Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 142 No. 3334 (2012)

Diabetes care among older adults in primary care in Austria

  • Eva Mann
  • Alexander Vonbank
  • Heinz Drexel
  • Christoph H Saely
Cite this as:
Swiss Med Wkly. 2012;142:w13646


QUESTIONS UNDER STUDY: The prevalence of diabetes mellitus in the older population is high, but hardly any data are available on current diabetes care in the primary care setting. We aimed at investigating the diabetes management of older patients with type 2 diabetes (T2DM) in the primary care setting, including adherence to current guidelines, comparing patients aged 70–79 years to those aged 80 years and above.

METHODS: From November 2008 through March 2009 a total of 23 primary care physicians and one consultant in internal medicine consecutively enrolled 203 unselected patients with T2DM aged ≥70 years.

RESULTS: From the 203 study participants 66% were 70–79 years of age, and 34% were 80 years or older. Mean HbA1c and LDL-cholesterol were not significantly different between the older and the younger age group (7.6 ± 1.6 vs. 7.1 ± 0.9%; p = 0.080; and 122 ± 40 vs. 114 ± 34 mg/dl; p = 0.273), whereas BMI was lower (27.5 ± 5.0 vs. 29.6 ± 5.0 kg/m2, p = 0.010), and the prevalent rates of coronary heart disease (55.1 vs. 37.1%, p = 0.011) and of dementia (29% vs. 6.1%, p = 0.001) were higher in the older age group. LDL-cholesterol (77.6% vs. 66.7%, p = 0.012), creatinine clearance (34.6% vs. 30.9%, p = 0.049) but not HbA1c (74.6% vs.73.9; p = 0.520) were monitored significantly less often in the older than in the younger age group.

CONCLUSIONS: While glycaemic control on average appears strict, there may be ample room for improvement in reaching lipid targets and in the monitoring of lipid and renal function among older adults in primary care, in particular among individuals aged ≥80 years.


