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Leungsuwan DS, Chandran M. Bone Fragility in Diabetes and its Management: A Narrative Review. Drugs 2024:10.1007/s40265-024-02078-5. [PMID: 39103693 DOI: 10.1007/s40265-024-02078-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2024] [Indexed: 08/07/2024]
Abstract
Bone fragility is a serious yet under-recognised complication of diabetes mellitus (DM) that is associated with significant morbidity and mortality. Multiple complex pathophysiological mechanisms mediating bone fragility amongst DM patients have been proposed and identified. Fracture risk in both type 1 diabetes (T1D) and type 2 diabetes (T2D) continues to be understated and underestimated by conventional risk assessment tools, posing an additional challenge to the identification of at-risk patients who may benefit from earlier intervention or preventive strategies. Over the years, an increasing body of evidence has demonstrated the efficacy of osteo-pharmacological agents in managing skeletal fragility in DM. This review seeks to elaborate on the risk of bone fragility in DM, the underlying pathogenesis and skeletal alterations, the approach to fracture risk assessment in DM, management strategies and therapeutic options.
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Affiliation(s)
| | - Manju Chandran
- Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, 20 College Road, ACADEMIA, Singapore, 169856, Singapore.
- DUKE NUS Medical School, Singapore, Singapore.
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Cheng Z, Li X, Xu H, Bao D, Mu C, Xing Q. Incidence of accidental falls and development of a fall risk prediction model among elderly patients with diabetes mellitus: A prospective cohort study. J Clin Nurs 2023; 32:1398-1409. [PMID: 35596277 DOI: 10.1111/jocn.16371] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/15/2022] [Accepted: 04/25/2022] [Indexed: 12/12/2022]
Abstract
AIMS To investigate the incidence of accidental falls and develop a fall risk prediction tool in elderly patients with diabetes mellitus. BACKGROUND The risk of fall in elderly patients with diabetes is higher than that in the general elderly, there is fewer fall assessment tools for elderly patients with diabetes. DESIGN A prospective cohort study. METHODS Between June and September 2019, a total of 1007 elderly patients with diabetes were enrolled from a tertiary specialist diabetes hospital in Tianjin and were prospectively followed up for 6 months to determine outcomes of accidental falls through telephone. Demographic and diseases related factors were collected at baseline. Incidence of falls was investigated, and a nomogram was developed based on logistic regression model. SPSS 21.0 and R 3.6.3 were used to analyse the data. The article was reported in accordance with STROBE guidelines. RESULTS Among 1007 elderly patients, 950 finished the follow-up. A total of 133 falls occurred in 93 patients during the follow-up period, with a fall rate of 9.79%. Diabetic peripheral neuropathy, walking aids, depression, fall history, fatigue and sex were independent predictors of accidental fall in diabetes elderly patients. The sensitivity and specificity of the predictive model were 73.12% and 52.63%, respectively, and a fall risk prediction nomogram was developed based on the regression model. CONCLUSIONS A nomogram including 6 easily available prediction factors (diabetic peripheral neuropathy, walking aids, depression, fall history within 1 year, fatigue, sex) was developed, and it can be used in safety management among Chinese elderly patients diagnosed with diabetes. RELEVANCE TO CLINICAL PRACTICE Nomogram can be used to identify diabetic elderly patients at high risk of accidental falls.
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Affiliation(s)
- Zhengnan Cheng
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xiaohui Li
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Hongmei Xu
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Di Bao
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Chun Mu
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Qiuling Xing
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
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AlTowayan A, Alharbi S, Aldehami M, Albahli R, Alnafessah S, Alharbi AM. Awareness Level of Hypoglycemia Among Diabetes Mellitus Type 2 Patients in Al Qassim Region. Cureus 2023; 15:e35285. [PMID: 36974247 PMCID: PMC10039802 DOI: 10.7759/cureus.35285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2023] [Indexed: 02/24/2023] Open
Abstract
Background Hypoglycemia has a major impact on patient health and glycemic management during insulin therapy for both type 1 (T1DM) and type 2 diabetes mellitus (T2DM). It is the rate-limiting complication in diabetes management that prevents stringent glucose control. Objectives To assess the knowledge and awareness about hypoglycemia as a complication of T2D in adults in Al Qassim, Saudi Arabia. Methods This is a cross-sectional study done among type 2 diabetes patients in Al-Qassim, Kingdom of Saudi Arabia, from January to June 2022. A previously validated online questionnaire was disseminated through social media to gather information from respondents. Participants were chosen via a simple random sampling technique. Data analysis was completed using SPSS (version 23; IBM Corp., Armonk, NY). Results Overall, 213 respondents were included in our study. The majority of them were females (70.9%). The participants' average age was 35.9 + 13.0 years. Our results revealed that the average awareness score of the study population was found to be 3.6 ± 1.1 (by using the Clarke method) and 3.7 ± 2.1 (by using the Gold method). Moreover, we found that impaired awareness of hypoglycemia's prevalence by Clarke's questionnaire was 52.1% and 53.5% by using the Gold questionnaire. In addition, almost half of the respondents reported weakness as a symptom of hypoglycemia over the last six months and unconsciousness over the last 12 months. Hypertension was the most commonly reported chronic disease by our participants. Lastly, factors such as age, gender, educational level, geographic distribution, and history of chronic illness did not show any significant association with impaired awareness of the prevalence of hypoglycemia. Conclusion According to our research, we concluded that patients with type 2 diabetes mellitus in the region of Al-Qassim, Saudi Arabia, had insufficient knowledge about hypoglycemia as a complication of T2D. Moreover, the impaired awareness of hypoglycemia in diabetic patients was found to be high. Hence, there is a need for interventional programs to raise public awareness.
