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CC BY-NC-ND 4.0 · Journal of Diabetes and Endocrine Practice 2023; 06(03): 126-133
DOI: 10.1055/s-0043-1771201
Review Article

Challenges and Management Strategies in the Nutrition of Older People with Diabetes

Khalid Farooqui
1   Department of Internal Medicine and Endocrinology, Hamad Medical Corporation, Qatar
2   Department of Medicine, College of Medicine, Qatar University, Doha, Qatar
,
Adeel Ahmad Khan 
1   Department of Internal Medicine and Endocrinology, Hamad Medical Corporation, Qatar
,
Theresa Paul 
1   Department of Internal Medicine and Endocrinology, Hamad Medical Corporation, Qatar
,
Jaseem Sirajudeen
1   Department of Internal Medicine and Endocrinology, Hamad Medical Corporation, Qatar
,
Haseeb Ahmad Khan
3   Department of Medicine, Nishtar Medical University, Multan, Pakistan
,
Farah K. Farooqui
4   Asther Medical Centre, Qatar
,
Khalid RFA Ferih 
1   Department of Internal Medicine and Endocrinology, Hamad Medical Corporation, Qatar
,
Hani Hassan Al-Yahary
1   Department of Internal Medicine and Endocrinology, Hamad Medical Corporation, Qatar
,
Farrookh Haider
1   Department of Internal Medicine and Endocrinology, Hamad Medical Corporation, Qatar
,
Abdel-Naser Elzouki
1   Department of Internal Medicine and Endocrinology, Hamad Medical Corporation, Qatar
2   Department of Medicine, College of Medicine, Qatar University, Doha, Qatar
5   Weill Cornell Medical College, Doha, Qatar
› Author Affiliations Funding and Sponsorship None.
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Abstract

Diabetes has increased in prevalence and is the most common chronic metabolic disease worldwide. Its incidence and prevalence have particularly increased among older adults over the last few decades. The older adult population older than 60 years is diagnosed chiefly with type 2 diabetes, prediabetes, and type 1 diabetes in a small percentage; there is also an incidence of a transient form of diabetes secondary to chronic underlying diseases or as a part of their treatment-related complications. The primary goal in managing older adults with diabetes is to maintain glycemic status against the risk of hypoglycemia and its complications. In the older adult population, the problem of polypharmacy and nutrition must be kept in mind while achieving glycemic targets and preventing diabetes complications. Few studies have highlighted the importance of nutrition in older adults with diabetes and hypoglycemia as a complication leading to increased morbidity and mortality. Many factors in the older aged groups interplay in diabetes patients. Increasing the risk of hypoglycemia and managing nutritional aspects is paramount in older adults with diabetes mellitus. This review highlights various aspects of nutritional management in older adults with diabetes based on the current evidence available in the literature. However, most dietary recommendations for older adults with diabetes are based on studies in the adult population, and further studies targeting the older adult population are needed.

Keywords

nutritional management - diabetes mellitus - older adults - nutritional deficiency

Compliance with Ethical Principles

No ethical approval is required for the review article type of study.


Authors' Contribution

K.F., A.A.K., H.H.A.-Y. were responsible for manuscript writing and literature review. T.P., J.S., H.A.K., F.H., and K.R.F.A.F. contributed to manuscript writing. A.-N.E. contributed to literature review and review of the manuscript. All the named authors approved the final version of the manuscript.