  1. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27(5):1047–53.
  2. Harris MI, Flegal KM, Cowie CC, Eberhardt MS, Goldstein DE, Little RR, et al. Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S. adults. The Third National Health and Nutrition Examination Survey, 1988–94. Diabetes Care. 1998;21(4):518–24.
  3. Trepp R, Wille T, Wieland T, Reinhart WH. Diabetes-related knowledge among medical and nursing house staff. Swiss Med Wkly. 2010;140(25-26):370–5.
  4. Bethel MA, Sloan FA, Belsky D, Feinglos MN. Longitudinal incidence and prevalence of adverse outcomes of diabetes mellitus in elderly patients. Arch Intern Med. 2007;167(9):921–7.
  5. Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med. 1998;339(4):229–34.
  6. Zhang X, Saaddine JB, Chou CF, Cotch MF, Cheng YJ, Geiss LS, et al. Prevalence of diabetic retinopathy in the United States, 2005-2008. JAMA. 2010;304(6):649–56.
  7. Hahr AJ, Molitch ME. Diabetes, cardiovascular risk and nephropathy. Cardiol Clin. 2010;28(3):467–75.
  8. Van Acker K, Bouhassira D, De Bacquer D, Weiss S, Matthys K, Raemen H, et al. Prevalence and impact on quality of life of peripheral neuropathy with or without neuropathic pain in type 1 and type 2 diabetic patients attending hospital outpatients clinics. Diabetes Metab. 2009;35(3):206–13.
  9. Bertoni AG, Kirk JK, Goff DC, Jr., Wagenknecht LE. Excess mortality related to diabetes mellitus in elderly Medicare beneficiaries. Ann Epidemiol. 2004;14(5):362–7.
  10. Kearney PM, Blackwell L, Collins R, Keech A, Simes J, Peto R, et al. Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet. 2008;371(9607):117–25.
  11. Cukierman T, Gerstein HC, Williamson JD. Cognitive decline and dementia in diabetes--systematic overview of prospective observational studies. Diabetologia. 2005;48(12):2460–9.
  12. Schwartz AV, Hillier TA, Sellmeyer DE, Resnick HE, Gregg E, Ensrud KE, et al. Older women with diabetes have a higher risk of falls: a prospective study. Diabetes Care. 2002;25(10):1749–54.
  13. Maraldi C, Volpato S, Penninx BW, Yaffe K, Simonsick EM, Strotmeyer ES, et al. Diabetes mellitus, glycemic control, and incident depressive symptoms among 70- to 79-year-old persons: the health, aging, and body composition study. Arch Intern Med. 2007;167(11):1137–44.
  14. Lee SJ, Eng C. Goals of glycemic control in frail older patients with diabetes. JAMA. 2011;305(13):1350–1.
  15. Austrian Diabetes Association. Diabetes mellitus - Clinical Practice Guidelines. 2009;121–21(Suppl5):1–87.
  16. Patel A, Macmahon S, Chalmers J, Neal B, Billot L, Woodward M, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358(24):2560–72.
  17. Gerstein HC, Miller ME, Byington RP, Goff Jr. DC, Bigger JT, Buse JB, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358(24):2545–59.
  18. Saremi A, Moritz TE, Anderson RJ, Abraira C, Duckworth WC, Reaven PD. Rates and determinants of coronary and abdominal aortic artery calcium progression in the Veterans Affairs Diabetes Trial (VADT). Diabetes Care. 2010;33(12):2642–7.
  19. Miller ME, Bonds DE, Gerstein HC, Seaquist ER, Bergenstal RM, Calles-Escandon J, et al. The effects of baseline characteristics, glycaemia treatment approach, and glycated haemoglobin concentration on the risk of severe hypoglycaemia: post hoc epidemiological analysis of the ACCORD study. BMJ. 2010;340:b5444.
  20. Whitmer RA, Karter AJ, Yaffe K, Quesenberry Jr. CP, Selby JV. Hypoglycemic episodes and risk of dementia in older patients with type 2 diabetes mellitus. JAMA. 2009;301(15):1565–72.
  21. Araki A, Ito H. Diabetes mellitus and geriatric syndromes. Geriatr Gerontol Int. 2009;9(2):105–14.
  22. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of diet in Renal Disease Study group. Ann Intern Med. 1999;130(6):461–70.
  23. Standards of medical care in diabetes 2011. Diabetes Care. 2011;34(Suppl1):S11–S61.
  24. Saely CH, Aczel S, Koch L, Schmid F, Marte T, Huber K, et al. Diabetes as a coronary artery disease risk equivalent: before a change of paradigm? Eur J Cardiovasc Prev Rehabil. 2010;17(1):94–9.
  25. Shepherd J, Blauw GJ, Murphy MB, Bollen EL, Buckley BM, Cobbe SM, et al. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet. 2002;360(9346):1623–30.
  26. Boyko EJ, Ahroni JH, Smith DG, Davignon D. Increased mortality associated with diabetic foot ulcer. Diabet Med. 1996;13(11):967–72.
  27. Whitlock G, Lewington S, Sherliker P, Clarke R, Emberson J, Halsey J, et al. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009;373(9669):1083–96.
  28. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351(13):1296–1305.
  29. Di Angelantonio E, Chowdhury R, Sarwar N, Aspelund T, Danesh J, Gudnason V. Chronic kidney disease and risk of major cardiovascular disease and non-vascular mortality: prospective population based cohort study. BMJ. 2010;341:c4986.
  30. Rein P, Saely CH, Muendlein A, Vonbank A, Drexel H. Serial decline of kidney function as a novel biomarker for the progression of atherothrombotic disease. Atherosclerosis. 2010;211(1):348–52.
  31. Crowe E, Halpin D, Stevens P. Early identification and management of chronic kidney disease: summary of NICE guidance. BMJ. 2008;337:a1530.
  32. Gerstein HC, Riddle MC, Kendall DM, Cohen RM, Goland R, Feinglos MN, et al. Glycemia treatment strategies in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. Am J Cardiol. 2007;99(12A):34i–43i.
  33. Duckworth W, Abraira C, Moritz T, Reda D, Emanuele N, Reaven PD, et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2009;360(2):129–39.
  34. Baigent C, Blackwell L, Emberson J, Holland LE, Reith C, Bhala N, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010;376(9753):1670–81.
  35. Baigent C, Keech A, Kearney PM, Blackwell L, Buck G, Pollicino C, et al. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet. 2005;366(9493):1267–78.
  36. Colhoun HM, Betteridge DJ, Durrington PN, Hitman GA, Neil HA, Livingstone SJ, et al. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial. Lancet. 2004;364(9435):685–96.
  37. Cannon CP, Braunwald E, McCabe CH, Rader DJ, Rouleau JL, Belder R, Jet al. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med. 2004;350(15):1495–1504.
  38. Tsunekawa T, Hayashi T, Kano H, Sumi D, Matsui-Hirai H, Thakur NK, et al. Cerivastatin, a hydroxymethylglutaryl coenzyme a reductase inhibitor, improves endothelial function in elderly diabetic patients within 3 days. Circulation. 2001;104(4):376–9.
  39. Catapano AL, Reiner Z, De Backer G, Graham I, Taskinen MR, Wiklund O, et al. ESC/EAS Guidelines for the management of dyslipidaemias: the Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Atherosclerosis. 2011;217 Suppl 1:S1–44.
  40. Beckett N, Peters R, Tuomilehto J, Swift C, Sever P, Potter J, et al. Immediate and late benefits of treating very elderly people with hypertension: results from active treatment extension to hypertension in the very elderly randomised controlled trial. BMJ. 2012;344:d7541.
  41. Introduction: The American Diabetes Association's (ADA) evidence-based practice guidelines, standards, and related recommendations and documents for diabetes care. Diabetes Care. 2012;35 Suppl 1:S1–S2.
  42. Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, et al. Management of hyperglycaemia in type 2 diabetes: a patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2012;55(6):1577–96.
  43. ADA Guidelines - 2012.
  44. Catapano AL, Chapman J, Wiklund O, Taskinen MR. The new joint EAS/ESC guidelines for the management of dyslipidaemias. Atherosclerosis. 2011;217(1):1.
  45. Gregg EW, Engelgau MM, Narayan V. Complications of diabetes in elderly people. BMJ. 2002;325(7370):916–7.
  46. Schwarzt AV, Vittinghoff E, Sellmeyer DE, Feingold KR. Health, Aging and Body Composition Study. Diabetes Care. 2008;31(3):391–6.
  47. Ismail H, Wright J, Rhodes P, Scally A. Quality of care in diabetic patients attending routine primary care clinics compared with those attending GP specialist clinics. Diabet Med. 2006;23(8):851–6.

Most read articles by the same author(s)