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Artime E, Romera I, Díaz-Cerezo S, Delgado E. Epidemiology and Economic Burden of Cardiovascular Disease in Patients with Type 2 Diabetes Mellitus in Spain: A Systematic Review. Diabetes Ther 2021; 12:1631-1659. [PMID: 33942247 PMCID: PMC8179862 DOI: 10.1007/s13300-021-01060-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/12/2021] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in people with type 2 diabetes mellitus (T2DM). The objectives of this systematic literature review were to identify and synthesize published data describing the epidemiology and mortality of CVD in the T2DM population and the associated economic burden. METHODS We conducted a systematic review searching the PubMed and MEDES databases from 2009 to 2019 using predefined selection criteria. Peer-reviewed observational studies reporting primary or secondary data on CVD prevalence, incidence, mortality, resource use and costs in patients with T2DM in Spain, written in English and Spanish, were included. Data were tabulated and summarized descriptively. RESULTS Of 706 articles identified, 52 were included in the review. Most studies were based on data from hospital discharge databases and registries. The reported prevalence of CVD among patients with T2DM ranged from 6.9 to 40.8%. The prevalence of coronary heart disease ranged from 4.7 to 37%, stroke from 3.5 to 19.6%, peripheral artery disease from 2.5 to 13.0%, and heart failure from 4.3 to 20.1%. In-hospital CVD mortality rates ranged from 5.6 to 10.8%. Direct costs due to CVD in hospitalized patients with T2DM were increased (> 50%) compared with patients without CVD. No studies analysed indirect costs of CVD in patients with T2DM. CONCLUSIONS The burden of CVD among patients with T2DM, combined with the elevated costs of care, highlights the importance of early prevention as part of integrated management of the disease to improve clinical and economic outcomes.
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Affiliation(s)
- Esther Artime
- Eli Lilly and Company, Avda. de la Industria 30, Alcobendas, 28108, Madrid, Spain.
| | - Irene Romera
- Eli Lilly and Company, Avda. de la Industria 30, Alcobendas, 28108, Madrid, Spain
| | - Silvia Díaz-Cerezo
- Eli Lilly and Company, Avda. de la Industria 30, Alcobendas, 28108, Madrid, Spain
| | - Elías Delgado
- Department of Endocrinology and Nutrition, University of Oviedo, Oviedo, Spain
- Central University Hospital of Asturias, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- Spanish Biomedical Research Network in Rare Diseases, Madrid, Spain
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Christiaens A, Boland B, Germanidis M, Dalleur O, Henrard S. Poor health status, inappropriate glucose-lowering therapy and high one-year mortality in geriatric patients with type 2 diabetes. BMC Geriatr 2020; 20:367. [PMID: 32972389 PMCID: PMC7517632 DOI: 10.1186/s12877-020-01780-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/20/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Glucose-lowering therapy (GLT) should be individualized in older patients with type 2 diabetes (T2D) according to their health status and their life expectancy. This study aimed at assessing the inappropriateness of GLT prescribing and the one-year mortality rate in geriatric patients with T2D. METHODS Retrospective cohort study of consecutive inpatients with T2D admitted to a geriatric ward of a Belgian university hospital. Inclusion criteria were age ≥ 75 years, T2D with GLT before admission, and HbA1c measurement during the hospital stay. Comorbidities and geriatric syndromes were collected. GLT agents were classified into hypoglycaemic and non-hypoglycaemic ones, and their dosages were expressed in daily defined dose (DDD). Health status (intermediate or poor) and GLT appropriateness (appropriate, overtreatment, undertreatment) were assessed according to the 2019 Endocrine Society guideline on diabetes treatment in older adults, in which GLT overtreatment requires the presence of hypoglycaemic therapy. One-year mortality was determined using the National Registry of vital status, and its associated factors were analysed using multivariable Cox' regression. RESULTS The 318 geriatric patients with T2D (median age 84 years; 46% female) were in intermediate (33%) or poor health (67%). These two groups reached similar low HbA1c values (median 6.9%) with similar GLT regimens. GLT overtreatment was frequent (57%) irrespectively of the geriatric features. One-year mortality rate was high (38.5%) and associated in multivariate analysis with poor health status (HR: 1.59, p = 0.033), malnutrition (HR: 1.67, p = 0.006) and GLT overtreatment (HR: 1.73, p = 0.023). Patients with GLT overtreatment had a higher mortality rate (44.5%). CONCLUSIONS GLT overtreatment was present in more than half of these geriatric patients. Many of them were in poor health status and died within one-year. Special attention should be paid to individualisation of the HbA1c goals in the geriatric patients with diabetes, and to GLT de-intensification in those being over-treated.
