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Yang X, Xue C, Chen K, Gao D, Wang H, Tang C. Characteristics of elderly diabetes patients: focus on clinical manifestation, pathogenic mechanism, and the role of traditional Chinese medicine. Front Pharmacol 2024; 14:1339744. [PMID: 38273819 PMCID: PMC10808572 DOI: 10.3389/fphar.2023.1339744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 12/28/2023] [Indexed: 01/27/2024] Open
Abstract
Diabetes mellitus has become a major public health issue globally, putting an enormous burden on global health systems and people. Among all diseased groups, a considerable part of patients are elderly, while their clinical features, pathogenic processes, and medication regimens are different from patients of other ages. Despite the availability of multiple therapies and techniques, there are still numerous elderly diabetes patients suffering from poor blood glucose control, severe complications, and drug adverse effects, which negatively affect the quality of life in their golden years. Traditional Chinese Medicine (TCM) has been widely used in the treatment of diabetes for several decades, and its relevant clinical practice has confirmed that it has a satisfactory effect on alleviating clinical symptoms and mitigating the progression of complications. Chinese herbal medicine and its active components were used widely with obvious clinical advantages by multiple targets and signaling pathways. However, due to the particular features of elderly diabetes, few studies were conducted to explore Traditional Chinese Medicine intervention on elderly diabetic patients. This study reviews the research on clinical features, pathogenic processes, treatment principles, and TCM treatments, hoping to provide fresh perspectives on the prevention and management strategies for elderly diabetes.
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Affiliation(s)
- Xiaofei Yang
- Beijing University of Chinese Medicine, Beijing, China
- Institute of Metabolic Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Chongxiang Xue
- Beijing University of Chinese Medicine, Beijing, China
- Institute of Metabolic Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Keyu Chen
- Institute of Metabolic Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Dongyang Gao
- Institute of Metabolic Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Han Wang
- Beijing University of Chinese Medicine, Beijing, China
| | - Cheng Tang
- Beijing University of Chinese Medicine, Beijing, China
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Asbaghi O, Kashkooli S, Amini MR, Shahinfar H, Djafarian K, Clark CCT, Shab-Bidar S. The effects of L-carnitine supplementation on lipid concentrations inpatients with type 2 diabetes: A systematic review and meta-analysis of randomized clinical trials. J Cardiovasc Thorac Res 2021; 12:246-255. [PMID: 33510873 PMCID: PMC7828761 DOI: 10.34172/jcvtr.2020.43] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 07/27/2020] [Indexed: 12/21/2022] Open
Abstract
This meta-analysis was performed to assess the effect of L-carnitine supplementation on lipid profile. A systematic search were conducted in PubMed and Scopus to identify randomized clinical trials (RCTs) which evaluated the effects of L-carnitine on lipid profile. Pooled effect sizes were measured using random-effect model (Dersimonian-Laird). Meta-analysis showed that L-carnitine supplementation significantly reduced total cholesterol (TC) (weighted mean difference [WMD]: -8.17 mg/dL; 95% CI,-14.68 to -1.65, I2=52.2%, P = 0.041). Baseline level of TC was a source of heterogeneity, with a greater effect in studies with a baseline level of more than 200 mg/d (WMD: -11.93 mg/dL; 95% CI, -20.80 to-3.05). L-carnitine also significantly decreased low-density lipoprotein-cholesterol (LDL-C) (WMD:-5.22 mg/dL; 95% CI, -9.54 to -0.91, I2=66.7%, P = 0.010), and LDL-C level <100 mg/dL), trial duration,and L-carnitine dosage were potential sources of heterogeneity. L-carnitine supplementation appeared to have no significant effect on high-density lipoprotein-cholesterol (HDL-C) (WMD: -0.51 mg/dL;95% CI, -2.45 to 1.44) and triglyceride (TG) (WMD: 2.80 mg/dL; 95% CI, -8.09 to 13.69). This meta-analysisrevealed that L-carnitine may have favorable effects on lipid profile, especially LDL-C and TC. However, further RCTs are needed to confirm the veracity of these results, particularly among hyperlipidemic patients.
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Affiliation(s)
- Omid Asbaghi
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Sara Kashkooli
- Nutritional Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mohammad Reza Amini
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.,Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Hossein Shahinfar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Kurosh Djafarian
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Cain C T Clark
- Centre for Intelligent Healthcare, Coventry University, Coventry, CV15FB, UK
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
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Multi-Omics Analysis of Diabetic Heart Disease in the db/db Model Reveals Potential Targets for Treatment by a Longevity-Associated Gene. Cells 2020; 9:cells9051283. [PMID: 32455800 PMCID: PMC7290798 DOI: 10.3390/cells9051283] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 12/13/2022] Open
Abstract
Characterisation of animal models of diabetic cardiomyopathy may help unravel new molecular targets for therapy. Long-living individuals are protected from the adverse influence of diabetes on the heart, and the transfer of a longevity-associated variant (LAV) of the human BPIFB4 gene protects cardiac function in the db/db mouse model. This study aimed to determine the effect of LAV-BPIFB4 therapy on the metabolic phenotype (ultra-high-performance liquid chromatography-mass spectrometry, UHPLC-MS) and cardiac transcriptome (next-generation RNAseq) in db/db mice. UHPLC-MS showed that 493 cardiac metabolites were differentially modulated in diabetic compared with non-diabetic mice, mainly related to lipid metabolism. Moreover, only 3 out of 63 metabolites influenced by LAV-BPIFB4 therapy in diabetic hearts showed a reversion from the diabetic towards the non-diabetic phenotype. RNAseq showed 60 genes were differentially expressed in hearts of diabetic and non-diabetic mice. The contrast between LAV-BPIFB4- and vehicle-treated diabetic hearts revealed eight genes differentially expressed, mainly associated with mitochondrial and metabolic function. Bioinformatic analysis indicated that LAV-BPIFB4 re-programmed the heart transcriptome and metabolome rather than reverting it to a non-diabetic phenotype. Beside illustrating global metabolic and expressional changes in diabetic heart, our findings pinpoint subtle changes in mitochondrial-related proteins and lipid metabolism that could contribute to LAV-BPIFB4-induced cardio-protection in a murine model of type-2 diabetes.