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Harris SB, Parente EB, Karalliedde J. Clinical Use of Insulin Glargine 300 U/mL in Adults with Type 2 Diabetes: Hypothetical Case Studies. Diabetes Ther 2022; 13:913-930. [PMID: 35355207 PMCID: PMC9373591 DOI: 10.1007/s13300-022-01247-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/23/2021] [Indexed: 11/03/2022] Open
Abstract
Type 2 diabetes (T2D) is a progressive disease, with many individuals eventually requiring basal insulin therapy to maintain glycaemic control. However, there exists considerable therapeutic inertia to the prompt initiation and optimal titration of basal insulin therapy due to barriers that include fear of injections, hypoglycaemia, weight gain, and burdensome regimens. Hypoglycaemia is thought to be a major barrier to optimal glycaemic control and is associated with significant morbidity and mortality. Newer second-generation basal insulin analogues provide comparable glycaemic control with lower risk of hypoglycaemia compared with first-generation basal insulin analogues. The present review article discusses clinical evidence for one such second-generation basal insulin analogue, insulin glargine 300 U/mL (Gla-300), in the context of hypothetical case studies that are representative of individuals who may attend routine clinical practice. These case studies discuss individualised treatment needs for people with T2D who are insulin-naïve or pre-treated. Clinical characteristics such as older age, frequent nocturnal hypoglycaemia, and renal impairment, which are known risk factors for hypoglycaemia, are also considered.
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Affiliation(s)
- Stewart B Harris
- Schulich School of Medicine & Dentistry at The University of Western Ontario, in London, 1151 Richmond St, London, ON, N6A 5C1, Canada.
| | - Erika B Parente
- Folkhälsan Research Center, Helsinki, Finland
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Janaka Karalliedde
- School of Cardiovascular Medicine & Sciences, King's College London, London, UK
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Yokote K, Suzuki R, Gouda M, Iijima H, Yamazaki A, Inagaki M. Association between glycemic control and cardiovascular events in older Japanese adults with diabetes mellitus: An analysis of the Japanese medical administrative database. J Diabetes Investig 2021; 12:2036-2045. [PMID: 33988907 PMCID: PMC8565425 DOI: 10.1111/jdi.13575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 04/23/2021] [Accepted: 05/01/2021] [Indexed: 12/25/2022] Open
Abstract
AIMS/INTRODUCTION The relationship between glycated hemoglobin (HbA1c) and cardiovascular events in older adults was investigated using a Japanese administrative medical database. MATERIALS AND METHODS Anonymized medical data on patients with diabetes mellitus aged ≥65 years for the period from January 2010 to December 2019 were extracted from the EBM Provider database. The primary end-point was a composite of cardiovascular events, whereas the other end-points included severe hypoglycemia and fracture. The association between cardiovascular events and HbA1c at the index date (i.e., approximately 10 months after initial diabetes mellitus diagnosis) was evaluated using the Cox proportional hazards model. RESULTS Among the 3,186,751 patients in the database, 3,946 older adults with diabetes mellitus were eligible for inclusion and were subsequently grouped according to HbA1c quartiles at the index date. Cardiovascular events occurred in 142 patients. Patients with HbA1c in the highest quartile had significantly higher risk of hospitalization for cardiovascular disease than those with HbA1c in the lowest quartile (hazard ratio 1.948; 95% confidence interval 1.252-3.031, P = 0.003). However, the events risk was similar across subgroups with HbA1c <7.2%. The incidence of hypoglycemia and fracture was not significantly associated with the level of glycemic control. CONCLUSIONS Among older adults with diabetes mellitus, those with poor glycemic control were at higher risk for cardiovascular events compared with those with better glycemic control. However, strict glycemic control had no effect on cardiovascular risk in patients with HbA1c <7.2%.
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Affiliation(s)
- Koutaro Yokote
- Department of Endocrinology, Hematology, and GerontologyGraduate School of MedicineChiba UniversityChibaJapan
| | - Ryo Suzuki
- Department of Diabetes, Metabolism and EndocrinologyTokyo Medical UniversityTokyoJapan
| | - Maki Gouda
- Data Science DepartmentMitsubishi Tanabe Pharma CorporationTokyoJapan
| | - Hiroaki Iijima
- Medical Affairs DepartmentMitsubishi Tanabe Pharma CorporationTokyoJapan
| | - Akiko Yamazaki
- Data Science DepartmentMitsubishi Tanabe Pharma CorporationTokyoJapan
| | - Masaya Inagaki
- Data Science DepartmentMitsubishi Tanabe Pharma CorporationTokyoJapan
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Kaneko S. Novel approaches to pharmacological management of type 2 diabetes in Japan. Expert Opin Pharmacother 2021; 22:2235-2249. [PMID: 34461791 DOI: 10.1080/14656566.2021.1974401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Newly developed anti-diabetic medications have had multiple activities, beyond a blood glucose-lowering effect. Current drugs for treating type 2 diabetes mellitus (T2DM) are based on the use of gastrointestinal hormones. Representative incretin preparations, such as those with glucagon-like peptide (GLP)-1 or gastric inhibitory polypeptide (GIP) activity, aim to provide new means of controlling blood glucose levels, body weight, and lipid metabolism. AREA COVERED In this manuscript, the pathophysiology of T2DM and the activities and characteristics of novel diabetic drugs are reviewed in the context of the Japanese population. This review also highlights the need for novel medicines to overcome the accompanying challenges. Finally, the author provides the reader with their expert perspectives. EXPERT OPINION The incidence of T2DM has been increasing in the aging of Japanese society. In older people, medical development should focus on safety, easier self-administration, and the relief of caregiver burden in terms of continuous administration. In the young, the focus should be on effectiveness, with a particular emphasis on the protection of organs, increasing the ease of adherence, and safety. Novel medicines will need to push the envelope in these areas.
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Affiliation(s)
- Shizuka Kaneko
- Department of Diabetes/Endocrinology/Metabolism, Takatsuki Red Cross Hospital, Takatsuki, Osaka, Japan
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Chen X, Lin Z, Gao R, Yang Y, Li L. Prevalence and Associated Factors of Falls among Older Adults between Urban and Rural Areas of Shantou City, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137050. [PMID: 34280986 PMCID: PMC8297296 DOI: 10.3390/ijerph18137050] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/25/2021] [Accepted: 06/29/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND To investigate the prevalence of falls and associated factors among older adults in urban and rural areas and to facilitate the design of fall prevention interventions. METHODS We used cluster random sampling to investigate the sociodemographic information, living habits, medical status, falls, home environment, and balance ability among 649 older adult participants. Univariate and multivariate logistic regression were used to examine the associated factors of falls. RESULTS The incidence of falls among older adults in Shantou City was 20.65%. Among them, the incidence was 27.27% in urban areas and 16.99% in rural areas. The rate of injury from falls among older adults was 14.48%, with18.61% in urban area and 12.20% in rural area. Multivariate analysis showed that the associated factors of falls among older adults in Shantou City included a high school or below education level (OR = 2.387, 95% CI: 1.305-4.366); non-farming as the previous occupation (OR = 2.574, 95% CI: 1.613-4.109); incontinence(OR = 2.881, 95% CI: 1.517-5.470); lack of fall prevention education (OR = 1.856, 95% CI: 1.041-3.311); and reduced balance ability (OR = 3.917, 95% CI: 2.532-6.058). DISCUSSION Older adults have a higher rate of falling in Shantou City, compared to the average rate in China. There are similarities and differences in the associated factors of falls among older adults between urban and rural areas of Shantou City. Targeted interventions for older adults in different regions may be more effective in reducing the risk of falls.