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Affiliation(s)
- Antoine Christiaens
- Fund for Scientific Research - FNRS, Brussels, Belgium. .,Clinical Pharmacy Research Group, Louvain Drug Research Institute (LDRI), Université catholique de Louvain, Brussels, Belgium. .,Institute of Health and Society (IRSS), Université catholique de Louvain, 30, Clos Chapelle-Aux-Champs bte B1.30.15, 1200, Brussels, Belgium.
| | - Benoit Boland
- Institute of Health and Society (IRSS), Université catholique de Louvain, 30, Clos Chapelle-Aux-Champs bte B1.30.15, 1200, Brussels, Belgium.,Geriatric Medicine Unit, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Marie Germanidis
- Geriatric Medicine Unit, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Olivia Dalleur
- Clinical Pharmacy Research Group, Louvain Drug Research Institute (LDRI), Université catholique de Louvain, Brussels, Belgium.,Pharmacy Department, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Séverine Henrard
- Clinical Pharmacy Research Group, Louvain Drug Research Institute (LDRI), Université catholique de Louvain, Brussels, Belgium.,Institute of Health and Society (IRSS), Université catholique de Louvain, 30, Clos Chapelle-Aux-Champs bte B1.30.15, 1200, Brussels, Belgium
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Padrós G, Ferrer A, Formiga F, Cunillera O, Badia T, Corbella X, Almeda J, Badia T, Fernández C, Ferrer A, Formiga F, Gil A, Llopart C, Megido M, Padrós G, Sarró M, Tobella A. Prevalence of Prediabetes and Associated Factors in the Oldest Old. A Cross Sectional Study in the Octabaix Cohort. INT J GERONTOL 2017. [DOI: 10.1016/j.ijge.2016.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Gómez-Huelgas R, Sabán-Ruiz J, García-Román F, Quintela-Fernández N, Seguí-Ripoll J, Bonilla-Hernández M, Romero-Meliá G. Safety and efficacy of a basal-plus regimen with insulin glargine and insulin glulisine for elderly patients with high cardiovascular risk and type 2 diabetes mellitus. Rev Clin Esp 2017. [DOI: 10.1016/j.rceng.2017.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Gómez-Huelgas R, Sabán-Ruiz J, García-Román F, Quintela-Fernández N, Seguí-Ripoll J, Bonilla-Hernández M, Romero-Meliá G. Eficacia y seguridad de una pauta basal plus con insulina glargina e insulina glulisina en pacientes ancianos de alto riesgo cardiovascular con diabetes mellitus tipo 2. Rev Clin Esp 2017; 217:201-206. [DOI: 10.1016/j.rce.2017.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 01/12/2017] [Accepted: 02/05/2017] [Indexed: 01/16/2023]
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Ferrer A, Formiga F, Padrós G, Badia T, Almeda J, Octabaix GE. [The Octabaix study. Baseline assessment and 5 years of follow-up]. Rev Esp Geriatr Gerontol 2017; 52:44-52. [PMID: 27133765 DOI: 10.1016/j.regg.2016.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 03/07/2016] [Indexed: 06/05/2023]
Abstract
This is a review of a prospective, community-based study with a follow-up period of 5years. It is a study of 328 participants aged 85 at baseline, of which 62% were female, 53% widows, and a third of them living alone. High blood pressure was observed in 75.9%, dyslipidaemia in 51.2%, and diabetes in 17.7%. At baseline the median Barthel Index was 95, the Spanish version of the Mini-Mental State Examination was 28, the Charlson index 1, the Mini Nutritional Assessment 25, the Gijón test 10, the visual analogue scale of the Quality of Life Test was 60, and with a mean of 6.1 prescription drugs. A lower quality of life was also associated with female gender, a phenotype of frailty, heart failure, and a high level of social risk. At 5years of follow-up, the mortality rate was high, with 138 (42.1%) of the population sample dying at the end of the period. It represents an annual mortality rate of 8.4%. Thus, a common denominator of this review has been the high importance of functionality and overall comorbidity factors associated with mortality in this very old age group, compared to other more traditional factors in younger populations. Several studies of frailty have also been assessed in this group, as well as falls, nutritional risk, diabetes and successful aging, including important aspects to better understand this population group.
