Morbidity from Diabetes

The main argument in favour of detection of diabetes in its early stages is to reduce or prevent its complications, which otherwise would lead to further morbidity (Samos and Roos 1998). Elderly diabetic persons have much higher use of ambulatory services than those without diabetes. Poor vision and blindness due to diabetic eye disease, lower limb amputation due to periph'eral vascular disease, neuropathy and infection, ischaemic heart disease, cerebrovascular accidents and chronic renal failure can all severely limit an elderly person's mobility, independence and quality of life.

Chronic complications are often present in elderly people with newly diagnosed diabetes; at diagnosis, 10-20% have established retinopathy or nephropathy and 10% have cardiovascular disease and neuropathy (Harris et al 1992; Muggeo 1998). Hypertension and Q-wave myocardial infarction are more prevalent, and the subsequent risk of developing retinopathy, peripheral vascular insufficiency and peripheral neuropathy is increased with age at diagnosis of diabetes (Davis et al 1997; Scheen 1997). Chronic diabetic complications can be more devastating to the patient's well-being when they first occur at an elderly age. By diagnosing diabetes early, complications may be prevented or even reversed. The current life expectancy for Australians is 76 years for men and 81 years for women and increasing yearly, so prevention of long-term diabetic complications is important even in this age group.

The elderly diabetic person is prone to certain acute complications of the disease. Hyperglycaemia leads to osmotic diuresis. With the decreased sense of thirst, the elderly diabetic person is less able to ingest sufficient fluids and therefore is at risk of sodium and water depletion, hypotension, hyperosmolality, hypokalae-mia (especially if the patient is taking diuretics), reduction in insulin secretion, and thrombotic events. Following myocardial infarction or septicaemia, elderly patients are more likely to develop shock, which may lead to lactic acidosis particularly in patients with poorly controlled diabetes. Such acute complications can become life-threatening but many can also be prevented by early diagnosis of diabetes and appropriate management.

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