The prevalence of obesity is rising so rapidly in so many countries that the World Health Organization (WHO) has declared
that there is now a global epidemic of obesity. Internationally, emergence of new cases of diabetes mellitus (diabetes) parallels
the increases seen in Western countries and are increasing even more quickly in Asia. The risks of type 2 diabetes in these
countries tend to increase at levels of body mass index generally classified as nonobese in Caucasian westerners (1). These
worldwide changes are due to an accelerated prevalence of obesity, today’s predominance of sedentary lifestyle, and the rapidly
growing population of older adults (2).
Key Points • Prevention or delay of the development of long-term complications of high blood glucose and related metabolic abnormalities
and improvement of quality of life are key issues for nutritional considerations in diabetes care.
• Preventive care can substantially add to quality of life in those living with diabetes, including those in their senior
years. In the United States, 44% of persons with self-reported diagnosed diabetes are of age 65 or older and 18% are over
age 75.
• Prevention of the development of diabetes in those with risk factors such as “metabolic syndrome” is highly relevant to
the care of older adults. Over 40% of adults over the age of 70 years have the metabolic syndrome.
• Older adults with diabetes may be functionally limited by the presence of hypoglycemia. Factors that may play a role in
the increased risk of hypoglycemia in the senior years include poor nutritional status, cognitive dysfunction, polypharmacy,
and comorbid illnesses.
• Diabetes prevalence-related comorbidities such as diabetic retinopathy, cardiovascular disease, peripheral vascular disease,
and congestive heart failure may result in decreased usual activity and limit activities of daily living, including transportation,
shopping for food, and ability to read food labels and restaurant menus.
• Given the high rates of depression in the diabetes population and in the senior years, careful assessment of depressive
symptomology and its impact on dietary intake, diabetes self-care, and health outcomes is critical.