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Affiliation(s)
- Assumpta Ferrer
- Centro de Atención Primaria «El Pla» CAP-I, Dirección de Atención Primaria Costa de Ponent, Institut Català de la Salut, Sant Feliu de Llobregat, Barcelona, España.
| | - Francesc Formiga
- Unidad de Geriatría, Servicio Medicina Interna, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, España
| | - Gloria Padrós
- Laboratori Clínic l'Hospitalet, Institut Català de la Salut, Hospitalet de Llobregat, Barcelona, España
| | - Teresa Badia
- Centro de Atención Primaria «Martorell Urbà», Dirección de Atención Primaria Costa de Ponent, Institut Català de la Salut, Martorell, Barcelona, España
| | - Jesús Almeda
- Unitat de Suport a la Recerca de Costa de Ponent, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Institut Català de la Salut. CIBER Epidemiología y Salud Pública (CIBERESP), Cornellà de Llobregat, Barcelona, España
| | - Grupo Estudio Octabaix
- Centro de Atención Primaria «El Pla» CAP-I, Dirección de Atención Primaria Costa de Ponent, Institut Català de la Salut, Sant Feliu de Llobregat, Barcelona, España
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Hjort J, Suomi J, Käyhkö J. Extreme urban-rural temperatures in the coastal city of Turku, Finland: Quantification and visualization based on a generalized additive model. THE SCIENCE OF THE TOTAL ENVIRONMENT 2016; 569-570:507-517. [PMID: 27362632 DOI: 10.1016/j.scitotenv.2016.06.136] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/13/2016] [Accepted: 06/17/2016] [Indexed: 06/06/2023]
Abstract
Fundamental knowledge on the determinants of air temperatures across spatial and temporal scales is essential in climate change mitigation and adaptation. Spatial-based statistical modelling provides an efficient approach for the analysis and prediction of air temperatures in human-modified environments at high spatial accuracy. The aim of the study was firstly, to analyse the environmental factors affecting extreme air temperature conditions in a coastal high-latitude city and secondly, to explore the applicability of generalized additive model (GAM) in the study of urban-rural temperatures. We utilized air temperature data from 50 permanent temperature logger stations and extensive geospatial environmental data on different scales from Turku, SW Finland. We selected five temperature situations (cases) and altogether 12 urban and natural explanatory variables for the analyses. The results displayed that (i) water bodies and topographical conditions were often more important than urban variables in controlling the spatial variability of extreme air temperatures, (ii) case specificity of the explanatory variables and their scales should be considered in the analyses and (iii) GAM was highly suitable in quantifying and visualizing the relations between urban-rural temperatures and environmental determinants at local scales. The results promote the use of GAMs in spatial-based statistical modelling of air temperature in future.
