Multiple complications and frequent severe hypoglycaemia in 'elderly' and 'old' patients with Type 1 diabetes

Diabet. Med. 29, e176–e179 (2012) Aim Elderly and old patients with Type 1 diabetes represent a growing population that requires thorough diabetes care. The increasing relevance of this subgroup, however, plays only a minor role in the literature. Here, we describe elderly patients with Type 1 diabetes on the basis of a large multi‐centre database in order to point out special features of this population. Method Data of 64 609 patients with Type 1 diabetes treated by 350 qualified diabetes treatment centres were assessed and analysed by age group. Results Compared with the age group ≤ 60 years, patients aged > 60 years (n = 3610 61–80 years and n = 377 > 80 years old) were characterized by a longer diabetes duration (27.7 vs. 7.7 years), an almost double risk for severe hypoglycaemia (40.1 vs. 24.3/100 patient‐years), a lower level of HbA1c [60 vs. 67 mmol/mol (7.6 vs. 8.3%)] and higher percentages of microalbuminuria (34.5 vs. 15.6%), diabetic retinopathy (45.2 vs. 8.3%), myocardial infarction (9.0 vs. 0.4%) or stroke (6.8 vs. 0.3%). Elderly patients used insulin pumps less frequently (12.2 vs. 23.8%), but more often used conventional premixed insulin treatment (10.8 vs. 3.8%). Differences between elderly and younger patient groups were significant, respectively. Conclusion Diabetes care of elderly patients with Type 1 diabetes involves individualized treatment concepts. Increased hypoglycaemia risk and functional impairment attributable to diabetes‐associated and/or age‐related disorders must be taken into account.