ABSTRACT
This chapter reviews the available literature on the epidemiology and pathophysiology of diabetes and insulin resistance among elderly individuals and how it relates to the development of macrovascular disease and the association with other cardiovascular disease (CVD) risk factors. Attempting to assess the association between CVD risk and insulin resistance is limited in part by the by the lack of agreement on what constitutes insulin resistance in the elderly. However, the increased risk for CVD in elderly persons with diabetes is quite convincing and there is growing evidence that earlier manifestations of metabolic derangements may heighten the risk for CVD. In addition, multiple blood pressure–lowering therapies may be required to treat high-risk individuals in order to reduce the risk of CVD. American Diabetes Association treatment guidelines support an individualized approach to achieve near normoglycemic control and optimize the management of cardiovascular risk factors.
