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Chua YCE, Lin YC, Lew JK, Wong SKW, Soon WSW, Wan J, Abdin E, Subramaniam M, Tang WE, Lee ES. Prevalence and risk factors of depression and anxiety in primary care. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2024; 53:293-305. [PMID: 38920221 DOI: 10.47102/annals-acadmedsg.2023195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Introduction Anxiety and depressive disorders are highly prevalent mental health conditions worldwide. However, little is known about their specific prevalence in primary care settings. This study aimed to determine the prevalence of depression and anxiety in the primary care population and identify associated patient characteristics. Method We conducted a cross-sectional study using stratified sampling by age with a self-administered questionnaire survey in Singapore's National Health-care Group Polyclinics from December 2021 to April 2022. A total score of Patient Health Questionnaire-9 (PHQ-9) ≥10 represents clinical depression, and a total score of Generalised Anxiety Disorder-7 (GAD-7) ≥10 indicates clinical anxiety. Multivariable logistic regression was used to identify the factors associated with depression and anxiety. Results A total of 5694 patients were approached and 3505 consented to the study (response rate=61.6%). There was a higher prevalence of coexisting clinical depression and anxiety (DA) (prevalence=5.4%) compared to clinical depression only (3.3%) and clinical anxiety only (1.9%). The odds of having DA were higher among those aged 21-39 years (odds ratio [OR] 13.49; 95% confidence interval [CI] 5.41-33.64) and 40-64 years (OR 2.28; 95% CI 1.03-5.03) compared to those ≥65 years. Women had higher odds of having DA (OR 2.33; 95% CI 1.54-3.50) compared to men. Respondents with diabetes had higher odds of having DA (OR 1.78; 95% CI 1.07-2.94) compared to those without diabetes. Conclusion Coexisting clinical depression and anxiety are significantly present in the primary care setting, especially among younger individuals, patients with diabetes and women. Mental health screening programmes should include screening for both depression and anxiety, and target these at-risk groups.
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Affiliation(s)
| | - Yijun Carol Lin
- Psychology Services, National Healthcare Group Polyclinics, Singapore
| | - Jeremy Kaiwei Lew
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore
| | | | | | - Jinhui Wan
- Woodlands Polyclinic, National Healthcare Group Polyclinics, Singapore
| | | | | | - Wern Ee Tang
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore
| | - Eng Sing Lee
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Kozela M, Matras A, Koziara K, Małecki MT, Pająk A. Prior Diagnosis of Diabetes but Not Its Control is Associated with Higher Depression Score Among Older Individuals. Diabetes Metab Syndr Obes 2023; 16:2051-2059. [PMID: 37441414 PMCID: PMC10335292 DOI: 10.2147/dmso.s403521] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 06/08/2023] [Indexed: 07/15/2023] Open
Abstract
Purpose The study assessed the relationship between prior diagnosis of diabetes and its control with depression score, differences in socioeconomic, lifestyle, health characteristics and diabetes control by adherence to treatment in population-based sample of older individuals. Patients and Methods The analysis of the sub-sample of Polish cohort of the HAPIEE (Health, Alcohol, and Psychosocial Factors in Eastern Europe) study was conducted; 464 participants were interviewed and random first 360 (78%) underwent physical examination and blood sample tests. Depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale. The robust regression method was applied to assess the association between depression score and diabetes diagnosis as well as diabetes control. Results There were 97 participants (21.0%) at mean age of 73.6 years (SD=6.31 years) with prior diagnosis of diabetes. Mean HbA1c concentration was 6.65% (SD=1.0) The majority of patients (55.7%) used oral medication with diet. Nearly 20% declared the use of oral treatment alone, and 10.3% used combined treatment of oral medications, insulin, and diet. In this study, 86.6% of the participants with diabetes confirmed self-monitoring of blood glucose levels and 58.8% were on high-quality diet. No differences in socioeconomic, lifestyle, health characteristics or control of diabetes by adherence to diabetes treatment were found. After adjustment for age and gender, diagnosis of diabetes was associated with greater depressive score by about 2 points (β=2.02, 95% CI=0.16;3.88). However, no significant association between depression score and any indicator of diabetes control was found. Conclusion In older individuals with diabetes, depression score was higher compared to those without diabetes, but it was not related to poorer diabetes control. No differences in socioeconomic, lifestyle, health characteristics and control of diabetes by adherence to diabetes treatment may suggest that in this age group some other, less known factors are substantial for achievement of treatment targets.
