A Longitudinal Study of Impaired Glucose Tolerance and Diabetes Mellitus in the Aged

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Abstract
This longitudinal study of glucose tolerance in the residents of a Jewish home for the aged (JHA) is now in its 25th year. Of 1,177 supposedly nondiabetic persons screened on admission from 1965 to 1986, 22.5% had impaired glucose tolerance (IGT), reflecting its undiagnosed prevalence among the Jewish elderly in the community. The incidence of IGT was lower in 1969–1973, when the average age on admission was 77 years, than in 1982–1986, when the average age was 83.5 years. However, aging was not the only factor affecting glucose tolerance (GT). The rise in the residents' age in the last 10 years was not accompanied by an increased rate of deterioration of GT in the annual screenings of 1970–1984, suggesting that there was a delay in the effect of age on IGT and diabetes mellitus (DM). This was attributed mainly to the multimodal antidiabetic regimen (ADR) prevailing in the JHA in those years. Relaxation of this regimen was associated with a marked increase in the incidence of IGT and DM in the screenings of 1985–1987.When 25 newly diagnosed diabetics were put on a diabetic diet, 60% had normal or improved glucose tolerance tests (GTT) one to five years later. By contrast, in over half of the 80 residents whose first GTT did not indicate diabetes and whose diet was not as strictly controlled, the repeat GTT showed deterioration and was diabetic in 31%.Conclusions: Screening led to early diagnosis and institution of antidiabetic measures, probably avoiding or postponing the need for antidiabetic medication with its risk of iatrogenic hypoglycemia. Periodic screening is recommended for older persons because of their high risk for DM.