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Affiliation(s)
- Xiaodong Chen
- Injury Prevention Research Center, Shantou University Medical College, Shantou 515041, China; (X.C.); (Z.L.); (R.G.)
- School of Public Health, Shantou University, Shantou 515041, China
| | - Zeting Lin
- Injury Prevention Research Center, Shantou University Medical College, Shantou 515041, China; (X.C.); (Z.L.); (R.G.)
- School of Public Health, Shantou University, Shantou 515041, China
| | - Ran Gao
- Injury Prevention Research Center, Shantou University Medical College, Shantou 515041, China; (X.C.); (Z.L.); (R.G.)
- School of Public Health, Shantou University, Shantou 515041, China
| | - Yijian Yang
- Department of Sports Science and Physical Education, Chinese University of Hong Kong, Hong Kong, China;
- Jockey Club Institute of Ageing, Chinese University of Hong Kong, Hong Kong, China
| | - Liping Li
- Injury Prevention Research Center, Shantou University Medical College, Shantou 515041, China; (X.C.); (Z.L.); (R.G.)
- School of Public Health, Shantou University, Shantou 515041, China
- Correspondence:
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Wen Y, Liao J, Yin Y, Liu C, Gong R, Wu D. Risk of falls in 4 years of follow-up among Chinese adults with diabetes: findings from the China Health and Retirement Longitudinal Study. BMJ Open 2021; 11:e043349. [PMID: 34103310 PMCID: PMC8190046 DOI: 10.1136/bmjopen-2020-043349] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES This study was to determine the incidence of falls and identify baseline factors increased risk for incident falls over time among people with diabetes. DESIGN This study was a secondary analysis using the baseline and 4 years of follow-up data from the China Health and Retirement Longitudinal Study (CHARLS). SETTING A nationally representative survey of 17 500 Chinese residents aged 45 years and older were recruited in the baseline national survey in 2011. These participants were followed up every 2 years. PARTICIPANTS A total of 1238 middle-aged and older adults with diabetes and no history of falls at baseline were included in the current study. PRIMARY AND SECONDARY OUTCOME MEASURES Information on incidence of falls and medical treatment resulting from falls were determined by self-report. RESULTS The findings showed that the incidence of falls was 29.4% during 4 years of follow-up. Participants with incident falls were younger, were more likely to be women, had lower education level and were less likely to be current drinkers. In addition, former drinkers were 2.22 times more likely to fall. Socially active individuals were 47% less likely to fall compared with those without social activities. Every 5 kg increase in grip strength was associated with a 13% lower risk of falls. A 10 mg/dL higher total cholesterol and 1 mg/dL higher blood urea nitrogen were associated with a 4% and 6% higher risk of falls. Finally, participants with depressive symptoms were 1.47 times more likely to fall compared with those without depressive symptoms. CONCLUSIONS These findings underscore the importance of developing a fall prevention programme for those with diabetes, and this programme should address potentially modifiable risk factors, including levels of total cholesterol, blood urea nitrogen, social activity, depressive symptoms and grip strength.
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Affiliation(s)
- Yue Wen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Liao
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yiqiong Yin
- Gastrointestinal Department, West China Hospital, Sichuan University, Chengdu, China
| | - Chunjuan Liu
- West China School of Nursing, Sichuan University/ West China Hospital, Sichuan University, Chengdu, China
| | - Renrong Gong
- Department of Surgery, West China Hospital, Sichuan University/ Department of Surgery, West China School of Nursing, Sichuan University /Nursing Key Laboratory of Sichuan Province, Chengdu, China
| | - Dongmei Wu
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
- Department of Nursing, The Fourth People's Hospital of Chengdu & Chengdu Mental Health Center, Chengdu, China
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A Japanese Study Assessing Glycemic Control with Use of IDegAsp Co-formulation in Patients with Type 2 Diabetes in Clinical Practice: The JAGUAR Study. Adv Ther 2021; 38:1638-1649. [PMID: 33560496 PMCID: PMC7932946 DOI: 10.1007/s12325-021-01623-y] [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: 11/12/2020] [Accepted: 01/12/2021] [Indexed: 12/18/2022]
Abstract
Introduction The aim of this study was to evaluate the glycemic control and safety of insulin degludec/insulin aspart (IDegAsp) co-formulation in Japanese patients with type 2 diabetes (T2D) in a real-world clinical setting, including elderly patients (aged > 75 years). Methods Patients (≥ 18 years) diagnosed with T2D, previously treated with insulin were included from the Japanese Medical Data Vision database. Baseline data were taken at the index date, defined as the first IDegAsp prescription claim. Change in glycated hemoglobin (HbA1c) at 12 months was estimated using a mixed model repeated measures analysis. The proportion of patients achieving target HbA1c < 8.0% without experiencing hypoglycemia (identified by International Classification of Disease codes) was calculated at 12 months (365 ± 90 days) after baseline. Results Overall, 10,798 patients were included, 3940 were aged > 75 years, and 913 had baseline HbA1c values available. Switching to IDegAsp was associated with significantly improved HbA1c values at 12 months (− 1.23% [− 1.43, − 1.02]95%CI, p < 0.001) versus baseline. Moreover, relative to baseline, a significantly greater proportion of patients achieved HbA1c < 8.0% without hypoglycemia at 12 months, relative rate (RR) 1.30 [1.15, 1.45]95%CI, p < 0.001. Results were similar for patients aged ≤ 75 years and aged > 75 years; 66% and 64% of patients, respectively, achieved HbA1c < 8.0% without hypoglycemia at 12 months. Conclusion Switching from insulin to IDegAsp co-formulation was associated with significantly improved glycemic control and a reduction in hypoglycemia rate during 12 months of follow-up in Japanese patients with T2D, including those aged > 75 years. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01623-y.