Publication History

Article published online:
12 September 2023

© 2023. Gulf Association of Endocrinology and Diabetes (GAED). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 World Health Organization. Diabetes. Accessed June 21, 2023 at: https://www.who.int/news-room/fact-sheets/detail/diabetes [Internet]. [cited 2021 Apr 23]
  • 2 Sinclair A, Saeedi P, Kaundal A. et al. Diabetes and global aging among 65–99-year-old adults: Findings from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Research and Clinical Practice [Internet]. 2020 Apr 1 [cited 2021 Apr 23];162. Accessed June 21, 2023 at: https://www.diabetesresearchclinicalpractice.com/article/S0168-8227(20)30137-6/abstract
  • 3 Cohen DL, Neil HA, Thorogood M, Mann JI. A population-based study of the incidence of complications associated with type 2 diabetes in the elderly. Diabet Med 1991; 8 (10) 928-933
    CrossrefPubMedGoogle Scholar
  • 4 Walters DP, Gatling W, Mullee MA, Hill RD. The prevalence of diabetic distal sensory neuropathy in an English community. Diabet Med 1992; 9 (04) 349-353
    CrossrefPubMedGoogle Scholar
  • 5 Hickson M, Wright L. Nutritional management of the elderly person with diabetes. In: Frost G, Dornhorst A, Moses R. eds. Nutritional Management of Diabetes Mellitus. Chichester, UK: Wiley; 2003: 147-168
    Google Scholar
  • 6 Arner P, Pollare T, Lithell H. Different aetiologies of type 2 (non-insulin-dependent) diabetes mellitus in obese and non-obese subjects. Diabetologia 1991; 34 (07) 483-487
    CrossrefPubMedGoogle Scholar
  • 7 Sinclair AJ, Meneilly GS. Re-thinking metabolic strategies for older people with type 2 diabetes mellitus: implications of the UK Prospective Diabetes Study and other recent studies. Age Ageing 2000; 29 (05) 393-397
    CrossrefPubMedGoogle Scholar
  • 8 Groeneveld Y, Petri H, Hermans J, Springer MP. Relationship between blood glucose level and mortality in type 2 diabetes mellitus: a systematic review. Diabet Med 1999; 16 (01) 2-13
    CrossrefPubMedGoogle Scholar
  • 9 Muggeo M, Zoppini G, Bonora E. et al. Fasting plasma glucose variability predicts 10-year survival of type 2 diabetic patients: the Verona Diabetes Study. Diabetes Care 2000; 23 (01) 45-50
    CrossrefPubMedGoogle Scholar
  • 10 Meneilly GS, Cheung E, Tessier D, Yakura C, Tuokko H. The effect of improved glycemic control on cognitive functions in the elderly patient with diabetes. J Gerontol 1993; 48 (04) M117-M121
    CrossrefPubMedGoogle Scholar
  • 11 Gu K, Cowie CC, Harris MI. Mortality in adults with and without diabetes in a national cohort of the U.S. population, 1971-1993. Diabetes Care 1998; 21 (07) 1138-1145
    CrossrefPubMedGoogle Scholar
  • 12 Sinclair AJ, Robert IE, Croxson SC. Mortality in older people with diabetes mellitus. Diabet Med 1997; 14 (08) 639-647
    CrossrefPubMedGoogle Scholar
  • 13 Volpato S, Blaum C, Resnick H, Ferrucci L, Fried LP, Guralnik JM. Women's Health and Aging Study. Comorbidities and impairments explaining the association between diabetes and lower extremity disability: the Women's Health and Aging Study. Diabetes Care 2002; 25 (04) 678-683
    CrossrefPubMedGoogle Scholar
  • 14 Strachan MW, Deary IJ, Ewing FM, Frier BM. Is type II diabetes associated with an increased risk of cognitive dysfunction? A critical review of published studies. Diabetes Care 1997; 20 (03) 438-445
    CrossrefPubMedGoogle Scholar
  • 15 Taylor CD, Hendra TJ. The prevalence of diabetes mellitus and quality of diabetic care in residential and nursing homes. A postal survey. Age Ageing 2000; 29 (05) 447-450
    CrossrefPubMedGoogle Scholar
  • 16 Tong P, Baillie SP, Roberts SH. Diabetes care in the frail elderly. Pract Diabetes 1994; 11: 163-164
    CrossrefGoogle Scholar
  • 17 Coulston AM, Mandelbaum D, Reaven GM. Dietary management of nursing home residents with non-insulin-dependent diabetes mellitus. Am J Clin Nutr 1990; 51 (01) 67-71
    CrossrefPubMedGoogle Scholar
  • 18 Funnell MM, Herman WH. Diabetes care policies and practices in Michigan nursing homes, 1991. Diabetes Care 1995; 18 (06) 862-866
    CrossrefPubMedGoogle Scholar
  • 19 British Diabetic Association. Guidelines of Practice for Residents with Diabetes in Care Homes. London: British Diabetic Association; 1999
    Google Scholar
