Acta Diabetol. 2025 Nov 27. doi: 10.1007/s00592-025-02624-x. Online ahead of print.
ABSTRACT
BACKGROUND AND AIMS: Thanks to the efforts made in the last century many patients with Type 1 Diabetes (T1D) are reaching and surpassing the age of 75, however, data on their clinical characteristics, prevalence of diabetes complications and quality of care are lacking.
METHODS: This multicenter, observational, retrospective study includes data from participants with T1D aged over 75 years, regularly evaluated in the year 2023 in 296 Diabetes Clinics in Italy included in the Associazione Medici Diabetologi (AMD) Annals Initiative. Socio-demographic characteristics, data on glycemic, lipid, and blood pressure control, data on the current insulin therapy regimen, the use of insulin pumps, as well as data on the prevalence of microvascular and macrovascular complications of diabetes was evaluated. Additionally, we evaluated some indicators of quality of care.
RESULTS: We included 2443 participants with mean age of 79.9 ± 3.9 years, in prevalence (54.9%) female. The mean duration of diabetes was 34.1 ± 17.5 years. Participants were evaluated regularly in person at the diabetes clinic on average 2.7 ± 2.1 times per year. 5% of participants were treated with insulin pumps. Mean glycated hemoglobin (HbA1c) was 7.8 ± 1.1. In comparison to standard therapy, better glycemic control was seen in participants on insulin pumps. Despite the high prevalence of diabetic retinopathy (33.3%) and chronic kidney disease (CKD) (39%) only a small portion of participants presented with end-stage complication, with 2.3% of participants having Proliferative Retinopathy (0.4% vision loss), 0.3% being on dialysis, and 2.5% having a history of amputation or foot ulcer. Cardiovascular disease was detected in 17.8% of participants. 77% of participants with previous CV event were treated with anti-platelet therapy. 68% of participants with proteinuria were treated with renin-angiotensin-aldosterone system (RAAS) inhibitors. LDL target of < 100 mg/dl was achieved in almost 2/3 of participants. Overall quality of care, expressed as Q-Score, was 27.4 ± 8.2.
CONCLUSION: Our data show that a consistent number of T1D participants regularly followed up by Italian diabetes centers reached an advanced age. The overall quality of care for participants regularly followed was good, within a lower-than-expected burden of end-stage renal disease, visual loss, and diabetic foot. Management of CV risk factors could be improved, as well as the use of technology in this setting.
PMID:41307692 | DOI:10.1007/s00592-025-02624-x