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Affiliation(s)
- Jan Hjort
- Geography Research Unit, University of Oulu, P.O. Box 3000, FI-90014, Finland.
| | - Juuso Suomi
- Department of Geography and Geology, University of Turku, FI-20014, Finland
| | - Jukka Käyhkö
- Department of Geography and Geology, University of Turku, FI-20014, Finland
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Formiga F, Vidal X, Agustí A, Chivite D, Rosón B, Barbé J, López-Soto A, Torres OH, Fernández-Moyano A, García J, Ramírez-Duque N, San José A. Inappropriate prescribing in elderly people with diabetes admitted to hospital. Diabet Med 2016; 33:655-62. [PMID: 26333026 DOI: 10.1111/dme.12894] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2015] [Indexed: 11/29/2022]
Abstract
AIMS To assess inappropriate prescribing in older people with diabetes mellitus during the month prior to a hospitalization, using tools on potentially inappropriate medicines (PIMs) and potential prescribing omissions (PPOs) and comparing inappropriate prescribing in patients with without diabetes. METHODS In an observational, prospective multicentric study, we assessed inappropriate prescribing in 672 patients aged 75 years and older during hospital admission. The Beers, Screening Tool of Older Person's Prescriptions (STOPP) and Screening Tool to Alert Doctors to Right Treatment (START) criteria and Assessing Care of Vulnerable Elders (ACOVE-3) medicine quality indicators were used. We analysed demographic and clinical factors associated with inappropriate prescribing. RESULTS Of 672 patients, 249 (mean age 82.4 years, 62.9% female) had a diagnosis of diabetes mellitus. The mean number of prescribing drugs per patient with diabetes was 12.6 (4.5) vs. 9.4 (4.3) in patients without diabetes (P < 0.001). Of those patients with diabetes, 74.2% used 10 or more medications; 54.5% of patients with diabetes had at least one Beers-listed PIM, 68.1% had at least one STOPP-listed PIM, 64.6% had at least one START-listed PPO and 62.8% had at least one ACOVE-3-listed PPO. Except for the Beers criteria, these prevalences were significantly higher in patients with diabetes than in those without. After excluding diabetes-related items from these tools, only STOPP-listed PIMs remained significantly higher among patients with diabetes (P = 0.04). CONCLUSIONS Polypharmacy is common among older patients with diabetes mellitus. Inappropriate prescribing is higher in older patients with diabetes, even when diabetes-related treatment is excluded from the inappropriate prescribing evaluation.
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Affiliation(s)
- F Formiga
- Internal Medicine Service, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
- Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain
| | - X Vidal
- Clinical Pharmacology Service, Fundació Institut Català de Farmacologia, Hospital Universitari Vall D'Hebron, Barcelona, Spain
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Agustí
- Clinical Pharmacology Service, Fundació Institut Català de Farmacologia, Hospital Universitari Vall D'Hebron, Barcelona, Spain
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - D Chivite
- Internal Medicine Service, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
- Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain
| | - B Rosón
- Internal Medicine Service, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - J Barbé
- Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain
- Internal Medicine Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona
| | - A López-Soto
- Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain
- Internal Medicine Service, Hospital Clínic, Barcelona, Spain
| | - O H Torres
- Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain
- Internal Medicine Service, Hospital Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Fernández-Moyano
- Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain
- Internal Medicine Service, Hospital San Juan De Dios del Aljarafe, Seville, Spain
| | - J García
- Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain
- Internal Medicina Service, Hospital General Juan Ramón Jiménez, Huelva, Spain
| | - N Ramírez-Duque
- Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain
- Internal Medicine Service, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - A San José
- Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain
- Internal Medicine Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona
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Formiga F, Rodriguez Mañas L. Improving drug prescription in elderly diabetic patients. Rev Esp Geriatr Gerontol 2016; 51:127-9. [PMID: 27006270 DOI: 10.1016/j.regg.2015.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 12/28/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Francesc Formiga
- Unidad de Geriatría, Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