  • 20 Currie CJ, Williams DR, Peters JR. Patterns of in and out-patient activity for diabetes: a district survey. Diabet Med 1996; 13 (03) 273-280
    CrossrefPubMedGoogle Scholar
  • 21 Corish CA, Kennedy NP. Protein-energy undernutrition in hospital in-patients. Br J Nutr 2000; 83 (06) 575-591
    CrossrefPubMedGoogle Scholar
  • 22 Association of Community Health Councils for England and Wales. Health News Briefing: Hungry in Hospital?. London: Association of Community Health Councils for England and Wales; 1997
    Google Scholar
  • 23 Health Advisory Service. Not because They Are Old. London: Stationery Office; 1998
    Google Scholar
  • 24 The British Association for Parenteral and Enteral Nutrition. Hospital Food as Treatment [Internet]. [cited 2021 Apr 23]. Accessed June 21, 2023 at: https://www.bapen.org.uk/resources-and-education/education-and-guidance/guidelines/hospital-food-as-treatment?start=1
  • 25 Dyson PA, Twenefour D, Breen C. et al. Diabetes UK evidence-based nutrition guidelines for the prevention and management of diabetes. Diabet Med 2018; 35 (05) 541-547
    CrossrefPubMedGoogle Scholar
  • 26 Marchesini G, Veronese G, Forlani G, Forlani G, Ricciardi LM, Fabbri A. Italian Society of Emergency Medicine SIMEU. The management of severe hypoglycemia by the emergency system: the HYPOTHESIS study. Nutr Metab Cardiovasc Dis 2014; 24 (11) 1181-1188
    CrossrefPubMedGoogle Scholar
  • 27 Meneilly GS, Tessier D. Diabetes in elderly adults. J Gerontol A Biol Sci Med Sci 2001; 56 (01) M5-M13
    CrossrefPubMedGoogle Scholar
  • 28 The Diabetes and Nutrition Study Group of the European Association for the Study of Diabetes. Recommendations for the nutritional management of patients with diabetes mellitus. Eur J Clin Nutr 2000; 54 (04) 353-355
    CrossrefPubMedGoogle Scholar
  • 29 Flodin L, Svensson S, Cederholm T. Body mass index as a predictor of 1 year mortality in geriatric patients. Clin Nutr 2000; 19 (02) 121-125
    CrossrefPubMedGoogle Scholar
  • 30 U.S. Department of Agriculture and U. S Department of Health and Human Services. Dietary Guidelines for Americans, 2010. 7th ed.. Washington, DC: Government Printing Office; 2010
    Google Scholar
  • 31 Società Italiana di Gerontologia e Geriatria (SID). Personalizzazione del trattamento dell'iperglicemia nell'anziano con diabete tipo 2. 2017: 1-52 Accessed June 21, 2023 at: http://www.sigg.it/docs/Documento-ufficiale.pdf
    PubMedGoogle Scholar
  • 32 Christmas C, Andersen RA. Exercise and older patients: guidelines for the clinician. J Am Geriatr Soc 2000; 48 (03) 318-324
    CrossrefPubMedGoogle Scholar
  • 33 Kupin WL, Cortes P, Dumler F, Feldkamp CS, Kilates MC, Levin NW. Effect on renal function of change from high to moderate protein intake in type I diabetic patients. Diabetes 1987; 36 (01) 73-79
    CrossrefPubMedGoogle Scholar
  • 34 Toeller M, Buyken A, Heitkamp G. et al. Protein intake and urinary albumin excretion rates in the EURODIAB IDDM Complications Study. Diabetologia 1997; 40 (10) 1219-1226
    CrossrefPubMedGoogle Scholar
  • 35 Food and Agriculture Organization, World Health Organization, and United Nations University. Energy and Protein Requirements. Report of a Joint Expert Consultation, 724. WHO Technical Report Series. Geneva: WHO; 1985
    Google Scholar
  • 36 Dufour M, Fuller RK. Alcohol in the elderly. Annu Rev Med 1995; 46: 123-132
    CrossrefPubMedGoogle Scholar
  • 37 Swade TF, Emanuele NV. Alcohol & diabetes. Compr Ther 1997; 23 (02) 135-140
    PubMedGoogle Scholar
  • 38 Safiri S, Nejadghaderi SA, Noori M. et al. Burden of diseases and injuries attributable to alcohol consumption in the Middle East and North Africa region, 1990-2019. Sci Rep 2022; 12 (01) 19301
    CrossrefPubMedGoogle Scholar
  • 39 Elliott P, Stamler J, Nichols R. et al; Intersalt Cooperative Research Group. Intersalt revisited: further analyses of 24 hour sodium excretion and blood pressure within and across populations. BMJ 1996; 312 (7041): 1249-1253
    CrossrefPubMedGoogle Scholar
  • 40 Albina JE. Nutrition and wound healing. JPEN J Parenter Enteral Nutr 1994; 18 (04) 367-376
    CrossrefPubMedGoogle Scholar
  • 41 Department of Health. Nutrition and Bone Health. Report of the Working Group of the Committee on Medical Aspects of Food Policy. Vol. 49: Report on Health and Social Subjects. London: The Stationery Office; 1998