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Wang RH, Hsu HC, Chen SY, Lee CM, Lee YJ, Ma SM, Chen WY. Risk factors of falls and the gender differences in older adults with diabetes at outpatient clinics. J Adv Nurs 2021; 77:2718-2727. [PMID: 33615509 DOI: 10.1111/jan.14795] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/08/2020] [Accepted: 01/30/2021] [Indexed: 11/29/2022]
Abstract
AIMS To explore the risk factors of falls and the gender differences based on demographic and disease characteristics, physical capability, and fear of falling in older adults with diabetes visiting outpatient clinics in Taiwan. DESIGN Cross-sectional design. METHODS A total of 485 patients with type 2 diabetes aged between 65 and 80 years were recruited from three endocrine outpatient clinics in Taiwan. Demographic and disease characteristics, fall history in the previous one year and fear of falling were collected by a self-reported questionnaire. Calf circumference, handgrip strength, one-leg standing and time up-and-go tests were all performed to assess the physical capability of participants. Data were collected from May 2019 to May 2020. RESULTS Female gender (OR = 1.75), handgrip strength (OR = 2.43) and fear of falling (OR = 3.38) were important risk factors of falls overall, although fear of falling (OR = 4.69) was the only important risk factor of falls in males, while handgrip strength (OR = 3.48) and fear of falling (OR = 2.86) were important risk factors of falls in females. The sensitivity of simultaneous screening handgrip strength and fear of falling were 85.7, 86.4 and 86.2 in males, females and older adults overall with diabetes, respectively. CONCLUSION Fear of falling was an important risk factor of falls in both genders, especially in males. Handgrip strength was an important risk factor of falls specifically for females. By simultaneously screening fear of falling and handgrip strength, risk of falls in older adults with diabetes at outpatient clinics could be identified in a more timely manner. Impact Nurses could periodically and simultaneously assess fear of falling and handgrip strength of older adults with diabetes at outpatient clinics. For those are identified at risk of falls on either fear of falling or handgrip strength, nurses could provide corresponding interventions to reduce the fear of falling or improve muscle strength to prevent such falls.
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Affiliation(s)
- Ruey-Hsia Wang
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | | | - Shi-Yu Chen
- Tri-Service General Hospital, Taipei, Taiwan
| | | | | | | | - Wan-Yi Chen
- Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
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Hermann M, Heimro LS, Haugstvedt A, Hernar I, Sigurdardottir AK, Graue M. Hypoglycaemia in older home-dwelling people with diabetes- a scoping review. BMC Geriatr 2021; 21:20. [PMID: 33413148 PMCID: PMC7792330 DOI: 10.1186/s12877-020-01961-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/14/2020] [Indexed: 12/21/2022] Open
Abstract
Background Hypoglycaemia is associated with cognitive and functional decline in older people with diabetes. Identification of individuals at risk and prevention of hypoglycaemia is therefore an important task in the management of diabetes in older home-dwelling individuals. The purpose of this scoping review was to map the literature on hypoglycaemia in home-dwelling older people with diabetes. Methods This scoping review included original research articles on hypoglycaemia in older (≥ 65 years) individuals with diabetes from developed countries. A broad search of the databases Cinahl, Embase and Medline was performed in July 2018. The report of the scoping review was conducted in accordance with the PRISMA Extension for Scoping Reviews. Results Our database search identified 577 articles of which 23 were eligible for inclusion. The identified literature was within four areas: 1) incidence of hypoglycaemia in older home-dwelling people with diabetes (11/23 articles), 2) risk factors of hypoglycaemia (9/23), 3) diabetes knowledge and self-management (6/23) and 4) consequences of hypoglycaemia for health care use (6/23). The majority of the literature focused on severe hypoglycaemia and the emergency situation. The literature on diabetes knowledge and management related to preventing adverse events relevant to older home-dwellers, was limited. We found no literature on long-term consequences of hypoglycaemia for the use of home health care services and the older persons’ ability to remain home-dwelling. Conclusions We identified a lack of studies on prevention and management of hypoglycaemia in the older individuals’ homes. Such knowledge is of utmost importance in the current situation where most western countries’ governmental policies aim to treat and manage complex health conditions in the patient’s home. Future studies addressing hypoglycaemia in older individuals with diabetes are needed in order to tailor interventions aiming to enable them to remain home-dwelling as long as possible. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-020-01961-6.
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Affiliation(s)
- Monica Hermann
- Faculty of Health and Social Sciences, Institute of Health and Caring Sciences, Western Norway University of Applied Sciences, Stord, Norway.
| | - Lovise S Heimro
- Faculty of Health and Social Sciences, Institute of Health and Caring Sciences, Western Norway University of Applied Sciences, Stord, Norway
| | - Anne Haugstvedt
- Faculty of Health and Social Sciences, Institute of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Ingvild Hernar
- Faculty of Health and Social Sciences, Institute of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Arun K Sigurdardottir
- School of Health Sciences, University of Akureyri, Akureyri, Iceland.,Akureyri Hospital, Akureyri, Iceland
| | - Marit Graue
- Faculty of Health and Social Sciences, Institute of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Demir T, Turan S, Unluhizarci K, Topaloglu O, Tukek T, Gogas Yavuz D. Use of Insulin Degludec/Insulin Aspart in the Management of Diabetes Mellitus: Expert Panel Recommendations on Appropriate Practice Patterns. Front Endocrinol (Lausanne) 2021; 12:616514. [PMID: 33776914 PMCID: PMC7996092 DOI: 10.3389/fendo.2021.616514] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/18/2021] [Indexed: 12/20/2022] Open
Abstract
Insulin degludec/insulin aspart (IDegAsp) is a fixed-ratio co-formulation of insulin degludec (IDeg), which provides long-lasting basal insulin coverage, and insulin aspart (IAsp), which targets post-prandial glucose. This expert panel aimed to provide a practical and implementable guidance document to assist clinicians in prescribing IDegAsp in the diabetes management with respect to different patient populations including children and adults with type 1 diabetes (T1D) or type 2 diabetes (T2D) as well as pregnant, elderly and hospitalized patients and varying practice patterns (insulin-naive, insulin-treated, switching from basal, basal bolus and premix regimens). The experts recommended that IDegAsp can be used in insulin-naive T2D patients with poor glycemic control (HbA1c >8.5%) despite optimal oral antidiabetic drugs (OADs) as well as in insulin-treated T2D patients by switching from basal insulin, basal-bolus therapy or premixed insulins in relation to lower risk of nocturnal hypoglycemia, fewer injections and lower intraday glycemic variability, respectively. The experts considered the use of IDegAsp in children with T2D as a basal bolus alternative rather than as an alternative to basal insulin after metformin failure, use of IDegAsp in adult T1D patients as a simplified basal bolus regimen with lesser nocturnal hypoglycemia, fewer injections and better fasting plasma glucose control and in children with T1D as an alternative insulin regimen with fewer injection to increase treatment adherence. The proposed expert opinion provides practical information on use of IDegAsp in different patient populations and practice patterns to assist clinicians, which seems to compensate the need for easily implementable guidance on this novel insulin regimen.
