Diabetes mellitus in the elderly: clinical and epidemiological characteristics of the all-Russian cohort of diabetic patients over 65 years

BACKGROUND: Population aging leads to an increase in the prevalence of age-associated diseases, which makes it relevant to study the characteristics of diabetes mellitus (DM) in older adults.

AIM: The aim of our study was to analyze the clinical and epidemiological characteristics of DM in elderly people (≥65 years), the state of carbohydrate metabolism (level of HbA_1c), the frequency of diabetic complications and the characteristics of glucose-lowering therapy (GLT) in the Russian Federation (RF).

MATERIALS AND METHODS: Object of the study: Russian cohort of patients with diabetes based on the depersonalized "Database of clinical and epidemiological monitoring of DM in the territory of the RF", certificate of state registration database №2020622447 (http://diaregistry.ru, register of DM), including patients from 87 regions of the RF, n=5205647. Patients were stratified by age ≥ and <65 years into 2 groups: “65+”, n=3085805 and “65-”, n=2119842 and analyzed in the subgroups of type 1 and type 2 DM, in dynamics 2013–2023.

RESULTS: The total number of DM patients aged 65+ is 3085805, which is 59,3% of the total number of DM patients; with type 2 diabetes (T2DM) — 63,8%, with type 1 diabetes (T1DM) — 8,1% of patients. Over the period 2013-2023, there was an ­increase in the proportion of elderly people with T2DM from 50,2% to 63,8%, with T1DM — 7,9-8,1%. The proportion of patients with onset of T2DM over the age 60 years increased from 51% to 63%. Clinical characteristics in the «65+» and «65-» group differed significantly in T1DM in the level of HbA_1c 7,8 vs 8,0%, level of GFR 75,0 vs 107,2 ml/min/1,73 m², BMI 26,9 vs 23,2 kg/m²; in T2DM the level of HbA_1c 7,3 vs 7,5%, level of GFR 73,1 vs 89,1 ml/min/1,73 m²; BMI 30,9 vs 32,0 kg/m², respectively. The proportion of obese patients increased with age in T1DM from 13% to 36%, and decreased in T2DM from 62% to 54%. In the group of older patients with both types of DM, a higher frequency of diabetic complications with combined damage to target organs of CKD, ASCVD and CHF was observed: on average 4,6 times with in T1DM, 2,2 times in T2DM. When analyzing the GLT in the group of 65+, sulfonylurea (SU) drugs dominate 45,3% vs 35,0%, the proportion of metformin and drugs with organoprotective effects (DPP-4 inhibitors, SGLT-2 inhibitors, arGLP-1) decreases.

CONCLUSION: An analysis of older patients from the all-Russian population of DM patients showed significant clinical differences characterizing the pathophysiological features of the course of DM in the elderly, which requires special attention to the aspects of individualization of treatment goals and choice of therapy from the standpoint of safety and risk reduction in this cohort of patients.

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