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Dharmarajan TS, Mahajan D, Zambrano A, Agarwal B, Fischer R, Sheikh Z, Skokowska-Lebelt A, Patel M, Wester R, Madireddy NP, Pandya N, Baralatei FT, Vance J, Norkus EP. Sliding Scale Insulin vs Basal-Bolus Insulin Therapy in Long-Term Care: A 21-Day Randomized Controlled Trial Comparing Efficacy, Safety and Feasibility. J Am Med Dir Assoc 2015; 17:206-13. [PMID: 26432623 DOI: 10.1016/j.jamda.2015.08.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/17/2015] [Accepted: 08/17/2015] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Sliding scale insulin (SSI) therapy remains a common means of insulin therapy in long-term care (LTC) for the management of type 2 diabetes mellitus, despite current recommendations not supportive of the form of therapy today. Lack of randomized trial data on the efficacy and safety of basal-bolus insulin (B-BI) therapy in nursing home residents may have precluded this form of insulin administration in the LTC setting. Our study is a comparison of the efficacy of SSI (control) and B-BI (intervention) therapies during a 21-day intervention trial in older nursing home residents. METHODS Fourteen LTC facilities in the US participated; 110 residents with type 2 diabetes volunteered to participate; 35 failed inclusion criteria, 75 signed informed written consent, and 11 were discharged to home/hospital or withdrew consent; data from 64 participants are reported. Recent fasting blood glucose (FBG), hemoglobin A1c, and chemistries were obtained. Four glucose readings (prior to breakfast, lunch, dinner, and bedtime), oral antiglycemic drug, and insulin doses and changes, and all adverse events/serious adverse events, both those related to glucose control [hypoglycemic (<70 mg/dL) and hyperglycemic (>200 mg/dL) episodes] and those unrelated, were recorded daily. Patients were randomized to either remain on SSI or be shifted to the B-BI group. RESULTS Nursing home residents 80 ± 8 (standard deviation) years, 66% female participated; Control and Intervention participants had similar age, gender, race distributions, comorbidity, and 3-day average pretrial FBG levels (all P > .05). At study end, B-BI volunteers had significantly lower 3-day average FBG levels vs pretrial (P = .0231) while SSI participants had no change in 3-day average FBG (P > .05). During the trial, participants from both groups had similar rates of hypoglycemia, hyperglycemia, other adverse events, and hospitalizations (serious adverse events) unrelated to glucose control (all P > .05). CONCLUSIONS B-BI therapy produced significantly lower average FBG levels after 21 days compared with SSI therapy; both groups had similar rates of hypo- and hyperglycemia. Switching to B-BI therapy is feasible, safe, and effective in the LTC setting.
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Affiliation(s)
| | - Dheeraj Mahajan
- Lakeview Nursing and Rehabilitation Center, Chicago, IL; Carlton at the Lake, Chicago, IL; Cedar Pointe Rehab and Nursing, Cicero, IL; Presence Villa Scalabrini Nursing and Rehabilitation Center, Northlake, IL
| | - Annie Zambrano
- Lakeview Nursing and Rehabilitation Center, Chicago, IL; Carlton at the Lake, Chicago, IL; Cedar Pointe Rehab and Nursing, Cicero, IL; Presence Villa Scalabrini Nursing and Rehabilitation Center, Northlake, IL
| | | | | | - Zahra Sheikh
- Beaumont Rehabilitation and Skilled Nursing Center at Worcester, Worcester, MA
| | | | - Meenakshi Patel
- Bethany Village, Dayton, OH; Trinity Community Nursing Home, Beavercreek, OH
| | - Rebecca Wester
- Nebraska Skilled Nursing and Rehabilitation Center, Omaha, NE
| | | | | | | | - Jackie Vance
- American Medical Directors Association Foundation, Columbia, MD
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Navarro-Martínez A, Vidal-Martínez M, García-Rosa I, Lázaro-Gómez MJ, Brotons-Román J. [Profile of prescription and adequacy of treatment with non-steroidal anti-inflammatory drugs in diabetic patients]. ACTA ACUST UNITED AC 2015; 30:256-64. [PMID: 26346581 DOI: 10.1016/j.cali.2015.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 06/05/2015] [Accepted: 06/29/2015] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The aim of this study was to quantify and describe the prescription profile, as well as to assess the adequacy of treatment with non-steroidal anti-inflammatory drugs (NSAIDs) in the diabetic population of a health district. MATERIAL AND METHODS This is a descriptive, cross-sectional study aimed at a target population of 2,795 diabetic patients. Data were collected from the computerised clinical records of a sample of 380 individuals. The adequacy of treatment was assessed using the recommendations proposed by the Spanish societies of Rheumatology, Cardiology and Gastroenterology. RESULTS More than one-quarter (28%) of the diabetic patients received treatment with NSAIDs. The most commonly used ones were ibuprofen, naproxen, and dexketoprofen, with a defined daily dose per 1,000 inhabitants per day of 35.3, 17.2, and 13.2, respectively. In patients with a history of chronic kidney disease and cardiovascular high risk, fewer NSAIDs were prescribed, while they were used most frequently in patients with a risk for gastrointestinal adverse events. The prescription was considered adequate in 46.5% of diabetic patients. The main causes of inappropriate use were the inadequate prescription of NSAIDs (25.2%), and the use of any NSAID other than naproxen (20.6%). CONCLUSIONS The most prescribed NSAIDs were those showing a low cardiovascular risk profile. Treatment with NSAIDs was inadequate in more than half of the patients. Risk factors for cardiovascular, and especially gastrointestinal, events must be considered in order to avoid its use when not indicated, as well as the use of any NSAIDs other than naproxen.