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Affiliation(s)
- Magdalena Kozela
- Department of Epidemiology and Population Studies, Institute of Public Health Jagiellonian University Medical College, Krakow, Poland
| | - Agnieszka Matras
- Department of Epidemiology and Population Studies, Institute of Public Health Jagiellonian University Medical College, Krakow, Poland
| | - Karolina Koziara
- Department of Epidemiology and Population Studies, Institute of Public Health Jagiellonian University Medical College, Krakow, Poland
| | - Maciej T Małecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Andrzej Pająk
- Department of Epidemiology and Population Studies, Institute of Public Health Jagiellonian University Medical College, Krakow, Poland
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Kalra S, Dhar M, Afsana F, Aggarwal P, Aye TT, Bantwal G, Barua M, Bhattacharya S, Das AK, Das S, Dasgupta A, Dhakal G, Dhingra A, Esfahanian F, Gadve S, Jacob J, Kapoor N, Latheef A, Mahadeb Y, Maskey R, Naseri W, Ratnasingam J, Raza A, Saboo B, Sahay R, Shah M, Shaikh S, Sharma SK, Shrestha D, Somasundaram N, Tiwaskar M, Jawdekar A. Asian Best Practices for Care of Diabetes in Elderly (ABCDE). Rev Diabet Stud 2022; 18:100-134. [PMID: 35831938 PMCID: PMC10044048 DOI: 10.1900/rds.2022.18.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The elderly population with diabetes is diverse with the majority experiencing a decline in physical and mental capabilities, impacting the entire diabetes management process. Therefore, a need for geriatric-specific guidelines, especially for the Asian population, was identified and
subsequently developed by an expert panel across government and private institutions from several Asian countries. The panel considered clinical evidence (landmark trials, position papers, expert opinions), recommendations from several important societies along with their decades of clinical
experience and expertise, while meticulously devising thorough geriatric-specific tailored management strategies. The creation of the ABCDE best practices document underscores and explores the gaps and challenges and determines optimal methods for diabetes management of the elderly population
in the Asian region.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Sambit Das
- Dr.Sambit's Centre of Diabetes and Endocrinology, India
| | | | | | | | | | | | | | | | - Ali Latheef
- National Diabetes Centre, Indira Gandhi Memorial, India
| | | | | | | | | | - Abbas Raza
- Shaukat Khanum Cancer Hospital and Research Centre, Pakistan
| | - Banshi Saboo
- Diabetes Care and Hormone Clinic, Ahmedabad, India
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Tiainen K, Raitanen J, Strandberg T, Koskinen S, Stenholm S. Type 2 Diabetes as a Predictor of Muscle Strength Decline over 11 years among Men and Women Aged 55 Years and Older. Gerontology 2021; 68:635-643. [PMID: 34818235 DOI: 10.1159/000518268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 07/04/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Long-term associations between type 2 diabetes, prediabetes, and muscle strength are obscure in older adults. The aim of this study was to examine type 2 diabetes as a predictor of handgrip strength decline during an 11-year follow-up among men and women aged 55 years. METHODS We used Finnish population-based Health 2000 Survey and its follow-up measurements in 2011. The study population consisted of 1,200 individuals, aged 55-86 years at baseline. Baseline fasting glucose level or use of diabetes medication was used to categorize the participants into diabetes (≥7.0 mmol/L), prediabetes (≥6.1 mmol/L but <7.0 mmol/L), and nondiabetes (<6.1 mmol/L) groups. Handgrip strength was measured at baseline and during 11-year follow-up. RESULTS Mean handgrip strength at baseline did not differ between diabetes groups in men or women. Among men during the 11-year follow-up, decline in muscle strength was significantly greater among diabetes group (-131.5 Newtons [N], 95% confidence interval (CI) -182.7 to -80.4) than nondiabetes group (-98.9 N, 95% CI -139.5 to -58.3) after adjusting for age, education, lifestyle factors, chronic conditions, and diabetes status at follow-up. Among women, muscle strength decline did not differ between diabetes, prediabetes, or nondiabetes groups after adjusting for all potential covariates, the results being -45.0 N (95% CI -73.2 to -16.7), -29.4 N (95% CI -59.7 to 0.9), and -42.3 N (95% CI -70.5 to -14.1), respectively. CONCLUSIONS The presence of type 2 diabetes was associated with greater muscle strength decline among older men but not among older women.
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Affiliation(s)
- Kristina Tiainen
- Faculty of Social Sciences, Unit of Health Sciences and Gerontology Research Center, Tampere University, Tampere, Finland
| | - Jani Raitanen
- Faculty of Social Sciences, Unit of Health Sciences and Gerontology Research Center, Tampere University, Tampere, Finland.,UKK Institute for Health Promotion Research, Tampere, Finland
| | - Timo Strandberg
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Clinicum, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Seppo Koskinen
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Sari Stenholm
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
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Jia Y, Liu R, Tang S, Zhang D, Wang Y, Cong L, Hou T, Ren J, Du Y. Associations of the Glycaemic Control of Diabetes with Dementia and Physical Function in Rural-Dwelling Older Chinese Adults: A Population-Based Study. Clin Interv Aging 2021; 16:1503-1513. [PMID: 34413638 PMCID: PMC8370580 DOI: 10.2147/cia.s319633] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/28/2021] [Indexed: 12/14/2022] Open
Abstract
Purpose To examine the associations of impaired fasting glucose (IFG) and glycaemic control of diabetes with dementia, global cognitive function and physical function among rural-dwelling Chinese older adults. Patients and Methods This population-based cross-sectional study included 4583 participants (age ≥65 years, 57.3% women) living in Yanlou Town, Yanggu County, western Shandong Province, China. In 2018, data were collected through interviews, clinical examinations, neuropsychological tests, and laboratory tests. Diabetes status was defined by self-reported physician-diagnosed diabetes, current use of antidiabetic agents, and fasting blood glucose tests. Global cognitive function was assessed using the Mini-Mental State Examination. Dementia was diagnosed following DSM-IV criteria, and Alzheimer's disease (AD) was diagnosed following the National Institute on Aging-Alzheimer's Association criteria. Physical function was assessed by the Short Physical Performance Battery. Data were analysed using multiple logistic and general linear regression models. Results IFG was found in 267 participants, and diabetes was diagnosed in 658 participants (257 with well-controlled diabetes, 401 with poorly controlled diabetes). Dementia was diagnosed in 166 participants (116 with AD), and physical functional impairment was found in 1973 participants. The multi-adjusted odds ratio (OR) of dementia associated with poorly controlled diabetes (vs without IFG or diabetes) was 2.41 (95% CI 1.52-3.84), and the OR of AD associated with poorly controlled diabetes was 2.32 (1.34-4.04). In addition, the adjusted OR of physical functional impairment was 1.40 (1.06-1.85) for well-controlled diabetes and 1.69 (1.35-2.12) for poorly controlled diabetes. However, IFG was not associated with cognitive or physical function. Conclusion The glycaemic control status of diabetes patients was associated with cognitive impairment and physical functional impairment.