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Viswanathan M, Ranjit Mohan A, Ranjit U, Prasanna Kumar G, Philips R, Saravanan J, Ulagamathesan V, Ganesan US, Kumaradas GV, Rajendran AK, Thangarajan R, Rajendra P, Coimbatore Subramanian SR. Clinical Profile of Elderly Patients (Over 90 Years) with Type 2 Diabetes Seen at a Diabetes Center in South India. Diabetes Technol Ther 2020; 22:79-84. [PMID: 31638436 DOI: 10.1089/dia.2019.0219] [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] [Indexed: 01/21/2023]
Abstract
Background: The current life expectancy in India is <70 years. Type 2 diabetes mellitus (T2DM) is known to reduce life expectancy by 6-8 years. Hence elderly people with T2DM in India would be rare. We report on the clinical profile of Asian Indian patients with T2DM who lived beyond 90 years of age and compared them with T2DM patients aged 50 to 60 years. Methods: From the diabetes electronic medical records of >470,000 diabetes patients, we identified T2DM patients who had lived ≥90 years and compared them with those in the 50-60 years age group, matched for gender and duration of diabetes. Clinical data included age at last visit, age at diagnosis, duration of diabetes, family history, smoking and alcohol, details of medications, body mass index (BMI), and blood pressure. Biochemical data included fasting and postprandial plasma glucose, glycated hemoglobin, fasting and stimulated C-peptide levels, lipid profile, and renal function studies. Assessment of retinopathy, nephropathy, neuropathy, coronary artery disease (CAD), and peripheral vascular disease (PVD) was also done. Results: A total of 325 T2DM patients aged ≥90 years and 278 T2DM patients aged between 50 and 60 years were selected for the study. Patients aged ≥90 years had higher systolic blood pressure (P < 0.001) and lower BMI (P < 0.001) than those between 50 and 60 years. Prevalence of retinopathy (29.7% vs. 53.5%) and macroalbuminuria (3.7% vs. 16.0%) was lower in the ≥90 years T2DM patients than in the 50-60 years age group. However, prevalence of neuropathy (89.8% vs. 50.8%), PVD (13.5% vs. 2.0%), and CAD (60.3% vs. 32.0%) was higher among the ≥90 years patients. Eighty-five percent of the T2DM aged ≥90 years were on oral hypoglycemic agents (OHAs), (of whom 64.9% were on sulfonylurea), 12% were on insulin, and 3% on diet alone. Among the 50-60 years old, 87.8% were on OHAs and 12.2% on insulin. Conclusions: This is the first report on the clinical profile of Asian Indians with T2DM aged ≥90 years, and significant differences are seen in their clinical profile compared with younger T2DM patients.
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Affiliation(s)
- Mohan Viswanathan
- Madras Diabetes Research Foundation, ICMR Center for Advanced Research on Diabetes, Chennai, India
- Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases Prevention and Control and IDF Centre of Excellence in Diabetes Care, Chennai, India
| | - Anjana Ranjit Mohan
- Madras Diabetes Research Foundation, ICMR Center for Advanced Research on Diabetes, Chennai, India
- Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases Prevention and Control and IDF Centre of Excellence in Diabetes Care, Chennai, India
| | - Unnikrishnan Ranjit
- Madras Diabetes Research Foundation, ICMR Center for Advanced Research on Diabetes, Chennai, India
- Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases Prevention and Control and IDF Centre of Excellence in Diabetes Care, Chennai, India
| | - Gupta Prasanna Kumar
- Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases Prevention and Control and IDF Centre of Excellence in Diabetes Care, Chennai, India
| | - Routary Philips
- Dr. Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases Prevention and Control and IDF Centre of Excellence in Diabetes Care, Chennai, India
| | - Jebarani Saravanan
- Madras Diabetes Research Foundation, ICMR Center for Advanced Research on Diabetes, Chennai, India
| | - Venkatesan Ulagamathesan
- Madras Diabetes Research Foundation, ICMR Center for Advanced Research on Diabetes, Chennai, India
| | - Uma Sankari Ganesan
- Madras Diabetes Research Foundation, ICMR Center for Advanced Research on Diabetes, Chennai, India
| | - Gini Venisha Kumaradas
- Madras Diabetes Research Foundation, ICMR Center for Advanced Research on Diabetes, Chennai, India
| | - Ashok Kumar Rajendran
- Madras Diabetes Research Foundation, ICMR Center for Advanced Research on Diabetes, Chennai, India
| | | | - Pradeepa Rajendra
- Madras Diabetes Research Foundation, ICMR Center for Advanced Research on Diabetes, Chennai, India
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Brenes-Salazar JA, de la Fuente J, Marella P, Chaliki H, Scott C, Connolly HM, Click RL. Echocardiography in centenarians: characteristics, utility and follow-up. J Geriatr Cardiol 2018; 15:328-333. [PMID: 30083185 PMCID: PMC6064771 DOI: 10.11909/j.issn.1671-5411.2018.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 03/13/2018] [Accepted: 03/13/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Echocardiography has been shown to be a valuable resource in the diagnosis of many cardiac conditions, and can be used in all age groups, from the fetus to the oldest old. In the context of an increasingly aging population, the impact and utility of echocardiography in centenarians is largely unknown. This study is to determine whether echocardiography in centenarians aids in making clinical patient management decisions. METHODS A retrospective review of echocardiograms from 1986 to 2014, at two affiliated tertiary centers, in individuals who were 100 years or older at the time of the examination. Patient and echocardiogram characteristics, management decisions based on echocardiography, and mortality were documented. RESULTS 114 centenarians had echocardiograms, with ages ranging from 100 to 107 years (101 ± 1.4 years). In 82 of the centenarians evaluated (72%), no changes in management occurred as a consequence of the echocardiogram. From all management changes directly related to the echocardiogram, 81% (n = 26) of these corresponded to medication adjustments; interventional or surgical procedures followed the echocardiogram only in 4% (n = 5) of the total number of centenarians. Echocardiogram-based changes in management were only significant in patients that were referred for congestive heart failure (P = 0.02). After the echocardiogram was performed, 1-month and 1-year mortality were 15% and 47%, respectively. The median survival after the echocardiogram was obtained was 13 months (range 0.03 to 145 months), with no difference if there was a change or no change in management (P = 0.21). CONCLUSIONS Among centenarians undergoing echocardiography, despite additional diagnostic information, echocardiograms in centenarians influence management in a minority of cases, most commonly in the form of medication changes for treatment of heart failure. A significant proportion of centenarians are deceased within a year of undergoing echocardiographic assessment. These findings may question the overall utility of echocardiography in these late survivors.
