Nutrition Considerations for the Growing Population of Older Adults With Diabetes

Etiology of type 2 diabetes in older adults The incidence of type 2 diabetes in older adults is attributable to two primary factors: 1) changes in metabolism (e.g., increased insulin resistance and decreased insulin production) and 2) changes in weight and physical activity. The development of glucose intolerance is a recognizable metabolic change that occurs during aging, and some degree of glucose intolerance is normal later in life, even in otherwise healthy people. Studies have reported increases of 5.3 mg/dl in postprandial glucose levels and 1–2 mg/dl in fasting glucose levels for every decade of life after the age of 30 years.1 The etiology of glucose intolerance in older adults is multifaceted. Factors such as slower glucose absorption, altered gluconeogenesis, decreased insulin production, reduced lean body mass, decreased physical activity, and altered digestion all contribute to reduced glucose utilization.2 Alterations in physical activity in older adults are common and often related to physical limitations, conditions such as atherosclerosis, and an increased risk of injury.3 In addition, many people in this age category also have one or more chronic health condition requiring prescription and nonprescription medications that may affect glucose metabolism.1,4