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Affiliation(s)
- Yanhong Jia
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China.,Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China.,Department of Neurology, Baotou Central Hospital, Baotou, Inner Mongolia, People's Republic of China
| | - Rui Liu
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Shi Tang
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China.,Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China.,Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, Shandong, People's Republic of China
| | - Dongming Zhang
- Department of General Surgery, Baotou Central Hospital, Baotou, Inner Mongolia, People's Republic of China
| | - Yongxiang Wang
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China.,Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China.,Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, Shandong, People's Republic of China
| | - Lin Cong
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China.,Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China.,Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, Shandong, People's Republic of China
| | - Tingting Hou
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China.,Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China.,Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, Shandong, People's Republic of China
| | - Juan Ren
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Yifeng Du
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China.,Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China.,Shandong Provincial Clinical Research Center for Neurological Diseases, Jinan, Shandong, People's Republic of China
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Seah SJ, Zheng H, Lim RBT. Efficacy of community-based self-care interventions to improve biophysical, psychosocial or behavioural outcomes among community-dwelling older adults with type 2 diabetes: A systematic review and meta-analysis. Diabetes Res Clin Pract 2020; 169:108411. [PMID: 32898575 DOI: 10.1016/j.diabres.2020.108411] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/23/2020] [Accepted: 08/27/2020] [Indexed: 01/04/2023]
Abstract
AIMS This review assessed the efficacy of self-care interventions to improve biophysical, psychosocial or behavioural outcomes among older adults with diabetes. METHODS Computerised and manual searches were performed. A total of 18 randomised control trials were included in the review, of which eight were subsequently included in the meta-analysis. RESULTS Most studies were from the United States of America and adopted a collaborative approach with participants. The specific needs of older adults were often not considered, and there was a predominance of biophysical measures. Meta-analysis revealed that among intervention condition participants, there were improvements in HbA1c (pooled weighted mean difference (WMD) -0.33, 95%CI -0.48 to -0.17), systolic blood pressure (WMD -1.55, 95%CI -2.93 to -0.18), diastolic blood pressure (WMD -1.41 95%CI -2.08 to -0.20), triglyceride (WMD -13.25, 95%CI -23.31 to -3.20), high-density lipoprotein (WMD 2.05, 95%CI 1.04 to 3.06) and Diabetes Self-Care Activities score (mean 4.10, 95%CI 3.11 to 5.10) compared to the control group. There was no significant change for low-density lipoprotein (WMD -5.93, 95%CI -12.08 to 0.22). CONCLUSIONS While continuing to adopt a collaborative approach, future self-care interventions should incorporate psychosocial and behavioural outcomes, consider the specific needs of older adults, and focus on more ethnically diverse populations.
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Affiliation(s)
- Siang Joo Seah
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore 117549, Singapore City, Singapore.
| | - Huili Zheng
- Health Promotion Board, Singapore, 3 Second Hospital Ave, Singapore 168937, Singapore City, Singapore.
| | - Raymond Boon Tar Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore 117549, Singapore City, Singapore.
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Abstract
Diabetes risk increases with age due to changes in β-cell function and increased insulin resistance and is one of the most common chronic medical conditions in the elderly. Diabetes management in this population requires a multidisciplinary, patient-centric approach due to wide heterogeneity in patients' health and functional capacities. Meticulous assessment of each patient before formulating a regimen and thorough patient education are keys to success in achieving glycemic goals, which should be individualized. Lifestyle modification is recommended for every patient.
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Affiliation(s)
- Zehra Tekin
- Endocrinology, Diabetes and Metabolism Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, F-20, Cleveland, OH 44195, USA
| | - Robert S Zimmerman
- Endocrinology, Diabetes and Metabolism Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, F-20, Cleveland, OH 44195, USA.
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Li J, Pan J, Li B, Tian H, Zhu Y, Liao Z, Kou L, Tang C, Wang M, Ye G, Wang M. Positive correlation between cognitive impairment and renal microangiopathy in patients with type 2 diabetic nephropathy: a multicenter retrospective study. J Int Med Res 2018; 46:5040-5051. [PMID: 30208748 PMCID: PMC6300957 DOI: 10.1177/0300060518789299] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objective This study was performed to explore the correlation between cognitive impairment and renal microangiopathy in patients with type 2 diabetic nephropathy (T2DN) by detecting changes in cognitive function and cerebral metabolism in these patients with different stages of T2DN. Methods Prospectively maintained databases were reviewed from 2006 to 2017. Blood biochemical indexes and the urinary albumin excretion rate (UAER) were measured in all participants. Cognitive function was assessed by the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment Scale (MoCA). Cognitive impairment was the primary endpoint. Renal microangiopathy was the secondary endpoint. Pearson correlation analysis was used to assess correlations. Results Two hundred sixteen patients with type 2 diabetes mellitus (T2DM) were divided into three groups according to their UAER: T2DM without nephropathy (n=72), early T2DM with nephropathy (n=74), and the clinical stage of early T2DM with nephropathy (n=70). Healthy participants were selected as the normal control group (n=70). Pearson correlation analysis demonstrated that the total MMSE and MoCA score was negatively correlated with the UAER (r=−0.327) and positively correlated with the estimated glomerular filtration rate (r=0.428) in patients with T2DN. Conclusions The present study showed a positive correlation between cognitive impairment and renal microangiopathy in patients with T2DN.
