The duration of type 2 diabetes and increasing age are independent predictors of disease-related complications and mortality, according to a study published Dec. 9 in JAMA: Internal Medicine.  The study found interaction of age and disease duration predicted microvascular complications and death, as well.

The study looked at 72,310 patients older than 60 years with diabetes in an integrated health care delivery system between 2004 and 2010. Events per 1,000 person-years were calculated for three age groups (60-69, 70-79 and ≥80 years), and according to the duration of diabetes (0-9 years versus ≥10 years). Patients were followed for the incidence of acute hyperglycemic and hypoglycemic events, microvascular complications, cardiovascular complications and all-cause mortality.

In general, increasing age and increasing disease duration were associated with a greater incidence of complications and mortality. Among patients with shorter disease duration, cardiovascular diseases and acute hypoglycemic events were the most common complications. The incidence rates of these complications were similar among those with longer disease duration, but the incidence of microvascular complications remained stable or decreased. Across all age groups, complication rates were higher with longer disease duration, and increased as patients aged.

"Our findings suggest the need for increased clinical and research focus on reducing and understanding the incidence of hypoglycemia in older adults with diabetes," note the authors. "For policymakers, the study provides important data that may be used for projecting health care expenditures. … More important, the data from this study may inform the design and scope of public policy interventions that meet the unique needs of elderly patients with the disease."

Keywords: Incidence, Diabetes Complications, Public Policy, Cardiovascular Diseases, Health Expenditures, Hypoglycemia