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Affiliation(s)
- Tevfik Demir
- Department of Endocrinology and Metabolism, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Serap Turan
- Department Pediatric Endocrinology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Kursad Unluhizarci
- Department of Endocrinology and Metabolism, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Oya Topaloglu
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara City Hospital, Ankara, Turkey
| | - Tufan Tukek
- Department of Endocrinology and Metabolism, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Dilek Gogas Yavuz
- Department of Endocrinology and Metabolism, Marmara University Faculty of Medicine, Istanbul, Turkey
- *Correspondence: Dilek Gogas Yavuz,
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Mattishent K, Loke YK. Meta-Analysis: Association Between Hypoglycemia and Serious Adverse Events in Older Patients Treated With Glucose-Lowering Agents. Front Endocrinol (Lausanne) 2021; 12:571568. [PMID: 33763024 PMCID: PMC7982741 DOI: 10.3389/fendo.2021.571568] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 01/11/2021] [Indexed: 12/17/2022] Open
Abstract
AIMS We conducted a meta-analysis of serious adverse events (dementia, macro- and micro-vascular events, falls and fractures, and death) associated with hypoglycemia in older patients treated with glucose lowering drugs. MATERIALS AND METHODS Meta-analysis of studies reporting on hypoglycemia and adverse events. The search included studies from two previously published systematic reviews, and an updated search of MEDLINE and EMBASE from April 2014 to November 2019. We assessed study validity based on ascertainment of hypoglycemia, adverse events and adjustment for confounders, and conducted a random effects meta-analyses, assessing heterogeneity using the I2 statistic. RESULTS We included 44 studies involving 2,507,434 participants. Most of the studies used adjusted analysis for confounders and hypoglycaemic events were typically identified based on healthcare databases (severe events). Hypoglycemia was associated with increased likelihood of death in a meta-analysis of eighteen studies, pooled OR 2.02 (95% Confidence Interval 1.75-2.32). Studies assessing mortality signal a time-response relationship with a higher risk of adverse events occurring within the first 90 days after hypoglycemia. Our meta-analysis of nine studies demonstrated that hypoglycaemic episodes were associated with dementia - pooled OR 1.50 (95% CI 1.29-1.74). Our meta-analysis of nineteen studies demonstrated associations between hypoglycaemia and macrovascular complications, pooled OR 1.81 (95% CI 1.70-1.94), and microvascular complications (two studies) pooled OR 1.77 (95% CI 1.49-2.10). There is also an association between hypoglycemia and cardiovascular death (six studies) - pooled OR 2.11 (95% CI 1.55 to 2.87). Similarly, our meta-analysis of six studies demonstrated an association between hypoglycemia and falls and fractures, pooled OR 1.78 (95% CI 1.44-2.21) and 1.68 (95% CI 1.37-2.07) respectively. CONCLUSION This meta-analysis confirms previously reported concerns of serious harm following hypoglycemia, especially in the immediate time period after a hypoglycaemic event. Avoidance of hypoglycaemic episodes should be a priority in this vulnerable population.
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14
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Mehta R, Chen R, Hirose T, John M, Kok A, Lehmann R, Unnikrishnan AG, Yavuz DG, Fulcher G. Practical use of insulin degludec/insulin aspart in a multinational setting: beyond the guidelines. Diabetes Obes Metab 2020; 22:1961-1975. [PMID: 32618405 PMCID: PMC7689716 DOI: 10.1111/dom.14128] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/17/2020] [Accepted: 06/26/2020] [Indexed: 12/17/2022]
Abstract
Insulin degludec/insulin aspart (IDegAsp) is a fixed-ratio co-formulation of insulin degludec, which provides long-lasting basal insulin coverage, and insulin aspart, which targets postprandial glycaemia. This review provides expert opinion on the practical clinical use of IDegAsp, including: dose timings relative to meals, when and how to intensify treatment from once-daily (OD) to twice-daily (BID) dose adjustments, and use in special populations (including hospitalized patients). IDegAsp could be considered as one among the choices for initiating insulin treatment, preferential to starting on basal insulin alone, particularly for people with severe hyperglycaemia and/or when postprandial hyperglycaemia is a major concern. The recommended starting dose of IDegAsp is 10 units with the most carbohydrate-rich meal(s), followed by individualized dose adjustments. Insulin doses should be titrated once weekly in two-unit steps, guided by individualized fasting plasma glucose targets and based on patient goals, preferences and hypoglycaemia risk. Options for intensification from IDegAsp OD are discussed, which should be guided by HbA1c, prandial glucose levels, meal patterns and patient preferences. Recommendations for switching to IDegAsp from basal insulin, premixed insulins OD/BID, and basal-plus/basal-bolus regimens are discussed. IDegAsp can be co-administered with other antihyperglycaemic drugs; however, sulphonylureas frequently need to be discontinued or the dose reduced, and the IDegAsp dose may need to be decreased when sodium-glucose co-transporter-2 inhibitors or glucagon-like peptide-1 receptor agonists are added. Considerations around the initiation or continuation of IDegAsp in hospitalized individuals are discussed, as well as in those undergoing medical procedures.