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Affiliation(s)
- Jinyu Li
- 1 The First College of Clinical Medical Science, China Three Gorges University, Yichang Central People's Hospital, Yichang, China
| | - Jiamin Pan
- 2 Ultrasonography Department, The First Affiliated Hospital of Sun Yat-sen University, Huangpu District, Guangzhou, China
| | - Bohan Li
- 3 Department of Microsurgery, Trauma and Hand Surgery, The First Affiliated Hospital of Sun Yat-sen University, Yuexiu District, Guangzhou, China
| | - Huiyu Tian
- 4 Intensive Care Unit, the First Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Ying Zhu
- 5 Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Yuexiu District, Guangzhou, China
| | - Zhihao Liao
- 6 Department of Microsurgery and Hand Surgery, The Third Affiliated Hospital of Guangzhou University of Traditional Chinese, Guangzhou, China
| | - Li Kou
- 7 Department of neurology, The Fifth Affiliated Hospital of The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Chaogang Tang
- 7 Department of neurology, The Fifth Affiliated Hospital of The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Mingwei Wang
- 8 Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Guoqiang Ye
- 6 Department of Microsurgery and Hand Surgery, The Third Affiliated Hospital of Guangzhou University of Traditional Chinese, Guangzhou, China
| | - Ming Wang
- 1 The First College of Clinical Medical Science, China Three Gorges University, Yichang Central People's Hospital, Yichang, China
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9
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Gu YJ, He CH, Li S, Zhang SY, Duan SY, Sun HP, Shen YP, Xu Y, Yin JY, Pan CW. Tea consumption is associated with cognitive impairment in older Chinese adults. Aging Ment Health 2018. [PMID: 28636413 DOI: 10.1080/13607863.2017.1339779] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To explore the association between tea consumption and cognitive impairment (CoI). METHODS 4579 adults (≥60 years) from the Weitang Geratric Diseases Study were assessed for characteristics of tea consumption and cognitive function by administering questionnaires and the Abbreviated Mental Test (AMT), respectively. We divided the subjects into normal cognitive function group (AMT score ≥8) and CoI group (AMT score ≤7). The association between tea consumption and risk of CoI was determined by logistic regression models. RESULTS The least-squared means of the AMT scores for the subjects who seldom consumed tea were less favorable than those who habitually consumed tea. An inverse association was found between tea consumption (of any type) and prevalence of CoI (odds ratio = 0.74, 95% confidence interval = 0.57-0.98, P = 0.032). Interestingly, the protective correlation of tea was more obvious in never smokers (odds ratio = 0.63), but vanished in current/former smokers (odds ratio = 1.10). In never smokers, frequency of tea consumption was significantly associated with CoI (P for trend = 0.010). CONCLUSION Habitual tea consumption is suggested to be associated with a decreased risk of CoI among elders in Suzhou, and a higher frequency of tea consumption was associated with a lower prevalence of CoI among never smokers.
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Affiliation(s)
- Ying-Jie Gu
- a Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health , Medical College of Soochow University , 199 Ren Ai Road, Suzhou , China.,b School of Basic Medicine , Medical College of Soochow University , 199 Ren Ai Road, Suzhou , China
| | - Chun-Hong He
- a Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health , Medical College of Soochow University , 199 Ren Ai Road, Suzhou , China.,b School of Basic Medicine , Medical College of Soochow University , 199 Ren Ai Road, Suzhou , China
| | - Su Li
- b School of Basic Medicine , Medical College of Soochow University , 199 Ren Ai Road, Suzhou , China
| | - Shu-Yi Zhang
- a Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health , Medical College of Soochow University , 199 Ren Ai Road, Suzhou , China
| | - Sheng-Yu Duan
- c Health supervision institute of Xiangcheng , No.55 Yangchenghu Road, Suzhou , China
| | - Hong-Peng Sun
- a Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health , Medical College of Soochow University , 199 Ren Ai Road, Suzhou , China
| | - Yue-Ping Shen
- a Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health , Medical College of Soochow University , 199 Ren Ai Road, Suzhou , China
| | - Yong Xu
- a Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health , Medical College of Soochow University , 199 Ren Ai Road, Suzhou , China
| | - Jie-Yun Yin
- a Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health , Medical College of Soochow University , 199 Ren Ai Road, Suzhou , China
| | - Chen-Wei Pan
- a Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health , Medical College of Soochow University , 199 Ren Ai Road, Suzhou , China
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10
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Tabesh M, Shaw JE, Zimmet PZ, Söderberg S, Koye DN, Kowlessur S, Timol M, Joonas N, Sorefan A, Gayan P, Alberti KGMM, Tuomilehto J, Magliano DJ. Association between type 2 diabetes mellitus and disability: What is the contribution of diabetes risk factors and diabetes complications? J Diabetes 2018; 10:744-752. [PMID: 29508937 DOI: 10.1111/1753-0407.12659] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 02/18/2018] [Accepted: 02/28/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the association between type 2 diabetes and disability in Mauritius and to assess the extent to which the effect of diabetes is explained by diabetes risk factors and concomitant complications. METHODS Data from a national survey in the multiethnic nation of Mauritius, which comprises South Asians and African Creoles, were analyzed. Disability was measured using the Katz activities of daily living questionnaire in participants aged >50 years. RESULTS Among 3692 participants, 487 (13.2%) had some level of disability. Diabetes was associated with significantly higher risk of disability (odds ratio [OR] 1.67; 95% confidence interval [CI] 1.34-2.08). After adjusting for demographic, behavioral, and metabolic factors, as well as comorbidities, disability was significantly associated with diabetes among African Creoles (OR 2.03; 95% CI 1.16-3.56), but not South Asians (OR 1.27; 95% CI 0.98-1.66). Obesity explained much of the association between diabetes and disability (excess percentage of risk: 26.3% in South Asians and 12.1% in African Creoles). Obesity, history of cardiovascular disease (CVD), asthma-like symptoms, and depression together explained 46.5% and 29.0% of the excess risk in South Asians and African Creoles, respectively. CONCLUSIONS Diabetes is associated with a 67% increased risk of disability. Diabetes risk factors and comorbidities explain more of the association between diabetes and disability among South Asians than Africans. Obesity and history of CVD explained the largest percentage of the relationship between diabetes and disability, indicating that weight and CVD management may be helpful in controlling disability related to diabetes.
