Introduction
In this episode of BDI Briefs, we discuss a recent study covering aging with type 1 diabetes and examine the good news revealed in the outcome. We talk about what this means for people living with type 1 diabetes along with the image problem diabetes wrestles with in research and the media.
The publication is titled, “Global burden of type 1 diabetes in adults aged 65 years and older, 1990-2019: population based study“
Burden? That Sounds Bad...
At first glance, the news isn’t good. More and more people over 65 are living with type 1 diabetes and more people with type 1 diabetes are older.
The Good News
The “bad” news was necessary to review and did a good job of setting the stage for the good news.
All of which leads to a memorable and exciting conclusion worthy of celebration!
Dr. Polonsky also points out that the study states these years are also healthy years, not just more years spent in poor health. This is all terrific news and makes me feel very hopeful about my future with type 1 diabetes.
Detailed Show Notes and Transcript
[00:00:00] Scott K. Johnson: Welcome to BDI Briefs. This is another exciting installment where we take a brief look at important issues about the emotional side of diabetes. Thanks for joining us today. I’m here with Dr. Bill Polonsky, President of the Behavioral Diabetes Institute, and Dr. Susan Guzman, Director of Clinical Education at the Behavioral Diabetes Institute.
Both are world-renowned diabetes psychologists and two of my favorite people to talk with. My name is Scott Johnson. I’ve lived with diabetes for over 40 years and have been active in the diabetes social media space and industry for a long time. And with introductions out of the way, Bill, what are we talking about today?
[00:00:41] Dr. William Polonsky: Thanks, Scott. Well, you know, what I try to do all the time is to find what’s new out there, what’s new in the literature, what’s happening that’s relevant to people with diabetes and to health care professionals. And this time it’s going to be really relevant to you, Scott, in particular. This is a new study just came out a couple of weeks ago, and you’re going to see a slide pop up about that just to show you the title of it.
It’s called the “Global burden of type 1 diabetes in adults aged 65 and older.” And as you can see from the title, what this group looked at–this is from Yang and their colleagues. It was published in one of our best journals, the British Medical Journal. And they looked at people with type 1 all over the world.
They looked at people with type 1 in 204 countries and looked back over the past 30 years to see what’s happened. And what’s happened is, well, what’s going to look like bad news. But actually, maybe it’s not really bad news at all. What looks to be the bad news, which you can see on this slide, and let’s read it together.
Dr. William Polonsky:It’s pretty straightforward. You can see what I’ve highlighted, is that globally the prevalence of type 1 diabetes amongst older people aged 65 years or older has increased by 180 percent between 1990 and 2019. So it’s grown. The number of people with type one over the age of 65. Back in 1990, it was 1. 3 million people.
And, well, at least in 2019 3.7. I can assure you it’s even higher now. And what we know, if you look at the proportion of older people with type 1, it’s been this slow, well, upward trend.
Dr. William Polonsky: So again, back in 1990, it was about 12 percent of people with type 1 were over the age of 65. And now it’s about 17%. And I can tell you, Scott, by the time you hit 65 It’s going to be higher.
Might be 20%, might even be 25%. So you’re going to have a lot of, uh, your old doddering colleagues to wander around with. That the number of type 1’s is getting older and older, that, that’s the bad news. It’s things we have to be concerned about. We’re going to have this, I hate to even call it elderly, I don’t think as 65 is that old anymore, but we’re going to have this older population with technology, um, there’s so many of these folks.
So it’s of some concern. So that’s the bad news. Now the good news is of course, well, I hope it’s obvious. The reason we have more and more and more and more people with type 1 diabetes up in those older age brackets It’s because you people with type 1 refuse to die early. The bottom line is people with type 1 are living longer and longer lives.
And you can see it on this slide. Again, let’s read that highlighted part together.
Dr. William Polonsky: The age, what’s called the age-standardized mortality from type 1 diabetes in this older age group has significantly decreased by 25 percent. Again, people are living longer lives with type 1, and that’s what’s really changed.
And we understand what that’s about, about our changes in newer insulins, newer additional medications, amazing technology, an appreciation that intensive glucose management really matters, better engagement with medical care. So all this has really been an extraordinary advancement. Now to be fair, it’s 204 countries.
I’m not going into the details, which is provided in this article, about the differences from one country to the next. And of course, in countries that have lower resources, right, where, that are poor, where insulin is unaffordable, we’re not seeing these benefits yet, but we’re seeing this remarkable change that’s happening over the course of time.
And it really highlights, I think, one of the most important messages we talk about here at the BDI that, again, with good care, with good effort, with good medical engagement, odds are, odds are you and most people can do well. and live long and healthy lives I’ve got to tell you, I think the most interesting thing in this article is about their conclusion.
I want to just say this one thing and then let’s all talk about this. And you can see on this slide, this is the second sentence in their discussion.
