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Diabetes in the elderly in a developing country
Diabetes Research and Clinical Practice, 15 (1992) 245-246 0
1992 Elsevier
Science Publishers
245
B.V. All rights reserved 0168-8227/92/$05.00
DIABET 00602
Diabetes in the elderly in a developing country D.J.S.
Fernando,
C.E. de Silva, S.F.R. Nanayakkara
Sri Jayawardenepura
and H.H.R.
Samarasinghe
General Hospital, Talapathpitiya, Nugegoda, Sri Lanka
(Received 25 June 1991) (Revision accepted 7 October 1991)
Summary
In developing countries diabetes in the elderly is thought to be uncommon and is consequently ignored by health planners. We assessed the prevalence of complications of diabetes mellitus and frequency of hospital admissions in patients aged 60 and over in a hospital diabetic clinic in Sri Lanka. Elderly diabetic patients, though comprising only 23”/’ of clinic patients, accounted for 46% of admissions. The prevalence of coronary artery disease, peripheral vascular disease, cerebrovascular disease, hypertension and visual handicap was increased in the diabetic patients when compared to age and gender matched controls. We conclude that diabetes in the elderly is a significant cause of morbidity in Sri Lanka. Key words: Diabetes mellitus; Elderly; Developing
Introduction It is well known that the prevalence of diabetes increases with age [ 13. In Sri Lanka, a developing country, life expectancy at birth is 72 and has risen from 68 in 1979 to 72 in 1985 [2]. Further increases in life expectancy and, consequently, in the proportion of ‘senior citizens’ may lead to an ‘epidemic’ of non-communicable diseases such as diabetes. Available mortality and morbidity data fail to highlight the importance of diabetes in the elderly as a cause of morbidity. We, therefore, assessed the prevalence of Correspondence to: D.J.S. Fernando, Sri Jayawardenepura General Hospital, Talapathpitiya, Nugegoda, Sri Lanka.
country;
Sri Lanka
diabetic complications amongst elderly diabetic patients attending a diabetic clinic in a teaching hospital.
Material
and Methods
A prospective study was conducted to ascertain the prevalence of long-term complications of diabetes in 204 patients, aged 6 1 and over, attending a hospital diabetic clinic. A control group of 170 non-diabetic age and gender matched patients was also studied (Table 1). A vascular disease questionnaire and clinical grading of retinopathy based on the methods of the WI-IO multinational study was used [3,4].
246 TABLE 1 Morbidity in diabetic and control populations
Mean age f SD Male/female Hypertension (“” ) Ischaemic heart disease ( “; ) Peripheral vascular disease ( ‘I,)) Cerebrovascular disease (“,,) Visual acuity < 619 (“0) Nephropathy (“,) Retinopathy (On) *P < 0.01 compared controls.
aged z 60
Diabetic subjects
Control subjects
69.2 + 1.9 121/83 36*
69.1 k 6.6 93161 30
42*
31
15*
12
31%
26
56 ’ 8 8
36
to controls;
-
+ P < 0.001 compared
to
Results Elderly diabetic patients demanded a disproportionate amount of health care resources, 46% of all admissions, 79% of deaths and 64Yf0of amputations, although amounting to only 23Yb of all diabetic patients registered at the diabetic clinic. The prevalence of coronary artery disease, peripheral vascular disease, cerebrovascular disease and hypertension was higher in diabetic patients when compared to controls (Table 1). Visual handicap among diabetic patients was as follows; 10% had maculopathy, 18% had cataracts, 8% retinopathy and 20% had refraction errors. Visual handicap amongst controls was due to cataract in 16% and refraction errors in lSo/, and macular degenerations accounted for the balance.
Discussion The challenging management problems posed by elderly diabetic patients and the significant eco-
nomic burden placed on health services by these patients are well documented [5,6]. However, in developing countries problems of the elderly are accorded low priority by health planners. We have shown that although they accounted for only 23 “//,of clinic attenders, 46 % of hospital admissions amongst diabetic patients are in the age group 60 and over. Elderly diabetic patients appear to be more likely to need in-patient care while mortality and morbidity amongst these patients also appears to be high. We conclude, therefore, that diabetes in the elderly is a significant cause of morbidity even in a developing country like Sri Lanka and that many preventable causes of morbidity exist in this group of patients. It is essential that an awareness be created among health professionals and administrators that diabetes in the elderly patient is a cause for concern even in developing countries.
References Petri, M.P., Gatling, W., Petri, L. and Hill, R.D. (1986) Diabetes in the elderly: an epidemiological perspective. Pratt. Diabetes 3, 153-155. Central Bank of Sri Lanka (1985) Sri Lanka; Socioeconomic data. World Health Organisation. (1979) Vascular Disease in Diabetics. NCD/OND/79.4. Jarrett, R.J., Keen, H. and Grabauska, Y. (1979) The WHO multinational study of vascular disease in diabetes: 1. General description. Diabetes Care 2, 175-186. Fernando, D.J.S. and Boulton, A.J.M. (1991) Diabetes management in old age. In: J.C. Brocklehurst, N. Tallis and H. Fillit (Eds.), Textbook of Geriatric Medicine and Gerontology, 4th edit., Churchill Livingston, London (in press). Tatersall, R.B. (1984) Diabetes in the elderly: a neglected area? Diabetologia 27, 167-173.