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Affiliation(s)
| | | | - I García-Rosa
- Centro de Salud Infante D. Juan Manuel, Murcia, España
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Influence of GSTM1, GSTT1, and GSTP1 Polymorphisms on Type 2 Diabetes Mellitus and Diabetic Sensorimotor Peripheral Neuropathy Risk. DISEASE MARKERS 2015; 2015:638693. [PMID: 26435566 PMCID: PMC4578743 DOI: 10.1155/2015/638693] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 08/26/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIMS Diabetic neuropathy is a frequent complication of type 2 diabetes mellitus (T2DM). Genetic susceptibility and oxidative stress may play a role in the appearance of T2DM and diabetic neuropathy. We investigated the relation between polymorphism in genes related to oxidative stress such as GSTM1, GSTT1, and GSTP1 and the presence of T2DM and diabetic neuropathy (DN). METHODS Samples were collected from 84 patients with T2DM (42 patients with DN and 42 patients without DN) and 98 healthy controls and genotyped by using polymerase chain reaction and restriction fragment length polymorphism method. RESULTS GSTP1 Ile105Val polymorphism was associated with the risk of developing T2DM (p = 0.05) but not with the risk of developing DN in diabetic cases. GSTM1 and GSTT1 gene polymorphisms were associated with neither the risk of developing T2DM nor the risk of DN occurrence in diabetic patients. No association was observed between the patients with T2DM and DSPN (diabetic sensorimotor peripheral neuropathy) and T2DM without DSPN regarding investigated polymorphism. CONCLUSION Our data suggest that GSTP1 gene polymorphisms may contribute to the development of T2DM in Romanian population. GSTM1, GSTT1, and GSTP1 gene polymorphisms are not associated with susceptibility of developing diabetic neuropathy in T2DM patients.
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Formiga F, Gómez-Huelgas R, Rodríguez Mañas L. [Differential characteristics of type 2 diabetes in the elderly. Role of dipeptidyl peptidase 4 inhibitors]. Rev Esp Geriatr Gerontol 2015; 51:44-51. [PMID: 26073221 DOI: 10.1016/j.regg.2015.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 04/21/2015] [Indexed: 12/30/2022]
Abstract
The prevalence of type 2 diabetes mellitus increases with age, reaching rates around 30% in those over 75 years. The type 2 diabetes mellitus in the elderly has different pathophysiological and clinical characteristics from those of the younger diabetic patient. Some differential aspects in this population are the lower life expectancy and the frequent comorbidity, frailty and associated disability. Avoiding hypoglycemia is a therapeutic priority, given their increased risk of severe hypoglycemia. It is a situation in which the benefits of intensive glycemic control are virtually non-existent, thus prevention of side effects of treatments becomes a priority. Therefore, the goals of glycemic control should be less stringent than in the general population (glycated hemoglobin>7%), and the drugs of choice should be those with a low risk of side effects (especially hypoglycemia) and well tolerated. Dipeptidyl peptidase 4 inhibitors (iDPP4) are particularly useful in this age group, either as a second drug added to metformin monotherapy, or as first line when metformin is contraindicated or not tolerated. In this article the evidence available on the efficacy and tolerance of different pharmacological options available in population over 70 years is reviewed.
