Diabetes Forecast

Never Too Late to Change

A researcher is learning that older adults are willing to make lifestyle changes for better diabetes control

Dennis T. Villareal, MD
Photograph by Phoebe Rourke-Ghabriel

Dennis T. Villareal, MD

Endocrinologist, Michael E. DeBakey VA Medical Center and Baylor College of Medicine

Lifestyle change through diet and regular exercise

ADA Research Funding
ADA-Lilly Clinical Research Award: Diabetes Care in Older Adults

Are we ever too old to change?

For people with diabetes, it’s an especially important question. Doctors often assume older patients—some with a lifetime of unhealthy habits behind them—are unlikely to make significant changes.

The American Diabetes Association recommends diet and exercise as the first-line treatments for type 2 diabetes, but doctors sometimes don’t bother encouraging older patients to change, prescribing them drugs instead of referrals to diabetes education and exercise programs.

Endocrinologist Dennis T. Villareal, MD, thinks that’s not the right way to go. His research has shown that such conventional wisdom might be dead wrong: Older people are capable of making dramatic changes to their lifestyles, and they’re eager. “It’s a common conception that it’s too late to change,” he says. “It seems the opposite is true—older people seem to be more motivated.”

The implications are tremendous. Over the next 15 years, as America’s Baby Boomers retire, the number of Americans over the age of 65 will surge by 75 percent, to 69 million. One in five Americans will be over 65, and more than one in three will be over 50.

Those statistics could mean a flood of new type 2 diabetes cases. Older people are particularly vulnerable to the disease. With increasing age, the body requires fewer calories—but people usually keep eating the same way they did when they were younger, resulting in extra calories and weight gain. At the same time, older people tend to exercise less, another common risk factor for type 2 diabetes.

Villareal, a researcher at the Michael E. DeBakey VA Medical Center and Baylor College of Medicine in Houston, thinks that intense counseling and education, combined with exercise programs tailor-made for older adults with type 2 diabetes, can build a solid foundation for long-lasting change.

To test his theory, Villareal has set up an experiment with funding from the ADA. Participants include 100 people with diabetes, all of them over 60. Half of the participants are assigned to a control group, receiving advice on diet and exercise similar to what they would usually get from their doctor. “Most of the time it’s not adhered to, and they end up being treated using drugs or medication or insulin,” Villareal says.

The other half are taking part in a lifestyle intervention, the kind of program Villareal thinks will be beneficial. For six months, they visit a dietitian once a week. They meet in small groups three times a week for exercise classes designed to reduce body fat, improve their flexibility, and build up their sense of balance. They are then asked to keep up their diet and exercise routines on their own, with classes at gyms and community centers. They also pay close attention to their blood glucose levels.

The results so far, Villareal says, have been surprising—and encouraging. The people in the study’s intervention group seem to keep up on their own the hard work it took to limit calories and exercise regularly, which decreased the number of times they met with dietitians and exercised under supervision. “We find that they are very motivated to change lifelong habits. They demonstrated significant weight loss and successful compliance,” says Villareal.

Digging into the data, he found that the lifestyle changes make a big difference, which is likely to slow the progression of their type 2 diabetes. “The participants follow glucose control closely, and we anticipate we can reduce their insulin requirements,” Villareal says. “They’re more insulin sensitive when they lose weight and are more physically active.”

Based on his research results, Villareal thinks older people are being given short shrift by doctors and health care providers—and society. Retirement, he says, should be looked at as an opportunity in disguise. “Most of them are retired [and] don’t have the distractions of trying to earn a living or maintain a family,” he points out.

Developing access for seniors to intense education and exercise programs will require provider-community collaboration (YMCAs are increasingly offering similar programs). However, Villareal hopes his data can make a difference in changing the way older people with diabetes are treated: By keeping people healthy, happy, and independent longer, intensive diet and exercise programs might be more time- and cost-effective in the long term than quicker fixes. “We can provide evidence [that] it’s not only successful, but has a significant impact on their quality of life,” he says.



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