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A growing number of older adults have diabetes. People with diabetes don't make or properly use insulin, a hormone that turns sugars, starches and other foods into energy. As a result, their blood sugar levels may get so high that they cause health problems.

Diabetes can damage blood vessels, causing many complications. Damage to the blood vessels in the back part of the eye called the retina can cause diabetic retinopathy, an eye disease that can lead to vision loss. Damage to blood vessels in the kidneys can cause a disorder called nephropathy, which can eventually lead to kidney failure.

Studies in younger adults with diabetes have found that taking steps to get "tight control" of blood sugar levels, high blood pressure, and blood fats such as cholesterol -- which can also damage blood vessels -- can help protect against these and other problems.

To get tight control over diabetes it's necessary to carefully follow your healthcare provider's advice about checking your blood sugar levels, exercising, and watching your diet. Using medications to control blood sugar, blood pressure and blood fat levels may also be needed. Tight control has some drawbacks -- it can also lead to times when your blood sugar is dangerously low, called hypoglycemia.

New Research in the Journal of the American Geriatrics Society

To get a better sense of how well tight control might work for older adults with diabetes, researchers studied more than 400 mostly non-obese Japanese adults with diabetes who had their blood sugar, blood pressure and blood fat levels under tight control. The adults were all 65 or older at the start of the study. Some of them had retinopathy and nephropathy at the start of the study. The study lasted 6 years.

Throughout the study, the researchers gave the adults tests to check their blood sugar, blood pressure and blood fat levels. They also checked for signs of retinopathy and nephropathy. In patients who had these conditions at the start of the study, or who developed them over the 6 years, the researchers also checked to see if these problems got better or worse during the study.

Those with tight control of blood sugar, blood pressure and blood fat levels were protected from retinopathy and nephropathy, the researchers found. Over the 6 years, far fewer of the adults developed retinopathy and nephropathy than expected. And considerably fewer people who had these diseases at the start of the study saw them get worse. In fact, some of the adults who had these conditions saw them get better during the study.

These results suggest that tight control of blood sugar, blood pressure and blood fat levels can help older adults with diabetes avoid complications such as eye and kidney disease. Because tight control can also cause problems such as blood sugar and blood pressure that are too low, however, healthcare providers need to carefully monitor older patients for whom they recommend tight control, the researchers report.

What Should I Do?

If you have diabetes, talk to your healthcare professional about how to manage the disease and follow his or her advice carefully. If you're interested in learning more about tight control, ask your healthcare provider.

For additional information about diabetes in older adults, including information about managing diabetes, visit Aging in the Know.

The summary above is from the full report titled, "Development, Worsening, and Improvement of Diabetic Microangiopathy in the Elderly: Six-Year-Prospective Study Under Intensive Diabetes Control." It is in the April 2007 issue of the Journal of the American Geriatrics Society (Volume 55, Issue 4). The report is authored by Masafumi Katakura, PhD, Motoji Naka, PhD, Teruki Kondo, PhD, Mitsuhisa Komatsu, PhD, Keishi Yamauchi, PhD, Kiyoshi Hashizume, PhD, and Toru Aizawa, PhD.