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Aaron Vinik, MD, PhD, FCP, MACP, FACE

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The Endocrinology of Aging:

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Endocrinology Today by Aaron Vinik, MD, PhD, FCP, MACP, FACE


A Key to Healthy Longevity

The average lifespan in the 19th century was 32-33 years but now reaches 78-87 years. Not all people age at the same rate or enjoy the same quality of life. Ultimately we are striving for healthful longevity. Endocrine function is critical for growth, development, reproduction, and hormonal regulation, which are areas of focus in the aging process. It is possible to live to be a centenarian and still be active and engaged. Leading a healthy lifestyle is crucial for such healthy aging. The goal is to improve the “healthspan” and not just “lifespan.” Calorie restriction apparently lowers metabolic rate and may increase longevity coupled with strength and balance training without which there is progressive loss of muscle mass.

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Sarcopenia or a low muscle mass leads to poor function (walking speed or grip strength). The prevalence of sarcopenia varies widely depending on the ethnic and socioeconomic group studied, with prevalence estimates of 5 to 13 percent in persons 60 to 70 years of age, and up to 50 percent in those 80 years of age and older. Sarcopenia leads to frailty, disability, hospitalization, nursing home admission and death. Endocrine issues include obesity, diabetes, a fall in testosterone, reduction in vitamin D, growth hormone, and IGF-1. At present the treatment of choice is a combination of resistance exercise and ingestion of leucine enriched essential aminoacid supplements that improve muscle mass, strength and function.

Falls are a major health issue for older adults. One third of people 65 years old or more will fall every year, and if diabetes coexists there is a 17 fold increase likelihood of falling each year leading to adverse events, even death and a $240 billion annual cost. Older persons with type 2 diabetes are at increased risk of falling compared to healthy adults of a similar age. Over 400 factors are associated with fall risk, making identification and targeting of key factors to prevent falls problematic. However, the major risk factors include hypertension, diabetes, pain and polypharmacy. In addition to age and polypharmacy, diabetes-related loss of strength, sensory perception and balance secondary to peripheral neuropathy along with decline in cognitive function lead to increased risk of falling. Specific interventions target strength and balance training, reducing polypharmacy to improve cognitive function, relaxation of diabetes management to avoid hypoglycemia and hypotension and relief of pain. These produce the greatest benefit for reducing falls in older persons with diabetes.

Given the general association between these variables and falls, being able to identify which measures negatively impact on balance in the elderly with diabetes is a critical step. Moreover, designing specific interventions to target these physiological functions underlying balance and gait control will produce the greatest benefit for reducing falls in older persons with diabetes.

Simple bedside tests to recognize those individuals at risk, what the likely factors are, their motivation to improve their risk and facilitating choices of therapies to reduce the fear of falling are recommended.

Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.
(Dylan Thomas, Botteghe Obscure, 1951)

 In an upcoming issue of the magazine we will address: Osteopenia diagnosis and management in the elderly, male and female gonadal dysfunction and the need for replacement therapy, aging and frailty with the need for modification or management of hyperglycemia, dyslipidemia and hypertension.

Aaron Vinik, MD, PhD, FCP, MACP, FACE
Murray Waitzer Endowed Chair for Diabetes Research
Professor of Medicine, Pathology, Neurobiology
Director of Research and Neuroendocrine Unit
Eastern Virginia Medical School
Strelitz Diabetes Center
Norfolk, VA  23510

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