Dr. William Polonsky: It’s very clear. The conclusion they say is simply this. The results suggest that type 1 diabetes is no longer a contributory factor in decreased life expectancy owing to improvements in medical care over the three decades. I’m still not quite convinced that’s really true. That’s extraordinary! And clearly, if that’s not true now, we’re getting there. It’s really quite amazing. It’s not type 1 anymore–type 1 isn’t necessarily going to limit your life. Now to be fair, out-of-control diabetes might contribute to that, but type 1 itself, no.
And again, with good care and effort. We can say, with great evidence now, which this supports, you can live a long and healthy life with diabetes. So, I just wanted to highlight this remarkable article on what this means, how this is happening all over the world. And, Susan, I want to know what you think.
Scott, this is going to be important for you, because, well, I know 65 isn’t that close, but you’re going to be getting there. You better be saving your money, because you’re going to have a long and healthy life. What do you guys think of this?
[00:06:06] Scott K. Johnson: Susan, I’ll let you go first. It’s, uh, yeah, this is big.
[00:06:09] Dr. Susan Guzman: I feel all kinds of feelings when I see this. One, is just hugely excited. And again, I feel like we have such an image problem in diabetes where we don’t seem to really celebrate major headlines like this. Even this very, very exciting conclusion was turned into something sounding negative, the burden.
Um, and I, I feel like people living with diabetes, and Scott, I’ll be interested in hearing what you think. Like, we’ve hammered people with scary statistics for so long. And Bill and I have, and, and Scott, I’m sure you know people that, that say, you know, I thought I was supposed to be dead by 30. Um, and just hearing that people get old with type 1 diabetes and that it’s possibly not even a contributory factor in decreased life expectancy, I just feel like, I imagine showing this to, to the people I work with and having them be emotional about it, um, and I wish we could talk about good news in a way that’s, that’s empowering, engaging, respectful, instead of we’re giving this good news with the title of the burden of type 1 diabetes.
[00:07:26] Dr. William Polonsky: Well, I want to give the authors credit, credit though, because if you look at their conclusion, you’re It’s certainly not negative. And once you know the problem continues, the burden on the healthcare system is going to be growing. That is likely to be true, simply because people are going to need care ongoing.
But to be fair to the authors, that’s a remarkably positive conclusion. I was awfully glad to see.
[00:07:46] Dr. Susan Guzman: Yeah. Right.
[00:07:47] Dr. William Polonsky: Scott, what about you?
[00:07:49] Scott K. Johnson: I mean, when I, I look at this and I feel, I feel very hopeful. You’re right, Susan. We’ve been kind of hammered throughout much of our lives, especially in the early years, decades ago, with scare tactics. And quite frankly, those never worked very well. For me, um, it made me kind of disconnect and, and disengage and kind of shut down.
But it’s, it’s really remarkable just how much a glimmer of hope can add to my resiliency to make me wanna continue working on being healthy with diabetes, and, um, pushing through those days that are hard because even. I don’t, you know, no matter what your therapy is, there’s going to be hard days, with diabetes.
But, uh, these glimmers of hope are, they’re very, very helpful in that, in that journey.
[00:08:40] Dr. William Polonsky: I hope this is more than a glimmer. This is big. Um, and again, it’s not just, you know, here, it’s, this is happening all over the world. I should add one thing I didn’t mention about this study, and they really get into the weeds here. But they also talk about this other metric called disability-adjusted life years, which we also see in this global population, has also dropped over this 30 year period.
And disability-adjusted life years is a fancy way of saying, not only are people with type 1 more likely to live long, long lives, but again, long, healthy lives. In other words, the years living with severe disabilities, right, with being on dialysis, you know, having, losing your vision, that’s beginning to decrease as well as we look in these large, large populations.
That’s just the average, though. That’s not everybody. It doesn’t mean bad things aren’t still happening to folks. But it does mean things are moving in a really positive direction and what isn’t, they weren’t able to take from their data, but we know from other data is that what this means is that one will know one everyone knows watching this now as type one, that again, by engaging with your own diabetes care, you can, you can be one of these folks.
You can hang out with Scott when he is 90 years old and hang out with him and his great-grandchildren, wondering where they’re going be going hiking next. Um, we expect to hear more and more about good news. As, these data, as these continue over the years and we want to do our best to make that possible and even more likely for folks.
[00:10:12] Scott K. Johnson: Very, a very good example of, uh, evidence-based hope, which is, I know, important to me and very important to both of you. Anything else to add, or are we ready to send this one home on a, on such a nice, positive note?
[00:10:26] Dr. William Polonsky: I don’t need to belabor any longer than it is. It’s nice and brief and it gets to the point that we want everybody to know. So I think we’re there, Scott.
[00:10:33] Scott K. Johnson: All right, great. Well, big thanks to everyone watching and of course, as always, thanks to both of you for, um, highlighting some of this hopeful news. It’s, it’s very refreshing, uh, to talk about such positive news and, um, I hope that we can continue our streak for many, many years to come, uh, healthy years with diabetes.
So, thank you and we will see you next time.
