabetic patients with macrovascular complications, aged 55 years and above, who were concurrently enrolled in the diabetes care clinic in a university hospital in the Netherlands, participated. Data on healthcare utilization, activities of daily living, geriatric conditions and quality of life were self-reported using a systematic diagnostic questionnaire. Mean age was 66.9 years (8.5 years), 62% were male and 22% were of Surinamese-South Asian descent. Loneliness was reported by 47%. The majority rated their quality of life (QoL) from 'reasonable' (45%) to 'good' (31%). In patients without ADL impairments, 60% were in need of assistance, compared to 95% among those with more than one impairment (p<0.01). In total, 19% had cognitive impairment, and 63% perceived pain. 84% of patients with impairments experienced social problems compared to 32% of patients in the other group.

This study demonstrates that the current focus of diabetes care may be too restricted given the high number of geriatric conditions that these patients present.