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Affiliation(s)
| | | | - Punnaiah Marella
- Department of Cardiovascular Diseases, Mayo Clinic, Arizona, USA
| | - Hari Chaliki
- Department of Cardiovascular Diseases, Mayo Clinic, Arizona, USA
| | | | - Heidi M Connolly
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, USA
| | - Roger L Click
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, USA
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Prevalence and clinical profile of metabolic syndrome in longevity: study from Guangxi Zhuang Autonomous Region, China. BMC Geriatr 2017; 17:169. [PMID: 28760137 PMCID: PMC5537925 DOI: 10.1186/s12877-017-0536-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 07/06/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) was a risk factor for cardiovascular diseases, yet the prevalence of MetS among nonagenarians and centenarians was rarely reported. Here we investigated the prevalence of MetS and its components among nonagenarians and centenarians in our Zhuang population from Bama, Guangxi Zhuang Autonomous Region, China. METHOD In Bama area, there registered 881 individuals who lived more than 90 years old in 269,800 local residents and our study involved 307 long-lived participants and 486 local younger (35-68 years) persons, as controls. MetS was defined according to the revised National Cholesterol Education Program's Adult Treatment Panel III (NCEP ATPIII) criteria. RESULTS The overall prevalence estimates of MetS among longevity group were 28.0% based on NCEP ATPIII criteria. The most common metabolic component was elevated blood pressure (61.1%), followed by raised fasting glucose (39.1%) and low high-density lipoprotein cholesterol (low HDL-C) (28.0%). The prevalence of MetS and abdominal obesity in women (33.6% and 22.1% respectively) was higher than that of men (19.8% and 3.7% respectively) (Prange < .001-0.019). Compared with controls, long-lived individuals were more likely to have two or more metabolic abnormalities (Prange < 0.001), and less likely to have zero or one metabolic abnormality (Prange < 0.001-0.020). CONCLUSION This study showed substantiality the prevalence and clinical profile of MetS in longevity population in Guangxi Zhuang Autonomous Region, China.
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Abstract
The prevalence of both type 2 diabetes and prediabetes increases with advancing age. The most important factors leading to hyperglycaemia are as follows: deficiency of insulin secretion developing with age, and growing insulin resistance caused by a change in body composition and sarcopaenia. Clinical features of diabetes in the elderly could be different. Diabetes in elderly people is often diagnosed with delay due to atypical symptoms (dementia, urinary incontinence) and occurrence of mainly postprandial hyperglycaemia. Elderly people are more exposed to diabetes complications, have more risk of myocardial infarction and end-stage renal disease, and are hospitalised more often due to hypoglycaemia than are younger patients. Elderly people with diabetes are a heterogeneous group with different life expectancy, concomitant of chronic diseases, and the ability to self-control blood glucose or give themselves an injection. The therapy should be individualised. Older people with long-term diabetes and numerous chronic complications need a more liberal approach to reach specific goals of therapy. Additional goals should be avoiding hypoglycaemia, safety of the therapy, and its acceptance by the patient.
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Kwon Y, Kim KJ, Roh YK, Park YG, Park S, Cho KH. Weight Status and All-Cause Mortality in Older Adults: A Study of Patients With Type 2 Diabetes Undergoing Subtotal Gastrectomy for Cancer. Ann Geriatr Med Res 2017. [DOI: 10.4235/agmr.2017.21.2.70] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Yeongkeun Kwon
- Division of Geriatrics, Department of Family Medicine, Korea University College of Medicine, Seoul, Korea
- Center for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, Korea
| | - Kyeong Jin Kim
- Center for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Yong Kyun Roh
- Department of Family Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Yong-Gyu Park
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sungsoo Park
- Center for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, Korea
- Division of Upper Gastrointestinal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Kyung-Hwan Cho
- Division of Geriatrics, Department of Family Medicine, Korea University College of Medicine, Seoul, Korea
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Lee BK, Kim SW, Choi D, Cho EH. Comparison of Age of Onset and Frequency of Diabetic Complications in the Very Elderly Patients with Type 2 Diabetes. Endocrinol Metab (Seoul) 2016; 31:416-423. [PMID: 27586451 PMCID: PMC5053054 DOI: 10.3803/enm.2016.31.3.416] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 05/02/2016] [Accepted: 07/26/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The prevalence of type 2 diabetes in elderly people has increased dramatically in the last few decades. This study was designed to clarify the clinical characteristics of type 2 diabetes in patients aged ≥80 years according to age of onset. METHODS We reviewed the medical records of 289 patients aged ≥80 years with type 2 diabetes at the outpatient diabetes clinics of Kangwon National University Hospital from September 2010 to June 2014. We divided the patients into middle-age-onset diabetes (onset before 65 years of age) and elderly-onset diabetes (onset at 65+ years of age). RESULTS There were 141 male and 148 female patients. The patients had a mean age of 83.2±2.9 years and the mean duration of diabetes was 14.3±10.4 years. One hundred and ninety-nine patients had elderly-onset diabetes. The patients with elderly-onset diabetes had a significantly lower frequency of diabetic retinopathy and nephropathy, lower serum creatinine levels, lower glycated hemoglobin (HbA1c) levels, and similar coronary revascularization and cerebral infarction rates compared to those with middle-age-onset diabetes. There was no frequency difference in coronary revascularization and cerebral infarction and HbA1c levels between three subgroups (<5, 5 to 15, and ≥15 years) of diabetes duration in elderly onset diabetes. However, both in the elderly onset diabetes and middle-age-onset diabetes, the cumulative incidence of retinopathy was increasing rapidly according to the duration of diabetes. CONCLUSION We report that individuals with elderly-onset diabetes have a lower frequency of diabetic retinopathy and nephropathy and similar cardiovascular complications compared to those with middle-age-onset diabetes.
