Non-insulin-dependent diabetes mellitus in the elderly. Influence of obesity and physical inactivity

The development of hyperglycemia in the elderly is often multifactorial in etiology, and its presentation is often confounded by the advanced age of the patient, the presence of coexisting diseases and altered mental states, the absence of symptoms, and physical conditions specific to the medical care of the geriatric patient. Manifestations of macro- and microvascular complications of non-insulin-dependent diabetes mellitus (NIDDM) often herald the disease in the elderly, yet there is incomplete knowledge of the natural history of the disease and poor guidelines for its effective management in the geriatric population. Once NIDDM is diagnosed in the older patient, the propensity for these patients to develop atherosclerotic vascular complications involving every organ system and the socioeconomic sequela of the disease make treatment prudent. Coexisting risk factors for atherosclerosis, such as dyshypoproteinemia, hypertension, obesity, and cigarette smoking, should be treated vigorously, and poor diet, physical inactivity, and medications affecting glucose tolerance modified. Hyperglycemia resistant to nonpharmacologic therapy should be treated with second-generation oral sulfonylureas, and the judicious use of insulin is advised because of a heightened risk for the hazards of hypoglycemia in the elderly. The treatment of NIDDM has important implications in the elderly because of its prevalence and its association with other age-related pathophysiologic processes. Such effective treatment may have the potential to reduce morbidity and mortality and improve the quality of life of older people.