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Affiliation(s)
- Maryam Tabesh
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Paul Z Zimmet
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Stefan Söderberg
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Digsu N Koye
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | - Maryam Timol
- Ministry of Health and Quality of Life, Port Louis, Mauritius
| | | | - Ameena Sorefan
- Ministry of Health and Quality of Life, Port Louis, Mauritius
| | - Praneel Gayan
- Ministry of Health and Quality of Life, Port Louis, Mauritius
| | - K George M M Alberti
- Department of Endocrinology and Metabolism, St Mary's Hospital and Imperial College, London, UK
| | - Jaakko Tuomilehto
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
- Dasman Diabetes Institute, Dasman, Kuwait
- Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Dianna J Magliano
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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11
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Fung ACH, Tse G, Cheng HL, Lau ESH, Luk A, Ozaki R, So TTY, Wong RYM, Tsoh J, Chow E, Wing YK, Chan JCN, Kong APS. Depressive Symptoms, Co-Morbidities, and Glycemic Control in Hong Kong Chinese Elderly Patients With Type 2 Diabetes Mellitus. Front Endocrinol (Lausanne) 2018; 9:261. [PMID: 29896155 PMCID: PMC5986894 DOI: 10.3389/fendo.2018.00261] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 05/07/2018] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Undiagnosed depression is an important comorbidity in type 2 diabetes (T2D) which can be detected using the Geriatric Depression Scale (GDS-15) questionnaire. In this cross-sectional study, we examined the associations of depression using GDS score with control of cardiometabolic risk factors and health status in elderly patients with T2D. SETTING AND PARTICIPANTS Between February and December 2013, patients aged ≥65 years who underwent structured comprehensive assessment as a quality improvement program at the Diabetes Center of a teaching hospital were invited to complete the GDS-15 questionnaire. MAIN OUTCOME MEASURES Depression was defined as a GDS score ≥7. Demographic data, prior history of co-morbidities, frequency of self-reported hypoglycemia, and attainment of treatment targets defined as HbA1c, <7%, blood pressure <130/80 mmHg, and LDL-C <2.6 mmol/L were documented. RESULTS Among 325 participants (65% male, median [interquartile range] age: 69 [8] years), 42 (13%) had depression. Patients with depression had longer disease durations (mean ± SD: 15.1 ± 9.1 vs. 11.6 ± 8.1 years, P = 0.02), more frequent self-reported hypoglycemic events (17 vs. 6%, P = 0.03) and were less likely to attain all three treatment targets (0 vs. 16%, P = 0.004) than those without depression. On multivariable analysis, patients with depression had an odds ratio of 2.84 (95% confidence intervals: 1.35-6.00, P = 0.006) of reporting prior history of co-morbidities. CONCLUSION In elderly patients with T2D, depression was not uncommon especially in those with poor control of risk factors, hypoglycemia, and co-morbidities. Inclusion of GDS-15 questionnaire during structured assessment for complications and risk factors can identify these high-risk patients for more holistic management of their physical and mental health.
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Affiliation(s)
- Annie C. H. Fung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Gary Tse
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Hiu Lam Cheng
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Eric S. H. Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Andrea Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Risa Ozaki
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Tammy T. Y. So
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Rebecca Y. M. Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Joshua Tsoh
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Elaine Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Yun Kwok Wing
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Juliana C. N. Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Alice P. S. Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Shatin, Hong Kong
- *Correspondence: Alice P. S. Kong,
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12
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Downer B, Crowe M, Markides KS. Influence of Type II Diabetes and High Depressive Symptoms on the Likelihood for Developing Activities of Daily Living (ADL) Disability and Mortality in Older Puerto Ricans. J Aging Health 2017; 29:1079-1095. [PMID: 28553827 DOI: 10.1177/0898264317708882] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To examine the development of activities of daily living (ADL) disability and mortality according to diabetes and high depressive symptoms among Puerto Rican adults aged 60 and older. METHOD Data came from Wave I and Wave II of the Puerto Rican Elderly: Health Conditions Study ( n = 3,419). Logistic regression was used. Using insulin and receiving psychiatric treatment were proxy measures of disease severity for diabetes and depressive symptoms, respectively. RESULTS High depressive symptoms at baseline were associated with developing ADL disability (OR = 2.21; 95% CI = [1.68, 2.91]). Diabetes at baseline was associated with mortality at follow-up (OR = 1.72; 95% CI = [1.34, 2.19]). Baseline diabetes was associated with developing ADL disability but only for those who reported using insulin (OR = 1.69; 95% CI = [1.08, 2.61]). Participants with comorbid diabetes and high depressive symptoms had the highest odds for developing ADL disability and mortality. DISCUSSION Diabetes and high depressive symptoms are risk factors of developing ADL disability and mortality for older Puerto Ricans.