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Affiliation(s)
- Bong Ki Lee
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Sang Wook Kim
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Daehee Choi
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Eun Hee Cho
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea.
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Yotsapon T, Sirinate K, Ekgaluck W, Somboon V, Tawee A, Worawit K, Soontaree N, Thep H. Clinical characteristics and outcomes of the oldest old people with type 2 diabetes - perspective from a tertiary diabetes center in Thailand. BMC Endocr Disord 2016; 16:30. [PMID: 27246619 PMCID: PMC4888215 DOI: 10.1186/s12902-016-0115-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 05/26/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Advance in medicine has led to an increase in life expectancy of elderly diabetic patients especially on the growing population called the "oldest old", those in their mid-80s upwards. The aim of this study is to describe clinical characteristics and outcomes of "oldest old" patients in a specialized diabetes center. METHODS A retrospective review was conducted on medical records of type 2 diabetes who were older than 85 years at Theptarin hospital from September 2014 to August 2015. RESULTS During the study period, there were 143 oldest old diabetic patients who visited our hospital regularly. Of the 133 active follow-up patients (median time of follow-up 15 years, range 1-30 years), 70.7 % was female, the mean age of onset was 68.3 ± 11.5 years and duration of diabetes was 20.1 ± 11.1 years. According to the Charlson co-morbidity index (CCI), 35.3 % of patients were classified as having severe co-morbidities. The mean A1C, blood pressure, LDL were 6.7 ± 1.1 %, 132/65 mmHg and 80 ± 29 mg/dl respectively. 66.9 % of patients had tight glycemic control (A1C <7 %) while 12.0 % had poor control (A1C >8 %). Oral hypoglycemic agent (OHA) dual therapy was the most common treatment (26.3 %) followed by OHA monotherapy (22.6 %), insulin alone (19.5 %), diet therapy alone (12.7 %), and insulin plus OHA (8.3 %). Hypoglycemia was found in 10.5 % of patients in previous 12 months. Diabetic retinopathy, chronic kidney disease, cardiovascular disease, and stroke were presented in 23.4, 54.9, 15.8, 18.0 % of patients, respectively. Among patients whose received diabetic medications and resulted in very low level of A1C (A1C less than 6.0 %), only 20.0 % underwent deintensification. CONCLUSIONS Our results revealed that real-world clinical outcomes of extreme elderly diabetic patients were diverse and being too "aggressive" diabetes treatment with older patients did occur frequently. Decision making in older people with diabetes is complex as chronic co-morbidities are very common.
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Centenarians and their hearts: A prospective registry with comprehensive geriatric assessment, electrocardiogram, echocardiography, and follow-up. Am Heart J 2015; 169:798-805.e2. [PMID: 26027617 DOI: 10.1016/j.ahj.2015.03.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 03/04/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Data on the cardiac characteristics of centenarians are scarce. Our aim was to describe electrocardiogram (ECG) and echocardiography in a cohort of centenarians and to correlate them with clinical data. METHODS We used prospective multicenter registry of 118 centenarians (28 men) with a mean age of 101.5±1.7 years. Electrocardiogram was performed in 103 subjects (87.3%) and echocardiography in 100 (84.7%). All subjects underwent a follow-up for at least 6 months. RESULTS Centenarians with abnormal ECG were less frequently females (72% vs 93%), had higher rates of previous consumption of tobacco (14% vs 0) and alcohol (24% vs 12%), and scored lower in the perception of health status (6.8±2.0 vs 8.3±6.8). Centenarians with significant abnormalities in echocardiography were less frequently able to walk 6 m (33% vs 54%). Atrial fibrillation/flutter was found in 27 subjects (26%). Mean left ventricular (LV) ejection fraction was 60.0±10.5%. Moderate or severe aortic valve stenosis was found in 16%, mitral valve regurgitation in 15%, and aortic valve regurgitation in 13%. Diastolic dysfunction was assessed in 79 subjects and was present in 55 (69.6%). Katz index and LV dilation were independently associated with the ability to walk 6 m. Age, Charlson and Katz indexes, and the presence of significant abnormalities in echocardiography were associated with mortality. CONCLUSIONS Centenarians have frequent ECG alterations and abnormalities in echocardiography. More than one fifth has atrial fibrillation, and most have diastolic dysfunction. Left ventricular dilation was associated with the ability to walk 6 m. Significant abnormalities in echocardiography were associated with mortality.