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Affiliation(s)
- Francesc Formiga
- Programa de Geriatría, Servicio de Medicina Interna, Hospital Universitari de Bellvitge, IDIBELL, ĹHospitalet de Llobregat, Barcelona, España.
| | - Ricardo Gómez-Huelgas
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Málaga, España
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Predicting factors of health-related quality of life in octogenarians: a 3-year follow-up longitudinal study. Qual Life Res 2015; 24:2701-11. [DOI: 10.1007/s11136-015-1004-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2015] [Indexed: 10/23/2022]
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Ferrer A, Formiga F, Padrós G, Badia T. Diabetes mellitus a los 85 años en la comunidad. Estudio Octabaix. Aten Primaria 2015; 47:318-9. [PMID: 25216942 PMCID: PMC6985608 DOI: 10.1016/j.aprim.2014.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 04/02/2014] [Indexed: 11/24/2022] Open
Affiliation(s)
- Assumpta Ferrer
- Centro de Atención Primaria CAP «El Plà», Sant Feliu de Llobregat, Barcelona, España.
| | - Francesc Formiga
- Unidad de Geriatría, Servicio de Medicina Interna, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
| | - Glòria Padrós
- Laboratori Clínic Territorial Metropolitana Sud, Unitat d'Atenció Primària, L'Hospitalet de Llobregat, Barcelona, España
| | - Teresa Badia
- Centro de Atención Primaria CAP «Martorell», Barcelona, España
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Formiga F, Ferrer A, Padrós G, Corbella X, Cos L, Sinclair AJ, Rodríguez-Mañas L. Diabetes Mellitus as a Risk Factor for Functional and Cognitive Decline in Very Old People: The Octabaix Study. J Am Med Dir Assoc 2014; 15:924-8. [DOI: 10.1016/j.jamda.2014.07.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 07/29/2014] [Accepted: 07/29/2014] [Indexed: 11/28/2022]
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Formiga F, Perez-Maraver M. La diabetes mellitus tipo 2 en el paciente anciano. Es básico saber cómo individualizar. Med Clin (Barc) 2014; 142:114-5. [DOI: 10.1016/j.medcli.2013.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 11/21/2013] [Indexed: 01/22/2023]
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Cruz-Jentoft AJ, Carpena-Ruiz M, Montero-Errasquín B, Sánchez-Castellano C, Sánchez-García E. Exclusion of older adults from ongoing clinical trials about type 2 diabetes mellitus. J Am Geriatr Soc 2013; 61:734-8. [PMID: 23590338 DOI: 10.1111/jgs.12215] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To assess the extent of exclusion of older individuals from ongoing clinical trials regarding type 2 diabetes mellitus. DESIGN Cohort study. SETTING World Health Organization Clinical Trials Registry Platform. PARTICIPANTS Using the Participation of the Elderly in Clinical Trials methodology, data from ongoing clinical trials on type 2 diabetes mellitus were extracted from the platform on July 31, 2011. MEASUREMENTS Proportion of trials excluding individuals using an arbitrary upper age limit or other exclusion criteria that might indirectly cause limited recruitment of older individuals. Exclusion criteria were classified as justified or poorly justified. RESULTS Of 440 trials investigating treatments for type 2 diabetes mellitus, 289 (65.7%) excluded individuals using an arbitrary upper age limit. Such exclusion was significantly more common in trials with calculated sample sizes of less than 100 subjects (73.6% vs 59.5%; P = .002). Exclusion for comorbidity was present in 338 trials (76.8%); this exclusion was poorly justified in 236 trials (53.6%). Exclusion for polypharmacy (29.5% of trials), cognitive impairment (18.4%), short life expectancy (8.9%), and other poorly justified exclusion criteria that could limit the inclusion of older individuals was also present. Only six trials (1.4%) were designed specifically to study older adults. CONCLUSION Despite the recommendations of international regulatory agencies, exclusion of older individuals from ongoing trials regarding type 2 diabetes mellitus is frequent--higher than reported for other age-related diseases. This exclusion limits the value of the evidence that clinicians use when treating old, frail, complex patients with diabetes mellitus.
