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Toschi E, O’Neal D, Munshi M, Jenkins A. Glucose Targets Using Continuous Glucose Monitoring Metrics in Older Adults With Diabetes: Are We There Yet? J Diabetes Sci Technol 2024; 18:808-818. [PMID: 38715259 PMCID: PMC11307211 DOI: 10.1177/19322968241247568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
The older population is increasing worldwide and up to 30% of older adults have diabetes. Older adults with diabetes are at risk of glucose-related acute and chronic complications. Recently, mostly in type 1 diabetes (T1D), continuous glucose monitoring (CGM) devices have proven beneficial in improving time in range (TIR glucose, 70-180 mg/dL or glucose 3.9-10 mmol/L), glycated hemoglobin (HbA1c), and in lowering hypoglycemia (time below range [TBR] glucose <70 mg/dL or glucose <3.9 mmol/L). The international consensus group formulated CGM glycemic targets relating to older adults with diabetes based on very limited data. Their recommendations, based on expert opinion, were aimed at mitigating hypoglycemia in all older adults. However, older adults with diabetes are a heterogeneous group, ranging from healthy to very complex frail individuals based on chronological, biological, and functional aging. Recent clinical trial and real-world data, mostly from healthy older adults with T1D, demonstrated that older adults often achieve CGM targets, including TIR recommended for non-vulnerable groups, but less often meet the recommended TBR <1%. Existing data also support that hypoglycemia avoidance may be more strongly related to minimization of glucose variability (coefficient of variation [CV]) rather than lower TIR. Very limited data are available for glucose goals in older adults adjusted for the complexity of their health status. Herein, we review the bidirectional associations between glucose and health status in older adults with diabetes; use of diabetes technologies, and their impact on glucose control; discuss current guidelines; and propose a new set of CGM targets for older adults with insulin-treated diabetes that are individualized for health and living status.
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Affiliation(s)
- Elena Toschi
- Joslin Diabetes Center, Harvard Medical
School, Boston, MA, USA
| | - David O’Neal
- Department of Medicine, St Vincent’s
Hospital, The University of Melbourne, Melbourne, VIC, Australia
- Department of Diabetes and
Endocrinology, St Vincent’s Hospital, Melbourne, VIC, Australia
- Australian Centre for Accelerating
Diabetes Innovations, The University of Melbourne, Melbourne, VIC, Australia
| | - Medha Munshi
- Joslin Diabetes Center, Harvard Medical
School, Boston, MA, USA
| | - Alicia Jenkins
- Department of Medicine, St Vincent’s
Hospital, The University of Melbourne, Melbourne, VIC, Australia
- Department of Diabetes and
Endocrinology, St Vincent’s Hospital, Melbourne, VIC, Australia
- Australian Centre for Accelerating
Diabetes Innovations, The University of Melbourne, Melbourne, VIC, Australia
- Baker Heart & Diabetes Institute,
Melbourne, VIC, Australia
- Faculty of Medicine, Monash University,
Melbourne, VIC, Australia
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Yang K, Yang X, Jin C, Ding S, Liu T, Ma B, Sun H, Zhang J, Li Y. Global burden of type 1 diabetes in adults aged 65 years and older, 1990-2019: population based study. BMJ 2024; 385:e078432. [PMID: 38866425 PMCID: PMC11167563 DOI: 10.1136/bmj-2023-078432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 06/14/2024]
Abstract
OBJECTIVES To estimate the burden, trends, and inequalities of type 1 diabetes mellitus (T1DM) among older adults at global, regional, and national level from 1990 to 2019. DESIGN Population based study. POPULATION Adults aged ≥65 years from 21 regions and 204 countries and territories (Global Burden of Disease and Risk Factors Study 2019)from 1990 to 2019. MAIN OUTCOME MEASURES Primary outcomes were T1DM related age standardised prevalence, mortality, disability adjusted life years (DALYs), and average annual percentage change. RESULTS The global age standardised prevalence of T1DM among adults aged ≥65 years increased from 400 (95% uncertainty interval (UI) 332 to 476) per 100 000 population in 1990 to 514 (417 to 624) per 100 000 population in 2019, with an average annual trend of 0.86% (95% confidence interval (CI) 0.79% to 0.93%); while mortality decreased from 4.74 (95% UI 3.44 to 5.9) per 100 000 population to 3.54 (2.91 to 4.59) per 100 000 population, with an average annual trend of -1.00% (95% CI -1.09% to -0.91%), and age standardised DALYs decreased from 113 (95% UI 89 to 137) per 100 000 population to 103 (85 to 127) per 100 000 population, with an average annual trend of -0.33% (95% CI -0.41% to -0.25%). The most significant decrease in DALYs was observed among those aged <79 years: 65-69 (-0.44% per year (95% CI -0.53% to -0.34%)), 70-74 (-0.34% per year (-0.41% to -0.27%)), and 75-79 years (-0.42% per year (-0.58% to -0.26%)). Mortality fell 13 times faster in countries with a high sociodemographic index versus countries with a low-middle sociodemographic index (-2.17% per year (95% CI -2.31% to -2.02%) v -0.16% per year (-0.45% to 0.12%)). While the highest prevalence remained in high income North America, Australasia, and western Europe, the highest DALY rates were found in southern sub-Saharan Africa, Oceania, and the Caribbean. A high fasting plasma glucose level remained the highest risk factor for DALYs among older adults during 1990-2019. CONCLUSIONS The life expectancy of older people with T1DM has increased since the 1990s along with a considerable decrease in associated mortality and DALYs. T1DM related mortality and DALYs were lower in women aged ≥65 years, those living in regions with a high sociodemographic index, and those aged <79 years. Management of high fasting plasma glucose remains a major challenge for older people with T1DM, and targeted clinical guidelines are needed.