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Alvarado-Vásquez N. Circulating cell-free mitochondrial DNA as the probable inducer of early endothelial dysfunction in the prediabetic patient. Exp Gerontol 2015; 69:70-8. [PMID: 26026597 DOI: 10.1016/j.exger.2015.05.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 05/09/2015] [Accepted: 05/25/2015] [Indexed: 12/16/2022]
Abstract
Recent evidence has shown that 346million people in the world have diabetes mellitus (DM); this number will increase to 439million by 2030. In addition, current data indicate an increase in DM cases in the population between 40 and 59years of age. Diabetes is associated with the development of micro- and macro-vascular complications, derived from chronic hyperglycemia on the endothelium. Some reports demonstrate that people in a prediabetic state have a major risk of developing early endothelial dysfunction (ED). Today, it is accepted that individuals considered as prediabetic patients are in a pro-inflammatory state associated with endothelial and mitochondrial dysfunction. It is important to mention that impaired mitochondrial functionality has been linked to endothelial apoptosis and release of mitochondrial DNA (mtDNA) in patients with sepsis, cardiac disease, or atherosclerosis. This free mtDNA could promote ED, as well as other side effects on the vascular system through the activation of the toll-like receptor 9 (TLR9). TLR9 is expressed in different cell types (e.g., T or B lymphocytes, mastocytes, and epithelial and endothelial cells). It is localized intracellularly and recognizes non-methylated dinucleotides of viral, bacterial, and mitochondrial DNA. Recently, it has been reported that TLR9 is associated with the pathogenesis of lupus erythematosus, rheumatoid arthritis, and autoimmune diabetes. In this work, it is hypothesized that the increase in the levels of circulating mtDNA is the trigger of early ED in the prediabetic patient, and later on in the older patient with diabetes, through activation of the TLR9 present in the endothelium.
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Affiliation(s)
- Noé Alvarado-Vásquez
- Department of Biochemistry, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Calz. de Tlalpan 4502, Col. Sección XVI, 14080 Mexico, D.F., Mexico, Mexico.
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Twito O, Frankel M, Nabriski D. Impact of glucose level on morbidity and mortality in elderly with diabetes and pre-diabetes. World J Diabetes 2015; 6:345-351. [PMID: 25789117 PMCID: PMC4360429 DOI: 10.4239/wjd.v6.i2.345] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 10/30/2014] [Accepted: 12/31/2014] [Indexed: 02/05/2023] Open
Abstract
The prevalence of type 2 diabetes mellitus (DM) increases with age and reaches 25% in those older than age 65 years. Pre-diabetes status is also very common in the elderly, and is present in about half of those age 75 years and older. Many physicians care for elderly patients with diabetes and pre-diabetes, dealing with the challenge of controlling glucose levels and improving health with minimal adverse events. Over the last decade, research on diabetes among the elderly population has proliferated, adding new information on this topic. This review summarizes the updated medical literature on diabetes and pre-diabetes in the elderly, including the significance of pre-diabetic conditions, new-onset DM in the elderly and long-standing DM. The role of therapeutic intervention and the level of glycemic control for this population are discussed in particular.
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Alipour B, Barzegar A, Panahi F, Safaeian A, Es.haghi M. Effect of L-Carnitine Supplementation on Metabolic Status in Obese Diabetic Women With Hypocaloric Diet. HEALTH SCOPE 2014. [DOI: 10.17795/jhealthscope-14615] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Twito O, Ahron E, Jaffe A, Afek S, Cohen E, Granek-Catarivas M, Klein P, Hermoni D. New-onset diabetes in elderly subjects: association between HbA1c levels, mortality, and coronary revascularization. Diabetes Care 2013; 36:3425-9. [PMID: 23877985 PMCID: PMC3816853 DOI: 10.2337/dc12-2503] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE New-onset diabetes mellitus (DM) in elderly patients is associated with increased risk of diabetes complications and mortality. It is unknown whether glycemic control in this population influences the mortality risk. RESEARCH DESIGN AND METHODS The current study was conducted using the computerized database of the Sharon-Shomron District of Clalit Health Services in Israel. Included in the study were subjects 65 years of age and above with new-onset DM. The primary outcome measures were all-cause mortality and coronary revascularization procedures with either percutaneous coronary intervention or coronary artery bypass grafting. RESULTS Participants (n = 2,994) were stratified into four groups according to their mean HbA1c levels during the follow-up period (<6.5% [48 mmol/mol], 6.5-6.99% [48-52 mmol/mol], 7-7.49% [53-57 mmol/mol], and ≥7.5% [58 mmol/mol]). During a mean follow-up of 5.54 ± 2.1 years, 1,173 (39.17%) participants died and 285 (9.51%) underwent coronary revascularization. An HbA1c level >7.5% (58 mmol/mol) was associated with a significantly increased all-cause mortality rate (hazard ratio [HR] 1.74 [95% CI 1.2-1.8], P < 0.0001). This difference remained statistically significant after a multivariate model adjusted for the conventional cardiovascular risk factors and for the use of hypoglycemic agents and statins. Kaplan-Meier survival plots revealed lower survival rates in this group of patients. Coronary revascularization rates were highest among subjects with HbA1c 6.5-6.99% (48-52 mmol/mol) (HR 1.6 [1.01-2.4], P < 0.05) and lowest in patients with HbA1c ≥7.5% (58 mmol/mol). CONCLUSIONS An HbA1c level >7.5% (58 mmol/mol) is associated with increased risk for all-cause mortality and with a lower revascularization rate in elderly patients with new-onset DM.