    Google Scholar
  • 42 Kong MF, Horowitz M. Gastric emptying in diabetes mellitus: relationship to blood-glucose control. Clin Geriatr Med 1999; 15 (02) 321-338
    CrossrefPubMedGoogle Scholar
  • 43 UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352 (9131): 837-853
    CrossrefPubMedGoogle Scholar
  • 44 Nathan DM, Genuth S, Lachin J. et al; Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329 (14) 977-986
    CrossrefPubMedGoogle Scholar
  • 45 Shorr RI, Ray WA, Daugherty JR, Griffin MR. Incidence and risk factors for serious hypoglycemia in older persons using insulin or sulfonylureas. Arch Intern Med 1997; 157 (15) 1681-1686
    CrossrefPubMedGoogle Scholar
  • 46 Sinclair AJ. Insulin regimens for older people with type 2 diabetes. Mod Diabetes Manag 2000; 1: 14-16
    Google Scholar
  • 47 Giorda CB, Ozzello A, Gentile S. et al; HYPOS-1 Study Group of AMD. Incidence and risk factors for severe and symptomatic hypoglycemia in type 1 diabetes. Results of the HYPOS-1 study. Acta Diabetol 2015; 52 (05) 845-853
    CrossrefPubMedGoogle Scholar
  • 48 Giorda CB, Rossi MC, Ozzello O. et al; HYPOS-1 Study Group of AMD. Healthcare resource use, direct and indirect costs of hypoglycemia in type 1 and type 2 diabetes, and nationwide projections. Results of the HYPOS-1 study. Nutr Metab Cardiovasc Dis 2017; 27 (03) 209-216
    CrossrefPubMedGoogle Scholar
  • 49 Johnston SS, Conner C, Aagren M, Smith DM, Bouchard J, Brett J. Evidence linking hypoglycemic events to an increased risk of acute cardiovascular events in patients with type 2 diabetes. Diabetes Care 2011; 34 (05) 1164-1170
    CrossrefPubMedGoogle Scholar
  • 50 Gerstein HC, Miller ME, Byington RP. et al; Action to Control Cardiovascular Risk in Diabetes Study Group. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008; 358 (24) 2545-2559
    CrossrefPubMedGoogle Scholar
  • 51 Riddle MC, Ambrosius WT, Brillon DJ. et al; Action to Control Cardiovascular Risk in Diabetes Investigators. Epidemiologic relationships between A1C and all-cause mortality during a median 3.4-year follow-up of glycemic treatment in the ACCORD trial. Diabetes Care 2010; 33 (05) 983-990
    CrossrefPubMedGoogle Scholar
  • 52 Asplund K, Wiholm BE, Lithner F. Glibenclamide-associated hypoglycaemia: a report on 57 cases. Diabetologia 1983; 24 (06) 412-417
    CrossrefPubMedGoogle Scholar
  • 53 Lee A, Morley JE. Metformin, anorexia, and weight loss. Obes Res 1998; 6: 47-53
    PubMedGoogle Scholar
  • 54 Stanley K. Nutrition considerations for the growing population of older adults with diabetes. Diabetes Spectr 2014; 27 (01) 29-36
    CrossrefPubMedGoogle Scholar
  • 55 Gilden JL. Nutrition and the older diabetic. Clin Geriatr Med 1999; 15 (02) 371-390
    CrossrefPubMedGoogle Scholar
  • 56 Steele JG. National Diet and Nutrition Survey: People Aged 65 Years and Over. Vol. 1: Report of the Oral Health Survey. London: The Stationery Office; 1998
    Google Scholar
  • 57 Kaneda H, Maeshima K, Goto N, Kobayakawa T, Ayabe-Kanamura S, Saito S. Decline in taste and odor discrimination abilities with age, and relationship between gustation and olfaction. Chem Senses 2000; 25 (03) 331-337
    CrossrefPubMedGoogle Scholar
  • 58 Lopez A, Seligman HK. Clinical management of food insecure individuals with diabetes. Diabetes Spectr 2012; 25: 14-18
    CrossrefGoogle Scholar
  • 59 Peyrot M, Rubin RR. Levels and risks of depression and anxiety symptomatology among diabetic adults. Diabetes Care 1997; 20 (04) 585-590
    CrossrefPubMedGoogle Scholar
  • 60 Boston PF, Dennis MS, Jagger C. Factors associated with vascular dementia in an elderly community population. Int J Geriatr Psychiatry 1999; 14 (09) 761-766
    CrossrefPubMedGoogle Scholar
  • 61 Ortega RM, Requejo AM, Andrés P. et al. Dietary intake and cognitive function in a group of elderly people. Am J Clin Nutr 1997; 66 (04) 803-809
    CrossrefPubMedGoogle Scholar
  • 62 Bernstein M, Munoz N. Academy of Nutrition and Dietetics. Position of the Academy of Nutrition and Dietetics: food and nutrition for older adults: promoting health and wellness. J Acad Nutr Diet 2012; 112 (08) 1255-1277
    CrossrefPubMedGoogle Scholar
  • 63 Terrio L. Self-sufficient diabetes management: maintaining independence in older adults. On the Cutting Edge 2009; 30: 14-19
    Google Scholar