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Formiga F, Rodriguez Mañas L. [Type 2 diabetes mellitus in the elderly, new evidence to apply the knowledge in daily clinical practice]. Rev Esp Geriatr Gerontol 2013; 48:53-54. [PMID: 23332413 DOI: 10.1016/j.regg.2012.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 11/07/2012] [Indexed: 06/01/2023]
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Abstract
Treatment of type 2 diabetes in the elderly represents a major challenge both in terms of clinical management and public health. Aging is causing a marked increase in the pandemic of diabetes in elderly people. However, scientific evidence to support the most appropriate treatment for diabetes in the elderly is scarce. Given the heterogeneity of the elderly population, which includes subjects with very different functional and cognitive capacities, co-morbidities, and life expectancy, it is critical to make a comprehensive assessment from a biopsychosocial perspective, to address the vascular risk factors integrally, and to establish individually tailored targets for glycemic control. In frail elderly or individuals with a short life expectancy, it may be reasonable to maintain HbA1c between 7.6%-8.5%. The therapeutic strategy for elderly patients with type 2 diabetes should be individualized and agreed with the patient and their caregivers, according to the objective. Improving quality of life, assuring patient safety and avoiding the adverse effects of antidiabetic treatment should be prioritized. Given the increased susceptibility of the elderly to severe hypoglycemia and its consequences, antidiabetic therapies that minimize the risk of hypoglycemic events should be selected.
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Yang DC, Lee LJH, Hsu CC, Chang YY, Wang MC, Lin WH, Chang CM, Wang JD. Estimation of expected life-years saved from successful prevention of end-stage renal disease in elderly patients with diabetes: a nationwide study from Taiwan. Diabetes Care 2012; 35:2279-85. [PMID: 22875232 PMCID: PMC3476928 DOI: 10.2337/dc12-0545] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Because of the increasing incidence and prevalence of diabetes as a leading cause of end-stage renal disease (ESRD) in the aging population, we estimated the expected life-years (LYs) saved from successful prevention of ESRD in elderly patients with diabetes. RESEARCH DESIGN AND METHODS We conducted a population-based cohort study using the National Health Insurance Research Database. We identified all incidences of ESRD in the individuals >65 years of age who were receiving maintenance hemodialysis (N = 24,243) from the registry files of catastrophic illnesses in Taiwan from 1 July 1997 to 31 December 2005. We then retrospectively searched the database to determine whether there had been a diagnosis of diabetes in these cases. After the exclusion of individuals with malignancy (n = 3,423), we extrapolated the survival rates through the end of 2006 using the Monte Carlo method. Using the data of preventable ESRD cases due to diabetes and expected years of life lost (EYLL) in each age stratum, we further estimated the expected LYs saved from successful prevention of ESRD in elderly patients with diabetes. RESULTS The estimated average EYLL was 10.6-5.8 and 12.3-7.3 years for diabetic males and females, respectively, aged 65-79 years. In total, 5,430.1 LYs and 10,177 LYs could be saved by the successful prevention of ESRD in male and female elderly patients with diabetes, respectively, in a single year. CONCLUSIONS The LYs saved by successful prevention of ESRD in elderly patients with diabetes in a single year are substantial and deserve special attention, especially in elderly females.
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Affiliation(s)
- Deng-Chi Yang
- Division of Geriatrics and Gerontology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Padrós G, Ferrer A, Formiga F, Almeda J, March MA, Pujol R. Dyslipidemia and ischemic cardiopathy associated with duration of diabetes mellitus in the oldest old: the OCTABAIX study. J Am Geriatr Soc 2012; 60:1594-6. [PMID: 22889033 DOI: 10.1111/j.1532-5415.2012.04087.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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