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Affiliation(s)
- Kaijie Yang
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, First Hospital of China Medical University, Shenyang, China
| | - Xue Yang
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, First Hospital of China Medical University, Shenyang, China
| | - Chenye Jin
- Department of Rheumatology and Immunology, First Hospital of China Medical University, Shenyang, China
| | - Shuangning Ding
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, First Hospital of China Medical University, Shenyang, China
| | - Tingting Liu
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, First Hospital of China Medical University, Shenyang, China
| | - Bing Ma
- Department of Clinical Epidemiology and Evidence-based Medicine, First Hospital of China Medical University, Shenyang, China
| | - Hao Sun
- Department of Clinical Epidemiology and Evidence-based Medicine, First Hospital of China Medical University, Shenyang, China
| | - Jing Zhang
- School of Public Health, Shenzhen University Medical School, Shenzhen, China
| | - Yongze Li
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, First Hospital of China Medical University, Shenyang, China
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Zhang X, Zhu Z, Tang G. Global prevalence of erectile dysfunction and its associated risk factors among men with type 1 diabetes: a systematic review and meta-analysis. Int J Impot Res 2024; 36:365-374. [PMID: 38396263 DOI: 10.1038/s41443-024-00855-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 02/09/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024]
Abstract
Various observational studies have examined the prevalence and determinants of erectile dysfunction (ED) in men with type 1 diabetes across different geographical areas. Nevertheless, a comprehensive systematic review and meta-analysis to consolidate the worldwide prevalence and risk factors remains lacking. Hence, the primary study objective was to perform an extensive systematic review and meta-analysis that specifically examined ED prevalence and determinants in men with type 1 diabetes. A thorough exploration was conducted by examining electronic databases, such as PubMed, Embase, and Web of Science. The general ED prevalence and a 95% confidence interval (CI) in men with type 1 diabetes were summarized. The relevant risk factors were analyzed by deriving a comprehensive odds ratio (OR) from merging the ORs using fixed- or random-effects models. The sources of heterogeneity were investigated using subgroup analyses and meta-regression. This systematic review and meta-analysis included 19 articles involving 3788 men with type 1 diabetes. The meta-analysis revealed that men with type 1 diabetes had a combined ED prevalence of 42.5% (95% CI: 34.3%-50.8%). This prevalence showed significant heterogeneity (I2 = 96.2%, P < 0.01). Meta-regression revealed that age (P = 0.016) and type 1 diabetes duration (P = 0.004) were significant causes of heterogeneity. Furthermore, the ED risk in men with type 1 diabetes was significantly influenced by age, type 1 diabetes duration, body mass index, glycated hemoglobin (HbA1c), retinopathy, and smoking habits (all P < 0.05). In summary, this systematic review and meta-analysis revealed a significant prevalence of ED in men with type 1 diabetes, highlighting the importance of clinicians addressing concerns regarding ED in this specific group of individuals.
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Affiliation(s)
- Xiaolong Zhang
- Department of Urology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Zhirong Zhu
- Department of Urology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Guiliang Tang
- Department of Urology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China.
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González-Vidal T, Rivas-Otero D, Agüeria-Cabal P, Ramos-Ruiz G, Delgado E, Menéndez-Torre E. Continuous Glucose Monitoring Alarms in Adults with Type 1 Diabetes: User Characteristics and the Impact of Hypoglycemia and Hyperglycemia Alarm Thresholds on Glycemic Control. Diabetes Technol Ther 2024; 26:313-323. [PMID: 38156962 DOI: 10.1089/dia.2023.0460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Background: Few studies have evaluated the implications of the alarm thresholds of continuous glucose monitoring (CGM) systems for individuals with diabetes. The present study aimed to investigate the influence of hypoglycemia and hyperglycemia alarm thresholds on glycemic control in adults with type 1 diabetes (T1DM) and the characteristics of patients who use these alarms more frequently. Methods: This observational cross-sectional study included 873 users of the FreeStyle Libre 2 system (501 men, median age 48 years, range 18-90 years) with T1DM from a single center. We investigated the role of demographic and metabolic factors on the use of alarms and the impact of hypoglycemia and hyperglycemia alarms and their thresholds on glycemic control. Results: Alarm users were older than nonusers (median age 49 vs. 43 years, respectively; P < 0.001). The hypoglycemia alarms were set by 76.1% of women and by 69.1% of men (P = 0.022). The hypoglycemia alarms reduced hypoglycemia features and glucose variability, although at the expense of shorter time in range. The higher the hypoglycemia alarm threshold, the greater these effects. The hyperglycemia alarms were effective in reducing hyperglycemia and lowering the glucose management indicator, although at the expense of a greater tendency to hypoglycemia. The lower the hyperglycemia alarm threshold, the greater these effects. Conclusions: CGM alarms contribute to better glycemic control. However, hypoglycemia and hyperglycemia alarms have advantages and disadvantages. Adults with T1DM should explore, under medical supervision, which alarm thresholds will best help them achieve their individual glycemic goals.
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Affiliation(s)
- Tomás González-Vidal
- Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias/University of Oviedo, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Diego Rivas-Otero
- Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias/University of Oviedo, Oviedo, Spain
| | - Pablo Agüeria-Cabal
- Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias/University of Oviedo, Oviedo, Spain
| | - Guillermo Ramos-Ruiz
- Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias/University of Oviedo, Oviedo, Spain
| | - Elías Delgado
- Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias/University of Oviedo, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Department of Medicine, University of Oviedo, Oviedo, Spain
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Edelmiro Menéndez-Torre
- Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias/University of Oviedo, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Department of Medicine, University of Oviedo, Oviedo, Spain
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
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