title: Present state of diabetes management in the elderly, Japan.
abstract: A recent dramatic increase in elderly patients with diabetes mellitus has made the proper management of the disease in this population more important. Here, we discuss the present status of diabetes management in the elderly in Japan. As a characteristic feature of elderly persons, body weight reduction is difficult, because of the profound adaptive reduction in resting energy expenditure under calorie restriction in the elderly. However, hyperglycemia increases the risk for diabetic complications, except proliferative retinopathy, similarly in elderly and non-elderly. Of note, there is marked clinical heterogeneity in this generation in the following aspects: duration, complication status (past aspect), insulin secretion, insulin sensitivity, familial support and physical exercise/activity (present aspect), as well as the expected lifespan (future aspect). This heterogeneity among the elderly should render diabetes treatment diverse, and in fact, one of the largest surveys in Japan demonstrated significant diversity in diabetes management in the elderly. In Japan, thus, the present management of diabetes in the elderly is considerably diverse, reflecting the clinical heterogeneity among elderly patients with diabetes. Further clinical evidence is awaited for the establishment of proper and safe management of diabetes in the elderly.
authors.affiliation: Department of Geriatric Medicine, Osaka Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan. fujisawa@geriat.med.osaka-u.ac.jp
authors.forename: Tomomi
authors.initials: T
authors.lastname: Fujisawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ikegami
authors.forename: Koji
authors.initials: K
authors.lastname: Nojima
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Kawabata
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Noso
authors.forename: Katsuaki
authors.initials: K
authors.lastname: Asano
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Hiromine
authors.forename: Aya
authors.initials: A
authors.lastname: Fukai
authors.forename: Nobuyasu
authors.initials: N
authors.lastname: Shindo
authors.forename: Toshio
authors.initials: T
authors.lastname: Ogihara
mesh_terms: D000368:Aged; D001835:Body Weight; D048909:Diabetes Complications / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy*; D004734:Energy Metabolism; D015444:Exercise; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology