One of India’s leading diabetologists, Dr. V. Mohan recently led and authored a study that draws a comparison between the clinical profiles of T2DM patients ≥90 years and patients aged between 50 and 60 years. The study is remarkable as it is possibly the only one that is based on T2DM patients above the age of 90 and concludes that diabetes patients can defy and go way beyond the average age expectancy. Our article here summarises the important aspects of the study.

Diabetes (T2DM) is said to reduce the life expectancy of diabetic Indians by six to eight years. So, with an average life expectancy of Indians being just about 70 years, to have diabetic patients in their nineties is rare and a study on them, unheard of.

Salient features of the study

1. Cases of T2DM patients who had lived for more than or equal to 90 years were compiled basis the available electronic records.
2. The diagnosis of diabetes in 54% of the patients ≥90 years had happened before they had turned 70.
3. Cases of T2DM patients in the age bracket of 50-60 years were used for comparison.
4. The cases were matched for gender and duration of diabetes.
5. Clinical profiles were studied for both the age groups.
   1. The data considered for study included age at last visit, age at diagnosis, duration of diabetes, family history, smoking and alcohol, details of medications, body mass index (BMI) and blood pressure.
   2. Biochemical data of the cases included fasting and postprandial plasma glucose, glycated haemoglobin, fasting and stimulated C-peptide levels, lipid profile and renal function studies.
   3. Cases were also assessed for retinopathy, nephropathy, neuropathy, coronary artery disease and peripheral vascular disease.

The study is the first ever to report clinical profiles of Asian-Indian T2DM patients for ages 90 and above. The comparison of the profiles between the two sets of cases brought out significant differences. 

The comparison

Comparison was drawn between Set 1: 325 cases of T2DM patients aged ≥ 90 years and Set 2: 278 patients in the age group of 50-60 years.

Comparative observations for Set 1

• Higher systolic blood pressure (p<0.001)
• Lower BMI (p<0.001)
• Prevalence of retinopathy 29.7%
• Macroalbuminuria 3.7%
• Prevalence of neuropathy (89.8%)
• Peripheral vascular disease (13.5%)
• Coronary artery disease (60.3%)
• 85% of the T2DM ≥ 90 years group were on oral hypoglycaemic agents (OHAs), (of whom 64.9% were on sulphonylurea), 12% were on insulin and 3% on diet alone

Comparative observations for Set 2

• Prevalence of retinopathy 53.5%
• Macroalbuminuria 16.0%
• Prevalence of neuropathy 50.8%
• Peripheral vascular disease 2.0%
• Coronary artery disease 32.0%
• 87.8% were on OHAs and 12.2% on insulin

The comparison reiterates that sulfonylureas can be tolerated by the elderly. Also, that retinopathy and macroalbuminuria were less common in the patients ≥90 years, was reflected. The comparison also hints towards a possibility that hyperglycaemia in the nonagenarians is less severe or reflects a survival bias.

Conclusion

The study presented a report describing the rarely available clinical profile of Asian Indian patients with T2DM aged 90 and above. The 325 cases of nonagenarians studied for the report were of those, who had registered at Dr. Mohan’s Diabetes Specialities Centre in Chennai.

This study, in particular, opens up avenues for future studies on the most suitable diabetes management options for the elderly T2DM patients.

Reference:

[1] Mohan V, Anjana RM, Ranjit U, Gupta PPK, Routray P, Jebarani S, et al. Clinical profile of elderly patients (over 90 years) with type 2 diabetes seen at a diabetes centre in South India. Diabetes Technology & Therapeutics. 2019; https://doi.org/10.1089/dia.2019.0219

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