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Sharifirad G, Najimi A, Hassanzadeh A, Azadbakht L. Does nutritional education improve the risk factors for cardiovascular diseases among elderly patients with type 2 diabetes? A randomized controlled trial based on an educational model. J Diabetes 2013; 5:157-62. [PMID: 22540523 DOI: 10.1111/j.1753-0407.2012.00203.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND To evaluate the effects of a nutritional education program on cardiovascular risk among elderly patients with type 2 diabetes (T2D). METHODS Ninety-seven elderly patients with T2D were enrolled in the present randomized controlled educational trial study. Patients were divided into intervention and control groups. The belief, attitude, subjective norm, enabling factors (BASNEF) educational model was used to design the educational intervention. Patients in the control group received their usual care during the study. Anthropometric data, lipid profiles and blood pressure measurements were collected at baseline and Week 12 in each group. RESULTS Significant declines were observed in the intervention compared with control group in terms of body weight (-1.3 ± 1.1 vs. 0.11 ± 0.58 kg, respectively), body mass index (-0.48 ± 0.37 vs. 0.05 ± 0.22 kg/m2, respectively), serum triglyceride levels (-18.25 ± 32.15 vs. -3.67 ± 22.61 mg/dL, respectively; P < 0.05 for all), and the waist-to-hip ratio (P = 0.03). There were no significant differences between the intervention and control groups in terms of high-density lipoprotein-cholesterol (-1.02 ± 4.35 vs. -1.10 ± 6.93 mg/dL, respectively; P = 0.9) or low-density lipoprotein-cholesterol (-4.04 ± 11.64 vs. -1.08 ± 4.35 mg/dL, respectively; P = 0.2). CONCLUSIONS Short-term nutritional education based on the BASNEF educational model improves serum triglyceride levels and anthropometric indices in elderly patients with T2D.
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Affiliation(s)
- Gholamreza Sharifirad
- Department of Health Education and Health Promotion, Isfahan University of Medical Sciences, Isfahan, Iran
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Wang JB, Zhang YJ, Zhang Y, Guan J, Chen LY, Fu CH, Du HJ, Sheng Y, Zhou L, Si YF, Zhang Y. Negative correlation between serum syndecan-1 and apolipoprotein A1 in patients with type 2 diabetes mellitus. Acta Diabetol 2013; 50:111-5. [PMID: 20683626 DOI: 10.1007/s00592-010-0216-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Accepted: 07/26/2010] [Indexed: 10/19/2022]
Abstract
Heparan sulfate proteoglycans (HSPGs) are involved in the regulation of cell growth, apoptosis and lipid metabolism in vitro. Syndecans are the primary form of HSPGs. Syndecan-1 is involved in the processes of cell growth, differentiation, adhesion, wound healing and inflammation. Additionally, as a sinusoidal transmembrane HSPG facing the plasma compartment, syndecan-1 is a promising target to be involved in lipoprotein physiology. We aimed to examine the possible correlation of syndecan-1 and lipid profile in type 2 diabetes mellitus. In this study, serum syndecan-1 was detected by ELISA, and potential correlations between syndecan-1 and triglyceride, cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, lipoprotein a, apolipoprotein (apo) B, apoA1 and apoB/apoA1 were analyzed. Forty-one patients with type 2 diabetes and 31 age-matched, non-diabetic healthy subjects (controls) were enrolled. Syndecan-1 in patients with diabetes (26.15 ± 2.42 ng/ml) was significantly higher than that of the controls (16.85 ± 1.98 ng/ml, t = -2.98, P = 0.005). Serum syndecan-1 level correlated negatively with apoA1 (r = -0.46, P = 0.003). Multiple regression analysis showed that apoA1 (b = -0.43, P = 0.003) was a predictor of serum syndecan-1 levels in subjects with type 2 diabetes.
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Affiliation(s)
- Jing-Bo Wang
- Department of Ophthalmology, The 309th Hospital of Chinese People's Liberation Army, Jia 17, Heishanhu Road, Haidian District, Beijing, 100091, China.
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Rabuñal-Rey R, Monte-Secades R, Gomez-Gigirey A, Pértega-Díaz S, Testa-Fernández A, Pita-Fernández S, Casariego-Vales E. Electrocardiographic abnormalities in centenarians: impact on survival. BMC Geriatr 2012; 12:15. [PMID: 22520618 PMCID: PMC3416736 DOI: 10.1186/1471-2318-12-15] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 04/20/2012] [Indexed: 11/23/2022] Open
Abstract
Background The centenarian population is gradually increasing, so it is becoming more common to see centenarians in clinical practice. Electrocardiogram abnormalities in the elderly have been reported, but several methodological biases have been detected that limit the validity of their results. The aim of this study is to analyse the ECG abnormalities in a prospective study of the centenarian population and to assess their impact on survival. Method We performed a domiciliary visit, where a medical history, an ECG and blood analysis were obtained. Barthel index (BI), cognitive mini-exam (CME) and Charlson index (ChI) were all determined. Patients were followed up by telephone up until their death. Results A total of 80 centenarians were studied, 26 men and 64 women, mean age 100.8 (SD 1.3). Of these, 81% had been admitted to the hospital at least once in the past, 81.3% were taking drugs (mean 3.3, rank 0–11). ChI was 1.21 (SD 1.19). Men had higher scores both for BI (70 -SD 34.4- vs. 50.4 -SD 36.6-, P = .005) and CME (16.5 -SD 9.1- vs. 9.1 –SD 11.6-, P = .008); 40.3% of the centenarians had anaemia, 67.5% renal failure, 13% hyperglycaemia, 22.1% hypoalbuminaemia and 10.7% dyslipidaemia, without statistically significant differences regarding sex. Only 7% had a normal ECG; 21 (26.3%) had atrial fibrillation (AF), 30 (37.5%) conduction defects and 31 (38.8%) abnormalities suggestive of ischemia, without sex-related differences. A history of heart disease was significantly associated with the presence of AF (P = .002, OR 5.2, CI 95% 1.8 to 15.2) and changes suggestive of ischemia (P = .019, OR 3.2, CI 95% 1.2-8.7). Mean survival was 628 days (SD 578.5), median 481 days. Mortality risk was independently associated with the presence of AF (RR 2.0, P = .011), hyperglycaemia (RR 2.2, P = .032), hypoalbuminaemia (RR 3.5, P < .001) and functional dependence assessed by BI (RR 1.8, P = .024). Conclusion Although ECG abnormalities are common in centenarians, they are not related to sex, functional capacity or cognitive impairment. The only abnormality that has an impact on survival is AF.
