Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Oct 15;54(5):73.
doi: 10.3390/medicina54050073.

Association Between the Vicious Cycle of Diabetes-Associated Complications and Glycemic Control Among the Elderly: A Systematic Review

Free PMC article

Association Between the Vicious Cycle of Diabetes-Associated Complications and Glycemic Control Among the Elderly: A Systematic Review

Muhammad Atif et al. Medicina (Kaunas). .
Free PMC article


Background and objectives: Improved quality of life (QoL) and life expectancy of elderly diabetic patients revolves around optimal glycemic control. Inadequate glycemic control may lead to the development of diabetes-associated complications (DAC), which not only complicate the disease, but also affect morbidity and mortality. Based on the available literature, the aim was to elucidate the vicious cycle underpinning the relationship between diabetes complications and glycemic control. Materials and Methods: A comprehensive literature search was performed to find eligible studies published between 1 January 2000 and 22 September 2018 pertaining to diabetes complications and glycemic control. Results: Initially, 261 studies were retrieved. Out of these, 67 were duplicates and therefore were excluded. From the 194 remaining articles, 85 were removed based on irrelevant titles and/or abstracts. Subsequently, the texts of 109 articles were read in full and 71 studies were removed at this stage for failing to provide relevant information. Finally, 38 articles were selected for this review. Depression, impaired cognition, poor physical functioning, frailty, malnutrition, chronic pain, and poor self-care behavior were identified as the major diabetes-associated complications that were associated with poor glycemic control in elderly diabetic patients. Conclusions: This paper proposes that diabetes-associated complications are interrelated, and that impaired glycemic control aggravates diabetes complications; as a result, patient's self-care abilities are compromised. A schema is generated to reflect a synthesis of the literature found through the systematic review process. This not only affects patients' therapeutic goals, but may also hamper their health-related quality of life (HRQoL) and financial status.

Keywords: cognition; depression; diabetes; frailty; glycemic control; health related quality of life; healthcare professionals; malnutrition; pain; physical functioning; self-care.

Conflict of interest statement

The authors declare no conflict of interest.


Figure 1
Figure 1
Schematic diagram explaining the assortment of studies/reports (2009 PRISMA flow diagram).
Figure 2
Figure 2
A vicious cycle explaining the relationship between of diabetes associated complications and glycemic control.

Similar articles

See all similar articles

Cited by 4 articles


    1. World Health Organization. Diabetes (Key Facts) [(accessed on 30 June 2016)]; Available online:
    1. Samaras K., Sachdev P.S. Diabetes and the elderly brain: Sweet memories? Ther. Adv. Endocrinol. Metab. 2012;3:189–196. doi: 10.1177/2042018812469645. - DOI - PMC - PubMed
    1. Bourdel Marchasson I., Doucet J., Bauduceau B., Berrut G., Blickle J.F., Brocker P., Constans T., Fagot Campagna A., Kaloustian E., Lassmann Vague V., et al. Key priorities in managing glucose control in older people with diabetes. J. Nutr. Health Aging. 2009;13:685–691. doi: 10.1007/s12603-009-0198-3. - DOI - PubMed
    1. Araki A., Ito H. Diabetes mellitus and geriatric syndromes. Geriatr. Gerontol. Int. 2009;9:105–114. doi: 10.1111/j.1447-0594.2008.00495.x. - DOI - PubMed
    1. Awad N., Gagnon M., Messier C. The relationship between impaired glucose tolerance, type 2 diabetes, and cognitive function. J. Clin. Exp. Neuropsychol. 2004;26:1044–1080. doi: 10.1080/13803390490514875. - DOI - PubMed