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Affiliation(s)
- Brian Downer
- 1 University of Texas Medical Branch, Galveston, USA
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13
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Downer B, Rote S, Markides KS, Al Snih S. The Comorbid Influence of High Depressive Symptoms and Diabetes on Mortality and Disability in Mexican Americans Aged 75 and Above. Gerontol Geriatr Med 2016; 2:2333721416628674. [PMID: 27617272 PMCID: PMC5017791 DOI: 10.1177/2333721416628674] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 09/27/2015] [Accepted: 11/02/2015] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To examine the individual and combined effects of depression and diabetes on mortality and disability over 6 years among Mexican Americans aged ≥75. METHOD The final sample included 1,785 participants from the Hispanic Established Population for the Epidemiological Study of the Elderly. Cox proportional hazards regression models were used to estimate the hazard ratios for incidence for mortality and disability according to diabetes and depressive symptoms. RESULTS Diabetics were more likely to become activities of daily living (ADL) disabled Hazard Ratio (HR) = 1.44, 95% confidence interval [CI] = [1.18, 1.77]) and deceased (HR = 1.47, 95% CI = [1.24, 1.74]) compared with non-diabetics. Diabetics reporting high depressive symptomatology were more than two times as likely to become ADL disabled and deceased compared with diabetics not reporting high depressive symptoms. Participants with high depressive symptoms and taking insulin alone or both oral medications and insulin were at the greatest risk of disability (HR = 3.83, 95% CI = [1.66, 8.81]). CONCLUSION Diabetes increases the risk of disability and mortality, especially among Mexican Americans with high depressive symptoms or who are taking insulin alone or both oral medications and insulin. Interventions that are able to reduce the prevalence of depression and diabetes are needed to limit the future burden of disability and mortality in this population.
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Affiliation(s)
- Brian Downer
- University of Texas Medical Branch, Galveston,TX, USA
| | | | | | - Soham Al Snih
- University of Texas Medical Branch, Galveston,TX, USA
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14
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de Rekeneire N, Volpato S. Physical Function and Disability in Older Adults with Diabetes. Clin Geriatr Med 2015; 31:51-65, viii. [DOI: 10.1016/j.cger.2014.08.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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15
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Jagielski AC, Jiang CQ, Xu L, Taheri S, Zhang WS, Cheng KK, Lam TH, Thomas GN. Glycaemia is associated with cognitive impairment in older adults: the Guangzhou Biobank Cohort Study. Age Ageing 2015; 44:65-71. [PMID: 25005262 DOI: 10.1093/ageing/afu088] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS an association between T2DM and cognitive impairment has been reported among Western populations, but data are limited in other settings. We investigated the cross-sectional association between fasting blood glucose (FBG) and cognition in an older Chinese population. METHODS the Guangzhou Biobank Cohort Study included 27,971 individuals (50-96 years, mean age 61.5 years, 72% female) with measures of cognitive function assessed using modified Delayed Word Recall Test (DWRT) and Mini-Mental State Examination (MMSE). Fasting glucose and lipids, and potential confounders were measured. RESULTS after adjustment for potential confounders, the risk for cognitive impairment as measured by DWRT, significantly increased [odds ratio (OR) = 1.18, 95% CI 1.00-1.40] but the association was of borderline significance when measured by MMSE (OR = 1.04, 95% CI 0.73-1.47) in those with diabetes relative to those without diabetes. Fasting blood glucose was significantly negatively associated with cognitive function as measured by DWRT but not MMSE, with an increase of 1 mmol/l of FBG associated with a decrease of 0.02 in DWRT (P < 0.05, 95% CI -0.03 to -0.002) and 0.03 in MMSE score (P = 0.114, 95% CI -0.06-0.01). CONCLUSIONS an FBG level indicative of T2DM was associated with increased risk for cognitive impairment. The findings also demonstrate that glycaemia is continuously associated with cognitive impairment, suggesting that dysfunction is associated with increasing glucose levels even in the normoglycaemic range.
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Affiliation(s)
- A C Jagielski
- Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK Birmingham and Black Country NIHR CLAHRC, Birmingham, UK
| | - C Q Jiang
- Guangzhou Number 12 People's Hospital, Guangzhou, China
| | - L Xu
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - S Taheri
- Birmingham and Black Country NIHR CLAHRC, Birmingham, UK Department of Medicine, Weill Cornell Medical College in New Youk, NY, USA Department of Medicine, Weill Cornell Medical College in Qatar, Doha, Qatar Department of Medicine, King's College London, London, UK
| | - W S Zhang
- Guangzhou Number 12 People's Hospital, Guangzhou, China
| | - K K Cheng
- Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
| | - T H Lam
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - G N Thomas
- Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK Mannheim Medical Faculty, Institute of Public Health, Social and Preventive Medicine, University of Heidelberg, Mannheim 68135, Germany
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16
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Ng X, Quinn CC, Burcu M, Harrington D. Assessment of an Expanded Functional Disability Scale for Older Adults With Diabetes. J Appl Gerontol 2014; 35:529-48. [DOI: 10.1177/0733464814563607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 11/08/2014] [Indexed: 12/26/2022] Open
Abstract
Although prior literature has shown the plausibility of combining the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) items to form an expanded scale for measuring the degree of functional decline, this has not been shown in older adults with diabetes who are disproportionately affected by functional disability. Using the 2009 Medicare Current Beneficiary Survey data, we evaluated the factor structure of the pooled ADL and IADL items. Based on our study comprising 2,158 community-dwelling older adults (≥65 years) with diabetes, the unidimensional model exhibited good fit. Despite well-fitting indices, high correlations were observed between the latent constructs (>.70) of the multi-factor models, suggesting a lack of discriminant validity. These findings provide empirical support for a combined scale that can comprehensively and efficiently characterize the extent of functional disability in older adults with diabetes for research, risk adjustment, and evaluation in patient-centered medical homes.
