Diabetes Mellitus

Traditional risk factors for cardiovascular disease, such as smoking, hypertension, and excess lipids, are associated with an increased risk of diabetes-related complications in the elderly. Modification of these risk factors may reduce the risk of these complications.

Studies suggest that treatment of hypertension with drugs such as the thiazide diuretics and calcium channel blockers reduces mortality and the risk of vascular complications related to diabetes in the elderly (Tuomilehto et al.; Curb et al.). In the Systolic Hypertension in the Elderly Patient study (SHEP), patients with systolic hypertension and type 2 diabetes who were treated with a thiazide diuretic, had a significantly lower incidence of cardiovascular events than subjects receiving a placebo. The absolute risk reduction with active treatment compared with the placebo was twice as great for diabetic as for nondiabetic patients who participated in this study. The Systolic Hypertension in Europe Trial (SystEur) undertook a similar subgroup analysis of older patients with both hypertension and type 2 diabetes. Among the nondiabetic participants who were started on a calcium-channel blocker, nitrendipine, a 55 percent reduction of mortality was observed compared to the placebo group. In the group receiving active treatment, reduction of overall mortality was significantly higher among the diabetic patients than among the nondiabetic ones.

There are no data from randomized trials in the elderly diabetic population to determine the benefits of treatment of excess lipids. Subgroup analysis of middle-aged patients with diabetes (Pyorala et al.; Goldberg et al.) and subjects sixty-five or older (LIPID Study Group) who enrolled in prevention trials suggesting that reduction of low-density lipoprotein (LDL) cholesterol can significantly decrease vascular events in this population.