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Affiliation(s)
- Ramón Rabuñal-Rey
- Internal Medicine Department, Lucus Augusti University Hospital (HULA), SERGAS, San Cibrao, s/n, 27003, Lugo, Spain.
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Davey A, Lele U, Elias MF, Dore GA, Siegler IC, Johnson MA, Hausman DB, Tenover JL, Poon LW. Diabetes mellitus in centenarians. J Am Geriatr Soc 2012; 60:468-73. [PMID: 22283370 PMCID: PMC3302973 DOI: 10.1111/j.1532-5415.2011.03836.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To describe the prevalence of diabetes mellitus (DM) in centenarians. DESIGN Cross-sectional, population-based. SETTING Forty-four counties in northern Georgia. PARTICIPANTS Two hundred forty-four centenarians (aged 98-108, 15.8% male, 20.5% African American, 38.0% community dwelling) from the Georgia Centenarian Study (2001-2009). MEASUREMENTS Nonfasting blood samples assessed glycosylated hemoglobin (HbA(1c)) and relevant clinical parameters. Demographic, diagnosis, and DM complication covariates were assessed. RESULTS 12.5% of centenarians were known to have DM. DM was more prevalent in African Americans (27.7%) than whites (8.6%, P < .001). There were no differences between men (16.7%) and women (11.7%, P = .41) or between centenarians living in the community (10.2%) and in facilities (13.9%, P = .54). DM was more prevalent in overweight and obese (23.1%) than nonoverweight (7.1%, P = .002) centenarians. Anemia (78.6% vs 48.3%, P = .004) and hypertension (79.3% vs 58.6%, P = .04) were more prevalent in centenarians with DM than in those without, and centenarians with DM took more nonhypoglycemic medications (8.6 vs 7.0, P = .02). No centenarians with HbA(1c) of less than 6.5% had random serum glucose levels greater than 200 mg/dL. DM was not associated with 12-month all-cause mortality, visual impairment, amputations, cardiovascular disease, or neuropathy. Thirty-seven percent of centenarians reported onset before age 80 (survivors), 47% between age 80 and 97 (delayers), and 15% aged 98 and older (escapers). CONCLUSION Diabetes mellitus is a risk factor for cardiovascular disease and mortality but is seen in persons who live into very old age. Aside from higher rates of anemia and use of more medications, few clinical correlates of DM were observed in centenarians.
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Affiliation(s)
- Adam Davey
- Department of Public Health, Temple University, Philadelphia, Pennsylvania 19122, USA.
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Malaguarnera M, Vacante M, Frazzetto PM, Motta M. The role of diabetes and aging in the determinism of hypertension and the related cerebrovascular complications. Arch Gerontol Geriatr 2011; 55:221-5. [PMID: 21920611 DOI: 10.1016/j.archger.2011.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 08/15/2011] [Accepted: 08/16/2011] [Indexed: 12/01/2022]
Abstract
Epidemiological studies carried out on a large sample (3191 elderly and 640 centenarians) with identical criteria and applying the actual diagnostic standards, have evidenced a high, statistically significant prevalence of diabetes mellitus type 2 (DMT2) (18.84%) in the elderly, as compared to the centenarians (7.50%). This aspect is correlated with the major frequency of maturity onset diabetes in elderly (MODE), compared to the centenarians, correlated also to the mortality of diabetes mellitus (DM) of long duration. The DMT2 and the aging interact in the determinism of vascular alterations, i.e., of the hypertension, and related cardio-cerebrovascular complications. The most frequently occurring hypertension in both the elderly and centenarians was always the systolic-isolated one. The prevalence of hypertension and acute myocardial infarction (AMI) was statistically significantly higher in diabetics, compared to the normoglycemic patients, in both the elderly and the centenarians. In addition, in a group of 914 elderly patients, being diabetics or normoglycemic at the start of the studies, but having neither AMI nor stroke at the baseline studies, after 5 years, these complications were more prevalent, significantly in statistical terms, in the diabetic subjects, compared to the normoglycemic ones. The increase of life-span causes an increase of the age when the aging phenomena appear, resulting in that the equal-age elderly people today are of better clinical conditions, compared to the previous periods. The increased life span with a consequent progressive aging of the population causes a worse general clinical state of the elderly population, characterized by polypathologies, frailty, and appearance of cognitive deficits or incapabilities for performing manual or instrumental activities.