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Affiliation(s)
- Xinyi Ng
- University of Maryland, Baltimore, USA
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17
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Taheri Tanjani P, Moradinazar M, Esmail Mottlagh M, Najafi F. The prevalence of diabetes mellitus (DM) type II among Iranian elderly population and its association with other age-related diseases, 2012. Arch Gerontol Geriatr 2014; 60:373-9. [PMID: 25623857 DOI: 10.1016/j.archger.2014.11.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Revised: 10/21/2014] [Accepted: 11/23/2014] [Indexed: 11/19/2022]
Abstract
DM type II is one of the most common chronic diseases. The objective of this study is to investigate the prevalence of DM and its association with other age-related diseases in Iran, 2012. In this cross-sectional study, people aged 60 years and over were selected using multistage sampling method. Mini-Nutritional Assessment (MNA), Activity of Daily Living (ADL), and Geriatric Depression Scale (GDS-15 items) questionnaires were used. History of common disorders was taken through self-report, medical records and the results of clinical examinations. A total of 1350 old people were studied. DM type II was found in 297 (22.0%) subjects and 371 (27.5%) of subjects were not aware of their DM status. Hypertension (55.6%), high serum cholesterol (51.8%), malnutrition (40.1%), Alzheimer's disease (16.9%), weight loss within past year (16.1%), weight gain within past year (11.7%), frailty (64.6%), insomnia (50.1%), and vision problems (62.6%) were significantly more common in diabetics. Those who were not aware of their status of DM either were between diabetics and non-diabetics or more similar to non-diabetics. Considering high prevalence of age-related diseases among Iranian elderly people, in particular women and those with DM type II, preventive measures are recommended so as to decrease and control DM type II and its consequent complications.
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Affiliation(s)
- Parisa Taheri Tanjani
- Geriatric Medicine, Department of Internal Medicine, Ayatollah Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Pediatrics Medicine, Jondishapour University of Medical Sciences, Ahvaz, Iran
| | - Mehdi Moradinazar
- Epidemiology, Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Farid Najafi
- Epidemiology, Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Abstract
Diabetes mellitus is a common chronic condition worldwide, especially in the elderly population. Several epidemiologic studies in the last 2 years have consistently associated diabetes with physical disability, a condition that may profoundly affect the quality of life of older people. Although in older people with diabetes, the pathogenesis of functional limitation and disability has not been completely elucidated, it is certainly complex and involves multiple potential pathways. In this narrative review, we described the most recent epidemiologic and clinical evidence supporting the association between diabetes and impaired physical function in older persons focusing on emerging biological mechanisms explaining the excess risk of disability associated with diabetes.
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Affiliation(s)
- Lara Bianchi
- Department of Medical Science, University of Ferrara, Via Savonarola, 9, I-44121, Ferrara, Italy
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Corriere M, Rooparinesingh N, Kalyani RR. Epidemiology of diabetes and diabetes complications in the elderly: an emerging public health burden. Curr Diab Rep 2013; 13:805-13. [PMID: 24018732 PMCID: PMC3856245 DOI: 10.1007/s11892-013-0425-5] [Citation(s) in RCA: 121] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Diabetes in the elderly is a growing public health burden. Persons with diabetes are living longer and are vulnerable to the traditional microvascular and macrovascular complications of diabetes but also at increased risk for geriatric syndromes. Peripheral vascular disease, heart disease, and stroke all have a high prevalence among older adults with diabetes. Traditional microvascular complications such as retinopathy, nephropathy, and neuropathy also frequently occur. Unique to this older population is the effect of diabetes on functional status. Older adults with diabetes are also more likely to experience geriatric syndromes such as falls, dementia, depression, and incontinence. Further studies are needed to better characterize those elderly individuals who may be at the highest risk of adverse complications from diabetes.
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Affiliation(s)
- Mark Corriere
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, 1830 East Monument St, Suite 333, Baltimore, MD, 21287, USA
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Wong E, Backholer K, Gearon E, Harding J, Freak-Poli R, Stevenson C, Peeters A. Diabetes and risk of physical disability in adults: a systematic review and meta-analysis. Lancet Diabetes Endocrinol 2013; 1:106-14. [PMID: 24622316 DOI: 10.1016/s2213-8587(13)70046-9] [Citation(s) in RCA: 273] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND According to previous reports, the risk of disability as a result of diabetes varies from none to double. Disability is an important measure of health and an estimate of the risk of disability as a result of diabetes is crucial in view of the global diabetes epidemic. We did a systematic review and meta-analysis to estimate this risk. METHODS We searched Ovid, Medline, Embase, Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature up to Aug 8, 2012. We included studies of adults that compared the risk of disability-as measured by activities of daily living (ADL), instrumental activities of daily living (IADL), or mobility-in people with and without any type of diabetes. We excluded studies of subpopulations with specific illnesses or of people in nursing homes. From the studies, we recorded population characteristics, how diabetes was diagnosed (by doctor or self-reported), domain and definition of disability, and risk estimates for disability. We calculated pooled estimates by disability type and type of risk estimate (odds ratio [OR] or risk ratio [RR]). RESULTS Our systematic review returned 3224 results, from which 26 studies were included in our meta-analyses. Diabetes increased the risk of mobility disability (15 studies; OR 1.71, 95% CI 1.53-1.91; RR 1.51, 95% CI 1.38-1.64), of IADL disability (ten studies; OR 1.65, 95% CI 1.55-1.74), and of ADL disability (16 studies; OR 1.82, 95% CI 1.63-2.04; RR 1.82, 95% CI 1.40-2.36). INTERPRETATION Diabetes is associated with a strong increase in the risk of physical disability. Efforts to promote healthy ageing should account for this risk through prevention and management of diabetes. FUNDING Monash University, Baker IDI Bright Sparks Foundation, Australian Postgraduate Award, VicHealth, National Health and Medical Research Council, Australian Research Council, Victorian Government.
