Over a third of people 65 and older have diabetes and roughly half of older adults — about 27.2 million — have prediabetes. Disease prevalence is even higher in older African Americans and in Hispanics. Aging is among the most important risk factors for diabetes, and as the U.S. population continues to grow older, the incidence of this disease is projected to double in the next 20 years.
Older adults are at greater risk of developing diabetes mellitus (Type 2) due to factors like declining insulin resistance and changes in metabolism. They are also more likely to have concurrent medical conditions like heart disease, and may struggle more to manage their health. Older people are more likely to have diabetes-related complications than younger people living with Type 2 diabetes, according to the Endocrine Society.
Other health conditions can worsen diabetes, and diabetes can trigger or worsen other serious health problems. This can lead to reduced functional status and increase the risk of institutionalization and premature death. Diabetes also increases the risk of depression, cognitive impairment, urinary incontinence, serious falls and chronic pain.
Common risk factors
Being overweight or obese.
Physical inactivity.
Family history of diabetes.
Having pre-diabetes.
Having had gestational diabetes.
Being of African-American, Hispanic or Latino, American Indian, or Alaska Native descent.
Cost of diabetes to the health system
The cost of all diabetes-related complications in older adults was over $37 billion in 2017, according to the CDC.
Direct medical costs associated with diabetes climbed 7% between 2017 and 2022 for all adults, according to an American Diabetes Association report.
People over 65 are three times more likely to be hospitalized than those without the disease if diabetes is listed as the first diagnosis, a 2020 study found.
Kidney disease, congestive heart failure and stroke were the most common complications among Medicare beneficiaries 65 or older with Type 2 diabetes, accounting for almost half of the total cost of all diabetes-related complications in this population.
In 2022, medical expenses averaged $19,736 for all people with diabetes. Approximately $12,000 can be directly attributable to the disease. These expenses are 2.6 higher than for people who don’t have diabetes.
Those over 65 spend roughly twice the amount per capita on diabetes-related health expenses than any other adult age group, the ADA reported.
Diabetes is the most expensive chronic disease in the U.S., according to the CDC. Additionally, “complications associated with diabetes are costly and vary by condition among Medicare beneficiaries 65 or older with type 2 diabetes.”
Diet and exercise are the first line of diabetes management, but many older people have problems with mobility, poor nutrition or food insecurity. That can make managing their condition challenging.
Many medications are available to help manage Type 2 diabetes, but often have side effects that some older people find difficult to cope with.
In 2023, The Inflation Reduction Act capped the cost of insulin at $35/month for Medicare recipients. While insulin is most often used for people with Type 1 diabetes, some people with Type 2 diabetes must also take insulin to control their disease. The price cap led to a surge in people filling their prescriptions for this potentially life-saving drug.
The Part D (drug) plan will cover common anti-diabetic medications including:
Story ideas and resources
Check with your local hospital about their admission and discharge rates for diabetes-specific diagnoses among older patients.
Are there any specific community-based education programs, particularly in marginalized communities, to help older adults manage their disease?
Check prescribing trends among physicians in your area to see if they are suggesting some of the newer, more expensive drugs, and ask how physicians are educating patients on their use.
Talk to local pharmacists too, and ask how they’re educating their older patients about the disease, the importance of medication adherence and drug interactions.
The American Diabetes Association offers education programs in every state and in many cities. Contact a local representative for up-to-date statistics for your area, or comments about a study or drug. You can find a list of local chapters on their website, along with more stats and information about programs which target specific minority and ethnic groups.
The National Diabetes Statistics 2018 report has a wealth of data on all age groups and also breaks down incidence and impact by race and ethnicity.
The Endocrine Society offers patient resources specific to older adults.
This CDC data brief looks at diabetes-related emergency department visits by adults. Several of the charts and figures are specific to adults 65 and older.
Liz Seegert is AHCJ’s health beat leader for aging. She’s an award-winning, independent health journalist based in New York’s Hudson
Valley, who writes about caregiving, dementia, access to care, nursing homes and policy. As AHCJ’s health beat leader for aging,