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Affiliation(s)
- Roopa Mehta
- Unidad de Investigación en Enfermedades Metabólicas, Departamento de Endocrinología y MetabolismoInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico CityMexico
| | - Roger Chen
- Department of EndocrinologySt Vincentʼs HospitalSydneyAustralia
- University of New South Wales, Office of Medical EducationUniversity of SydneySydneyAustralia
| | - Takahisa Hirose
- Division of Diabetes, Metabolism and Endocrinology, Department of MedicineToho University School of MedicineTokyoJapan
| | - Mathew John
- Providence Endocrine and Diabetes Specialty CentreThiruvananthapuramKeralaIndia
| | - Adri Kok
- Netcare Union and Clinton HospitalsAlbertonSouth Africa
- University of WitwatersrandJohannesburgSouth Africa
| | - Roger Lehmann
- Department of EndocrinologyUniversity Hospital ZurichZurichSwitzerland
| | | | - Dilek Gogas Yavuz
- Department of Endocrinology and MetabolismMarmara University School of MedicineIstanbulTurkey
| | - Gregory Fulcher
- Northern Clinical SchoolUniversity of SydneySydneyAustralia
- Department of Diabetes, Endocrinology & MetabolismRoyal North Shore Hospital, University of SydneySydneyAustralia
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Kim J, Lee W, Lee SH. A Systematic Review of the Guidelines and Delphi Study for the Multifactorial Fall Risk Assessment of Community-Dwelling Elderly. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176097. [PMID: 32825699 PMCID: PMC7504076 DOI: 10.3390/ijerph17176097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/17/2020] [Accepted: 08/20/2020] [Indexed: 12/22/2022]
Abstract
As falls are among the most common causes of injury for the elderly, the prevention and early intervention are necessary. Fall assessment tools that include a variety of factors are recommended for preventing falls, but there is a lack of such tools. This study developed a multifactorial fall risk assessment tool based on current guidelines and validated it from the perspective of professionals. We followed the Meta-Analysis of Observational Studies in Epidemiology’s guidelines in this systematic review. We used eight international and five Korean databases to search for appropriate guidelines. Based on the review results, we conducted the Delphi survey in three rounds; one open round and two scoring rounds. About nine experts in five professional areas participated in the Delphi study. We included nine guidelines. After conducting the Delphi study, the final version of the “Multifactorial Fall Risk Assessment tool for Community-Dwelling Older People” (MFA-C) has 36 items in six factors; general characteristics, behavior factors, disease history, medication history, physical function, and environmental factors. The validity of the MFA-C tool was largely supported by various academic fields. It is expected to be beneficial to the elderly in the community when it comes to tailored interventions to prevent falls.
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Affiliation(s)
- Jieun Kim
- Red Cross College of Nursing, Chung-Ang University, Seoul 06974, Korea;
| | - Worlsook Lee
- National Evidence-based Healthcare Collaborating Agency, Seoul 04554, Korea;
| | - Seon Heui Lee
- Department of Nursing Science, College of Nursing, Gachon University, Incheon 13120, Korea
- Correspondence: ; Tel.: +82-32-820-4230
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16
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Abe H, Shikuma J, Suwanai H, Sano K, Okumura T, Kan K, Takahashi T, Miwa T, Suzuki R, Odawara M. Assessing hypoglycemia frequency using flash glucose monitoring in older Japanese patients with type 2 diabetes receiving oral hypoglycemic agents. Geriatr Gerontol Int 2019; 19:1030-1035. [PMID: 31486247 PMCID: PMC6852429 DOI: 10.1111/ggi.13765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 07/29/2019] [Accepted: 08/05/2019] [Indexed: 12/18/2022]
Abstract
AIM It is important to consider hypoglycemia for glycemic control in elderly patients with type 2 diabetes. Continuous blood glucose monitoring system is an effective method to investigate blood glucose fluctuation. This study examined hypoglycemia frequency using continuous blood glucose monitoring system in older patients with type 2 diabetes. METHODS A total of 70 patients with type 2 diabetes aged >65 years, receiving oral treatment only and having a glycated hemoglobin (HbA1c) level of <8% were enrolled. Flash glucose monitoring system was used for the device. Patients were classified into three groups according to the type of medicine administered, in addition to other oral hypoglycemics, and were compared: (i) those taking sulfonylureas (SU); (ii) those taking glinides; and (iii) those who did not take either SU or glinides. RESULTS There was a significant positive correlation between the coefficient of variation and hypoglycemic frequency in all the patients, and a significant negative correlation between HbA1c and hypoglycemia in those receiving SU. When hypoglycemia was defined as glucose levels <54 mg/dL and <70 mg/dL, the cut-off HbA1c values for developing hypoglycemia were 6.3% and 6.7%, sensitivity was 75.0% and 76.2%, and specificity was 90.9% and 77.6%, respectively. CONCLUSIONS In older patients with type 2 diabetes receiving SU, hypoglycemic frequency increases with decreases in HbA1c level. In particular, in patients with HbA1c levels of <6.3% receiving SU, it is necessary to consider medication modification. Geriatr Gerontol Int 2019; 19: 1030-1035.