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Affiliation(s)
- Evelyn Wong
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Kathryn Backholer
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Emma Gearon
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Jessica Harding
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Rosanne Freak-Poli
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | | | - Anna Peeters
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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21
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Malmstrom TK, Morley JE. Frailty and cognition: linking two common syndromes in older persons. J Nutr Health Aging 2013; 17:723-5. [PMID: 24154641 DOI: 10.1007/s12603-013-0395-y] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- T K Malmstrom
- John E. Morley, MB, BCh, Director, Divisions of Geriatric Medicine and Endocrinology, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, Missouri 63104,
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22
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Cognitive impairment and the associated risk factors among the elderly in the Shanghai urban area: a pilot study from China. Transl Neurodegener 2012; 1:22. [PMID: 23210893 PMCID: PMC3546888 DOI: 10.1186/2047-9158-1-22] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 11/21/2012] [Indexed: 11/26/2022] Open
Abstract
Objectives Our study aimed to investigate the prevalence of cognitive impairment(CI) and the associated risk factors among elderly people in Shanghai urban area, China. Methods A population-based survey was conducted among people aged 55 years or older in urban areas of Shanghai. Face-to-face interviews were carried out to collect information including demographic characteristics, medical history, and medication use, etc. The validated Chinese version of the Mini-Mental State Examination(MMSE) was used to screen subjects with CI, and the criteria of CI were adjusted for education levels. Results A total of 3,176 home-living residents (≥55 years old) were included in the study. Among them, 266 people (102 men and 164 women) were identified as cognition impaired, with a prevalence of 8.38% (266/3,176, 95% CI: (8.26, 8.49)) for both genders, 9.21% (102/1,107,95% CI: (9.18, 9.33)) for men and 7.93% (164/2,069, 95% CI: (7.80, 8.09)) for women, respectively. Furthermore, we found that several significant risk factors, including social factors(education, number of children, marriage status, and family structure), physiological factors (age, blood glucose level, and obesity), factors on living styles(physical exercise, diet & chronic diseases), and genetic factor(ApoE), associated with CI onset. Conclusions This study confirms the high prevalence of CI among the elderly population in the Shanghai urban in China, similar to previous epidemiologic studies in Western countries. The putative risk factors associated with CI merit further investigated.
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Wong E, Backholer K, Harding J, Gearon E, Stevenson C, Freak-Poli R, Peeters A. A systematic review and meta-analysis of diabetes and risk of physical disability and functional impairment - protocol. Syst Rev 2012; 1:47. [PMID: 23075379 PMCID: PMC3534584 DOI: 10.1186/2046-4053-1-47] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 10/05/2012] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED BACKGROUND Diabetes and increased age are known risk factors for physical disability. With the increasing prevalence of diabetes within our aging population, the future burden of disability is expected to increase. To date, there has not been a pooled estimate of the risk for disability associated with diabetes or its precursor states, impaired glucose tolerance and impaired fasting glucose. We aim to conduct a systematic review and meta-analysis of the association between prediabetes and diabetes with disability, and quantify the risk of association. METHODS/DESIGN We will search for relevant studies in Medline via Pubmed, Embase, Cochrane library and Cumulative Index to Nursing and Allied Health Literature (CINAHL), as well as scan reference lists from relevant reviews and publications included in our review. We will review all publications that include studies on human adults (18 years and older) where information is included on diabetes status and at least one measure of disability (Activities of Daily Living (ADL), Instrumental ADL (IADL) or functional/mobility limitation), and where a risk association is available for the relationship between diabetes and/or prediabetes with disability, with reference to those without diabetes.We will further conduct a meta-analysis to pool estimates of the risk of disability associated with prediabetes and diabetes. Sensitivity analysis will be conducted to assess for publication bias and study quality.Findings from this systematic review and meta-analysis will be widely disseminated through discussions with stake-holders, publication in a peer-reviewed journal and conference presentation.
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Affiliation(s)
- Evelyn Wong
- Department of Epidemiology & Preventive Medicine, Faculty of Medicine, Nursing & Health Sciences, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, Alfred Hospital, Commercial Road, Melbourne, VIC, 3004, Australia
- BakerIDI Heart and Diabetes Institute, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Kathryn Backholer
- Department of Epidemiology & Preventive Medicine, Faculty of Medicine, Nursing & Health Sciences, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, Alfred Hospital, Commercial Road, Melbourne, VIC, 3004, Australia
- BakerIDI Heart and Diabetes Institute, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Jessica Harding
- BakerIDI Heart and Diabetes Institute, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Emma Gearon
- BakerIDI Heart and Diabetes Institute, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Christopher Stevenson
- School of Health and Social Development, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Rosanne Freak-Poli
- Department of Epidemiology & Preventive Medicine, Faculty of Medicine, Nursing & Health Sciences, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, Alfred Hospital, Commercial Road, Melbourne, VIC, 3004, Australia
- BakerIDI Heart and Diabetes Institute, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Anna Peeters
- Department of Epidemiology & Preventive Medicine, Faculty of Medicine, Nursing & Health Sciences, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, Alfred Hospital, Commercial Road, Melbourne, VIC, 3004, Australia
- BakerIDI Heart and Diabetes Institute, 99 Commercial Road, Melbourne, VIC, 3004, Australia
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Detecting Frailty in Primary Care: A Major Challenge for Primary Care Physicians. J Am Med Dir Assoc 2012; 13:669-72. [DOI: 10.1016/j.jamda.2012.07.015] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 07/27/2012] [Indexed: 11/19/2022]
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25
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Morley JE. Diabetes Mellitus: “The Times They Are A-Changin”. J Am Med Dir Assoc 2012; 13:574-5. [DOI: 10.1016/j.jamda.2012.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 06/08/2012] [Indexed: 12/27/2022]
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