22 November 2024
Institute news
It has been traditionally viewed as a disorder of children or adolescents, but the face of type 1 diabetes now looks very different, according to a new review by Australian researchers.
The number of older adults with type 1 diabetes is growing, in part because of new onset type 1 diabetes occurring in middle age and older adults, but also because of long-term survival of people diagnosed in youth, say researchers from the Baker Heart and Diabetes Institute in Natures Reviews Endocrinology.
In Australia, 33% of those with type 1 diabetes in 2015 were aged over 60 years, and 63% were aged over 40 years.
In examining the epidemiology of type 1 diabetes in adults, the researchers highlight that differentiating type 1 from type 2 diabetes in adults is a challenge that requires careful judgement in interpreting clinical presentations and biochemical test results.
Lead author, Professor Dianna Magliano says misclassification of type 1 diabetes increases with the increasing age of onset, which can partly be attributed to a substantial overlap in adult-onset type 1 and type 2 diabetes that makes diagnosis challenging.
There is also evidence that older adults with type 1 diabetes have reduced life expectancies compared to those without diabetes of the same age. An Australian analysis from 1997–2010 found that the remaining life expectancy of those with type 1 diabetes aged 60–64 years was 6.5 years shorter for men and 8.5 years shorter for women compared to the general population of the same age. With better risk factor care and new treatments, including diabetes technology, this gap is likely reducing.
But the jury is still out as to whether the incidence of type 1 diabetes is higher in older adults compared to children. There is conflicting data due to lack of agreement around diagnostic definitions, and the increase in misclassification of type 1 diabetes with increasing age of onset.
Professor Magliano says as life expectancy of people with type 1 diabetes improves, the demography of type 1 diabetes will shift further towards an increased number of older adults with complex care needs.
“A feature of type 1 diabetes demography that is not well-recognised is the relatively large proportion of people with type 1 diabetes who are middle-aged or older adults,” she says. “This is important information for healthcare professionals, service providers and policymakers so we can adequately support these people.”
Diabetes clinician, researcher and co-author, Professor Alicia Jenkins, says one of the biggest issues is that there are relatively few specialist clinics or resources for older people with type 1 diabetes.
“We therefore need to make sure that we have appropriate training, resources and support for mature-aged people with type 1 diabetes, including those using technologies to manage their condition,” Professor Jenkins says.