1992 Elsevier
Science Publishers
245
B.V. All rights reserved 0168-8227/92/$05.00
DIABET 00602
Diabetes in the elderly in a developing country D.J.S.
Fernando,
C.E. de Silva, S.F.R. Nanayakkara
Sri Jayawardenepura
and H.H.R.
Samarasinghe
General Hospital, Talapathpitiya, Nugegoda, Sri Lanka
(Received 25 June 1991) (Revision accepted 7 October 1991)
Summary
In developing countries diabetes in the elderly is thought to be uncommon and is consequently ignored by health planners. We assessed the prevalence of complications of diabetes mellitus and frequency of hospital admissions in patients aged 60 and over in a hospital diabetic clinic in Sri Lanka. Elderly diabetic patients, though comprising only 23”/’ of clinic patients, accounted for 46% of admissions. The prevalence of coronary artery disease, peripheral vascular disease, cerebrovascular disease, hypertension and visual handicap was increased in the diabetic patients when compared to age and gender matched controls. We conclude that diabetes in the elderly is a significant cause of morbidity in Sri Lanka. Key words: Diabetes mellitus; Elderly; Developing
Introduction It is well known that the prevalence of diabetes increases with age [ 13. In Sri Lanka, a developing country, life expectancy at birth is 72 and has risen from 68 in 1979 to 72 in 1985 [2]. Further increases in life expectancy and, consequently, in the proportion of ‘senior citizens’ may lead to an ‘epidemic’ of non-communicable diseases such as diabetes. Available mortality and morbidity data fail to highlight the importance of diabetes in the elderly as a cause of morbidity. We, therefore, assessed the prevalence of Correspondence to: D.J.S. Fernando, Sri Jayawardenepura General Hospital, Talapathpitiya, Nugegoda, Sri Lanka.
country;
Sri Lanka
diabetic complications amongst elderly diabetic patients attending a diabetic clinic in a teaching hospital.
Material
and Methods
A prospective study was conducted to ascertain the prevalence of long-term complications of diabetes in 204 patients, aged 6 1 and over, attending a hospital diabetic clinic. A control group of 170 non-diabetic age and gender matched patients was also studied (Table 1). A vascular disease questionnaire and clinical grading of retinopathy based on the methods of the WI-IO multinational study was used [3,4].
246 TABLE 1 Morbidity in diabetic and control populations
Mean age f SD Male/female Hypertension (“” ) Ischaemic heart disease ( “; ) Peripheral vascular disease ( ‘I,)) Cerebrovascular disease (“,,) Visual acuity < 619 (“0) Nephropathy (“,) Retinopathy (On) *P < 0.01 compared controls.
aged z 60
Diabetic subjects
Control subjects
69.2 + 1.9 121/83 36*
69.1 k 6.6 93161 30
42*
31
15*
12
31%
26
56 ’ 8 8
36
to controls;
-
+ P < 0.001 compared
to
Results Elderly diabetic patients demanded a disproportionate amount of health care resources, 46% of all admissions, 79% of deaths and 64Yf0of amputations, although amounting to only 23Yb of all diabetic patients registered at the diabetic clinic. The prevalence of coronary artery disease, peripheral vascular disease, cerebrovascular disease and hypertension was higher in diabetic patients when compared to controls (Table 1). Visual handicap among diabetic patients was as follows; 10% had maculopathy, 18% had cataracts, 8% retinopathy and 20% had refraction errors. Visual handicap amongst controls was due to cataract in 16% and refraction errors in lSo/, and macular degenerations accounted for the balance.
Discussion The challenging management problems posed by elderly diabetic patients and the significant eco-
nomic burden placed on health services by these patients are well documented [5,6]. However, in developing countries problems of the elderly are accorded low priority by health planners. We have shown that although they accounted for only 23 “//,of clinic attenders, 46 % of hospital admissions amongst diabetic patients are in the age group 60 and over. Elderly diabetic patients appear to be more likely to need in-patient care while mortality and morbidity amongst these patients also appears to be high. We conclude, therefore, that diabetes in the elderly is a significant cause of morbidity even in a developing country like Sri Lanka and that many preventable causes of morbidity exist in this group of patients. It is essential that an awareness be created among health professionals and administrators that diabetes in the elderly patient is a cause for concern even in developing countries.
References Petri, M.P., Gatling, W., Petri, L. and Hill, R.D. (1986) Diabetes in the elderly: an epidemiological perspective. Pratt. Diabetes 3, 153-155. Central Bank of Sri Lanka (1985) Sri Lanka; Socioeconomic data. World Health Organisation. (1979) Vascular Disease in Diabetics. NCD/OND/79.4. Jarrett, R.J., Keen, H. and Grabauska, Y. (1979) The WHO multinational study of vascular disease in diabetes: 1. General description. Diabetes Care 2, 175-186. Fernando, D.J.S. and Boulton, A.J.M. (1991) Diabetes management in old age. In: J.C. Brocklehurst, N. Tallis and H. Fillit (Eds.), Textbook of Geriatric Medicine and Gerontology, 4th edit., Churchill Livingston, London (in press). Tatersall, R.B. (1984) Diabetes in the elderly: a neglected area? Diabetologia 27, 167-173.