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Affiliation(s)
- Michele Malaguarnera
- Research Center The Great Senescence, University of Catania, Cannizzaro Hospital, Via Messina, 829, I-95125 Catania, Italy
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Roughead EE, Kalisch LM, Ramsay EN, Ryan P, Gilbert AL. Use of health services and medicines amongst Australian war veterans: a comparison of young elderly, near centenarians and centenarians. BMC Geriatr 2010; 10:83. [PMID: 21050484 PMCID: PMC2989975 DOI: 10.1186/1471-2318-10-83] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Accepted: 11/04/2010] [Indexed: 11/23/2022] Open
Abstract
Background Age and life expectancy of residents in many developed countries, including Australia, is increasing. Health resource and medicine use in the very old is not well studied. The purpose of this study was to identify annual use of health services and medicines by very old Australian veterans; those aged 95 to 99 years (near centenarians) and those aged 100 years and over (centenarians). Methods The study population included veterans eligible for all health services subsidised by the Department of Veterans' Affairs (DVA) aged 95 years and over at August 1st 2006. A cohort of veterans aged 65 to 74 years was identified for comparison. Data were sourced from DVA claims databases. We identified all claims between August 1st 2006 and July 31st 2007 for medical consultations, pathology, diagnostic imaging and allied health services, hospital admissions, number of prescriptions and unique medicines. Chi squared tests were used to compare the proportion of centenarians (those aged 100 years and over) and near centenarians (those aged 95 to 99 years) who accessed medicines and health services with the 65 to 74 year age group. For those who accessed health services during follow up, Poisson regression was used to compare differences in the number of times centenarians and near centenarians accessed each health service compared to 65 to 74 year olds. Results A similar proportion (98%) of centenarians and near centenarians compared to those aged 65 to 74 consulted a GP and received prescription medicine during follow up. A lower proportion of centenarians and near centenarians had claims for specialist visits (36% and 57% respectively), hospitalisation (19% and 24%), dental (12% and 18%), physiotherapy (13% and 15%), pathology(68% and 78%) and diagnostic imaging services (51% and 68%) (p < 0.0001) and a higher proportion had claims for care plans (19% and 25%), occupational therapy (15% and 17%) and podiatry services (54% and 58%) (p < 0.0001). Compared to those aged 65 to 74, a lower proportion of centenarians and near centenarians received antihypertensives, lipid lowering therapy, antiinflammatories, and antidepressants (p < 0.0001) and a higher proportion received antibiotics, analgesics, diuretics, laxatives, and anti-anaemics (p < 0.0001). Conclusions Medical consultations and medicines are the health services most frequently accessed by Australian veteran centenarians and near centenarians. For most health services, the proportion of very old people who access them is similar to or less than younger elderly. Our results support the findings of other studies which suggest that longevity is not necessarily associated with excessive health service use.
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Affiliation(s)
- Elizabeth E Roughead
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
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Vacante M, Malaguarnera M, Motta M. Revision of the ADA-classification of diabetes mellitus type 2 (DMT2): the importance of maturity onset diabetes (MOD), and senile diabetes (DS). Arch Gerontol Geriatr 2010; 53:113-9. [PMID: 20800300 DOI: 10.1016/j.archger.2010.06.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Revised: 06/22/2010] [Accepted: 06/26/2010] [Indexed: 02/06/2023]
Abstract
The changing social and economic conditions and the increase of the life span induced a progressive increase of the general prevalence of DMT2, particularly in the elderly population of the highly evoluted countries. Up to now 18 genetic loci have been identified, each of them consisting of several single nucleotide polymorphisms (SNPs). The evidence that the DMT2 is regulated by a high number of genes, demonstrate the pathogenetic complexity of this disease. The onset of diabetes mellitus (DM) in medium age is a consequence of the breakdown of the glycemic homeostasis in correlation with the genetic factors, such as the variants of the TCF7L2, obesity, etc., and the environmental factors, such as the life-style, the evolution of chronic-degenerative diseases, etc. In case of DM that onsets in old age we have to add the deterioration of the anti-aging defense mechanisms, characterized by the antagonistic action of the genes of longevity and aging. One can observe several clinical and therapeutic differences; therefore, the authors of this review propose the reinsertion of three forms into the DMT2 correlated with the age of onset and with the actual age of the subjects: the maturity onset diabetes (MOD), the maturity onset diabetes in elderly (MODE), and the senile diabetes (DS).
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Affiliation(s)
- Marco Vacante
- Department of Senescence, Urological and Neurological Sciences, University of Catania, Ospedale Cannizzaro, Viale Messina, 829, I-95125 Catania, Italy
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Malaguarnera M, Vacante M, Avitabile T, Malaguarnera M, Cammalleri L, Motta M. L-Carnitine supplementation reduces oxidized LDL cholesterol in patients with diabetes. Am J Clin Nutr 2009; 89:71-6. [PMID: 19056606 DOI: 10.3945/ajcn.2008.26251] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Patients with type 2 diabetes are under high oxidative stress, and levels of hyperglycemia correlate strongly with levels of LDL oxidation. Carnitine favorably modulates oxidative stress. OBJECTIVE This objective of this study was to evaluate the efficacy of L-carnitine on the reduction of oxidized LDL cholesterol in patients with type 2 diabetes. DESIGN Eighty-one patients with diabetes were randomly assigned to 1 of 2 treatment groups for 3 mo. The 2 groups received either 2 g L-carnitine once daily (n = 41) or placebo (n = 40). The following variables were assessed at baseline, after washout, and at 1, 2, and 3 mo of treatment: body mass index, fasting plasma glucose, glycosylated hemoglobin, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, apolipoprotein A1, apolipoprotein B-100, oxidized LDL cholesterol, thiobarbituric acid-reactive substances, and conjugated dienes. RESULTS At the end of the study period, the L-carnitine-treated patients showed significant improvements compared with the placebo group in the following markers: oxidized LDL levels decreased by 15.1 compared with 3.0 U/L (P < 0.001); LDL cholesterol decreased by 0.45 compared with 0.16 mmol/L (P < 0.05); triglycerides decreased by 1.02 compared with 0.09 mmol/L (P < 0.001); apolipoprotein A1 concentrations decreased by 0.12 compared with 0.03 mg/dL (P < 0.05); apolipoprotein B-100 concentrations decreased by 0.13 compared with 0.04 mg/dL (P < 0.05); thiobarbituric acid-reactive substance concentrations decreased by 1.92 compared with 0.05 (P < 0.001), and conjugated diene concentrations decreased by 0.72 compared with 0.11 in the placebo group (P < 0.001). CONCLUSION Our study indicates that oral administration of L-carnitine reduces oxidized LDL cholesterol levels in patients with type 2 diabetes.
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Affiliation(s)
- Mariano Malaguarnera
- Department of Senescence, Urological and Neurological Sciences, University of Catania, Catania, Italy.
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