This was why Drs. Susan Benbow of Liverpool's University Clinical Department of Medicine and Geoffrey Gill along with Angela Walsh of Liverpool's Diabetes Center were prompted to study the characteristics and causes of brittle diabetes in the elderly.
What they did was sent out questionnaires to all United Kingdom hospital clinics for diabetic adults. In this way they were able to obtain reports for 55 patients who met the standards for brittle diabetes among the senior population. What are these criteria? In order to become participants for this research, first, they have to be 60 years old or over.
The second standard is that they have to be treated with insulin. And they have had their lives disrupted by glycemic instability. Moreover, they must have been hospitalized for a long period and this hospitalization should have been not only of long duration but often.
After calculating the mean age, the result came up as 74 years old. The number of cases for females is a high 71%.
The researchers classified the brittle diabetes among the senior population into three categories:
varied instability in 44%
repeated ketoacidosis in 29%
recurrent hypoglycemia in 15%
You must wonder why the aforementioned statistics did not arrive at a total of 100%. It's because enough information was not available in some cases. There was not a single cause for brittle diabetes among two-thirds of the participants which amounted to 66% brittle diabetes. In fact, the researchers found many causes for this diabetes in this age group,
As for the single cause of this condition, they discovered that the main reason for this condition is medical disease. The researchers did not identify the medical disease although another study reported that their cases also involved other chronic diseases. Another cause is that only 6% of the participants were unaware of the hypoglycemic event.
Problems about behavior and memory were found not to be common.
Only four cases were found showing patients who intentionally manipulated the treatment. And 84% of the elderly who were afflicted with brittle diabetes were living alone.
Among the four cases who manipulated the treatment, two with repeated ketoacidosis were thought of as seeking attention by leaving out insulin. One had problems with her marriage and possibly was suffering from depression. She seemed to be wanting to gain personally from her glycemic instability.
The last subject who manipulated the therapy case was deemed to be calculating and depressed. Her hypoglycemic events all occurred in public. However in all these cases there were other issues that may have led to the instability. Most of these would be the chronic non-diabetic medical condition.
Among the younger cases, the main characteristic of brittle diabetes is recurrent ketoacidosis but this research seems to indicate that brittle diabetes in the elderly have different causes and patterns. With the older group now making use of insulin treatment, we may see more of the same cases.
The diabetes health care team found many causes of the condition but it is more important to note that this survey found that brittle diabetes among the senior population exists. And this problem should not be ignored. It is quite a problem not only for the health care team but for the family as well.
When the elderly is admitted to the hospital for diabetes, the reason given is usually varied. The most cause is mixed brittleness whereas for the younger patients, ketoacidosis is the most common reason for hospitalization. There are more females than males among the elderly but this does not come as a surprise so it is not considered as statistically important.
There is not enough publications on unstable diabetes in the elderly. The report in Birmingham, UK is that 25% of those with repeated episodes were over 59 years old. That most of these have mixed brittleness was found by Griffin and Yudkin. They did not identify any clear cause for the instability.
Gale et al from Nottingham in 1981 reported that 33% of diabetic patients who were admitted to the hospital over a period of 7 years were over 50 years old. There is a need therefore to think of strategies to face the clear indication that brittle diabetes in the elderly is a reality. Multidisciplinary approach is the way to go when dealing with prevention and management.
Roger Guzman, M.D. was Director of Forensic Psychiatry at Centracare for ten years and published numerous articles in the Journal of the American College of Forensic Psychiatry and other medical magazines.