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Affiliation(s)
- Hironori Abe
- Department of Diabetes, Metabolism, Endocrinology, Rheumatology and Collagen Diseases, Tokyo Medical University, Tokyo, Japan
| | - Junpei Shikuma
- Department of Diabetes, Metabolism, Endocrinology, Rheumatology and Collagen Diseases, Tokyo Medical University, Tokyo, Japan
| | - Hirotsugu Suwanai
- Department of Diabetes, Metabolism, Endocrinology, Rheumatology and Collagen Diseases, Tokyo Medical University, Tokyo, Japan
| | - Koji Sano
- Department of Diabetes, Metabolism, Endocrinology, Rheumatology and Collagen Diseases, Tokyo Medical University, Tokyo, Japan
| | - Takako Okumura
- Department of Diabetes, Metabolism, Endocrinology, Rheumatology and Collagen Diseases, Tokyo Medical University, Tokyo, Japan
| | - Kenshi Kan
- Department of Diabetes, Metabolism, Endocrinology, Rheumatology and Collagen Diseases, Tokyo Medical University, Tokyo, Japan
| | - Tomono Takahashi
- Department of Diabetes, Metabolism, Endocrinology, Rheumatology and Collagen Diseases, Tokyo Medical University, Tokyo, Japan
| | - Takashi Miwa
- Department of Diabetes, Metabolism, Endocrinology, Rheumatology and Collagen Diseases, Tokyo Medical University, Tokyo, Japan
| | - Ryo Suzuki
- Department of Diabetes, Metabolism, Endocrinology, Rheumatology and Collagen Diseases, Tokyo Medical University, Tokyo, Japan
| | - Masato Odawara
- Department of Diabetes, Metabolism, Endocrinology, Rheumatology and Collagen Diseases, Tokyo Medical University, Tokyo, Japan
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Borzì AM, Condorelli G, Biondi A, Basile F, Vicari ESD, Buscemi C, Luca S, Vacante M. Effects of vildagliptin, a DPP-4 inhibitor, in elderly diabetic patients with mild cognitive impairment. Arch Gerontol Geriatr 2019; 84:103896. [PMID: 31204117 DOI: 10.1016/j.archger.2019.06.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/02/2019] [Accepted: 06/02/2019] [Indexed: 01/06/2023]
Abstract
INTRODUCTION There is an unclear association between type 2 diabetes and mild cognitive impairment in the elderly. Both diseases are more prevalent in the older adults compared to the younger counterpart. Some anti-diabetic drugs seem to influence positively the evolution of mild cognitive impairment. This retrospective study investigated the effect of vildagliptin, an inhibitor of the enzyme dipeptidyl peptidase-4 (DPP-4), on the cognitive functioning of elderly diabetic patients with mild cognitive impairment (MCI) documented at mini mental state examination (MMSE). METHODS We included 60 diabetic elderly people which were divided in 2 groups: Group A, 30 patients with HbA1c (glycated hemoglobin) ≤7.5% and treated with metformin, and Group B, 30 patients with HbA1c >7.5%, and treated with metformin plus vildagliptin. We collected data on MMSE, fasting plasma glucose (FPG) and HbA1c at baseline and after 180 ± 10 days from the beginning of treatment. RESULTS The two groups exhibited significantly different values in FPG (P < 0.05) and HbA1c (P < 0.01) at baseline, and in MMSE score (P < 0.001) after treatment. The intragroup comparison showed a significant (P < 0.05) reduction in MMSE score in group A, and in HbA1c (P = 0.01) in group B. CONCLUSION Vildagliptin in addition to metformin resulted in the maintenance of MMSE score, showing a protecting role on cognitive functioning compared to the metformin only group.
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Affiliation(s)
- Antonio Maria Borzì
- Department of Clinical and Experimental Medicine, Specialization School in Geriatrics, University of Catania, AOU Policlinico, Catania, Italy.
| | - Giovanni Condorelli
- Department of Clinical and Experimental Medicine, Specialization School in Geriatrics, University of Catania, AOU Policlinico, Catania, Italy.
| | - Antonio Biondi
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy.
| | - Francesco Basile
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy.
| | - Enzo Saretto Dante Vicari
- Department of Clinical and Experimental Medicine, Specialization School in Geriatrics, University of Catania, AOU Policlinico, Catania, Italy.
| | - Carola Buscemi
- Department of Clinical and Experimental Medicine, Specialization School in Geriatrics, University of Catania, AOU Policlinico, Catania, Italy.
| | - Salvatore Luca
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy.
| | - Marco Vacante
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy.
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Abstract
PURPOSE OF REVIEW Based on a systematic literature search, we performed a comprehensive review of risk factors for falls and fractures in patients with diabetes. RECENT FINDINGS Patients with diabetes have an increased risk of fractures partly explained by increased bone fragility. Several risk factors as altered body composition including sarcopenia and obesity, impaired postural control, gait deficits, neuropathy, cardiovascular disease, and other co-morbidities are considered to increase the risk of falling. Diabetes and bone fragility is well studied, but new thresholds for fracture assessment should be considered. In general, the risk factors for falls in patients with diabetes are well documented in several studies. However, the fall mechanisms among diabetic patients have only been assessed in few studies. Thus, a gab of knowledge exits and may influence the current understanding and treatment, in order to reduce the risk of falling and thereby prevent fractures.
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Affiliation(s)
| | - Jakob Dal
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
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19
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Fulcher G, Mehta R, Fita EG, Ekelund M, Bain SC. Efficacy and Safety of IDegAsp Versus BIAsp 30, Both Twice Daily, in Elderly Patients with Type 2 Diabetes: Post Hoc Analysis of Two Phase 3 Randomized Controlled BOOST Trials. Diabetes Ther 2019; 10:107-118. [PMID: 30474818 PMCID: PMC6349271 DOI: 10.1007/s13300-018-0531-0] [Citation(s) in RCA: 5] [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: 08/06/2018] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION The majority of elderly patients (≥ 65 years of age) with type 2 diabetes mellitus (T2DM) will eventually require insulin therapy, but they are particularly vulnerable to hypoglycemia and challenging to treat. Insulin degludec/insulin aspart (IDegAsp) is a novel co-formulation of 70% insulin degludec and 30% insulin aspart administered in a single injection, either once or twice daily with main meals. METHODS A combined analysis of the phase 3 BOOST INTENSIFY PREMIX I (NCT01009580) and BOOST INTENSIFY ALL (NCT01059812) trials has previously reported lower rates of hypoglycemia during the maintenance period in patients with T2DM treated with IDegAsp twice daily (BID) versus biphasic insulin aspart 30 (BIAsp 30) BID. This post hoc analysis examined the safety and efficacy of IDegAsp versus BIAsp 30 in elderly patients from the global population of these two trials, and also from the Japanese cohort of BOOST INTENSIFY ALL. RESULTS Change in HbA1c was similar for IDegAsp versus BIAsp 30 (p > 0.5). Compared with BIAsp 30, IDegAsp resulted in significant reductions in fasting plasma glucose (p < 0.0001), numerically lower rates of overall and nocturnal hypoglycemia (global estimated rate ratios: 0.92 [0.67; 1.26]95% confidence interval [CI], p = 0.5980 and 0.67 [0.39; 1.18]95% CI, p = 0.1676, respectively), and a significantly lower total daily insulin dose at end of trial (global estimated treatment difference 0.79 [0.73; 0.87]95% CI, p < 0.0001) in elderly patients. CONCLUSION The results described here are consistent with those of the overall trial populations, demonstrating that IDegAsp BID is efficacious in elderly patients and suggesting that there is no need for special safety precautions. FUNDING Novo Nordisk. TRIAL REGISTRATION ClinicalTrials.gov identifiers, NCT01009580 and NCT01059812. Plain language summary available for this article.
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Affiliation(s)
- Greg Fulcher
- Royal North Shore Hospital, University of Sydney, Sydney, NSW, Australia.
| | - Roopa Mehta
- Unidad de Investigación en Enfermedades Metabólicas, Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | - Stephen C Bain
- Diabetes Research Unit Cymru, Swansea University, ABM University Health Board, Swansea, UK
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Ferrari SL, Abrahamsen B, Napoli N, Akesson K, Chandran M, Eastell R, El-Hajj Fuleihan G, Josse R, Kendler DL, Kraenzlin M, Suzuki A, Pierroz DD, Schwartz AV, Leslie WD. Diagnosis and management of bone fragility in diabetes: an emerging challenge. Osteoporos Int 2018; 29:2585-2596. [PMID: 30066131 PMCID: PMC6267152 DOI: 10.1007/s00198-018-4650-2] [Citation(s) in RCA: 193] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 07/19/2018] [Indexed: 12/11/2022]
Abstract
Fragility fractures are increasingly recognized as a complication of both type 1 and type 2 diabetes, with fracture risk that increases with disease duration and poor glycemic control. Yet the identification and management of fracture risk in these patients remains challenging. This review explores the clinical characteristics of bone fragility in adults with diabetes and highlights recent studies that have evaluated bone mineral density (BMD), bone microstructure and material properties, biochemical markers, and fracture prediction algorithms (i.e., FRAX) in these patients. It further reviews the impact of diabetes drugs on bone as well as the efficacy of osteoporosis treatments in this population. We finally propose an algorithm for the identification and management of diabetic patients at increased fracture risk.
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Affiliation(s)
- S L Ferrari
- Division of Bone Diseases, Department of Internal Medicine Specialties, Geneva University Hospital & Faculty of Medicine, 1205, Geneva, Switzerland.
| | - B Abrahamsen
- Department of Medicine, Holbaek Hospital, Holbaek, Denmark
- OPEN, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - N Napoli
- Unit of Endocrinology and Diabetes, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
- Division of Bone and Mineral Diseases, Washington University in St Louis, St Louis, MO, USA
| | - K Akesson
- Department of Clinical Sciences, Clinical and Molecular Osteoporosis Unit, Lund University, Malmö, Sweden
| | - M Chandran
- Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - R Eastell
- Academic Unit of Bone Metabolism, Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
| | - G El-Hajj Fuleihan
- Department of Internal Medicine, Division of Endocrinology, Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut Medical Center, Riad El Solh, Beirut, Lebanon
| | - R Josse
- Department of Medicine and Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
- Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, ON, Canada
| | - D L Kendler
- Department of Medicine, Division of Endocrinology, University of British Columbia, Vancouver, BC, Canada
| | - M Kraenzlin
- Endonet, Endocrine Clinic and Laboratory, Basel, Switzerland
| | - A Suzuki
- Division of Endocrinology and Metabolism, Fujita Health University, Toyoake, Aichi, Japan
| | - D D Pierroz
- International Osteoporosis Foundation, Nyon, Switzerland
| | - A V Schwartz
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - W D Leslie
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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21
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Abstract
An estimated 30.2 million Americans have diabetes, and this number is expected to increase based on trends over recent decades and compounded by an aging U.S. POPULATION As reviewed in this article, type 2 diabetes mellitus (T2DM) is associated with impaired health-related quality of life (HRQoL) and with a substantial socioeconomic burden. Compared with individuals without T2DM, those with T2DM have worse HRQoL, greater decrements in HRQoL over time, and possibly greater depressive symptomology. Diabetes-related complications and comorbidities (e.g., obesity and cardiovascular disease) are associated with worse HRQoL. Hypoglycemic episodes are associated with reduced HRQoL and greater levels of depression; they can also interfere with social and occupational activities. In turn, low HRQoL can be a driver for poor glycemic control. In 2012, the total estimated cost associated with diagnosed diabetes in the United States was $245 billion. Factors contributing to increased health care resource utilization and costs in patients with T2DM include medical comorbidities, diabetes-related complications, inadequate glycemic control, and hypoglycemic episodes. Readmission is a key driver of hospital-related costs and is more common among elderly patients with T2DM. Elderly patients with T2DM represent a particularly vulnerable population given that these patients may have varying degrees of physical and mental comorbidities that can increase their risk of hypoglycemia, falls, and depression. This review demonstrates that T2DM imposes a considerable burden on both the individual and society. Treatment strategies should consider the effects of treatment on HRQoL and on outcomes (e.g., complications and hypoglycemia) that affect both HRQoL and costs. Management strategies that maximize HRQoL while minimizing the risk of hypoglycemia and other treatment-related complications are particularly critical in the elderly. DISCLOSURES This supplement was funded by Novo Nordisk. Cannon reports speaker fees and owns stock in Novo Nordisk. Handelsman reports research grants from Amgen, AstraZeneca, Bristol-Myers Squibb, Boehringer Ingelheim, Grifols, Janssen, Lexicon, Merck, Novo Nordisk, Regeneron, and Sanofi; speaker fees from Amarin, Amgen, AstraZeneca, Boehringer Ingelheim-Lilly, Janssen, Merck, Novo Nordisk, Regeneron, and Sanofi; and has served in advisory capacity to Amarin, Amgen, AstraZeneca, Boehringer Ingelheim, Eisai, Intarcia, Janssen, Lilly, Merck, Merck-Pfizer, Novo Nordisk, Regeneron, and Sanofi. Heile reports speaker fees from and has served as advisor to Novo Nordisk. Shannon reports consultant and speaker fees from Novo Nordisk and Boehringer Ingelheim-Lilly Alliance.
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22
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Hope SV, Taylor PJ, Shields BM, Hattersley AT, Hamilton W. Are we missing hypoglycaemia? Elderly patients with insulin-treated diabetes present to primary care frequently with non-specific symptoms associated with hypoglycaemia. Prim Care Diabetes 2018; 12:139-146. [PMID: 28918198 PMCID: PMC5857285 DOI: 10.1016/j.pcd.2017.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 08/19/2017] [Indexed: 12/20/2022]
Abstract
INTRODUCTION We assessed if patients with known hypoglycaemia present on other occasions with non-specific symptoms associated with (but not diagnosed as) hypoglycaemia, potentially representing missed hypoglycaemia. METHODS 335 primary care records (5/2/12-4/2/13) from patients aged >65 (79 on insulin, 85 on sulphonylureas, 121 on metformin only, 50 without diabetes) were assessed for hypoglycaemia episodes and consultations with non-specific symptoms, "hypo clues". RESULTS 27/79(34%) insulin-treated patients had >1 documented hypoglycaemia episode, compared to 4/85(5%) sulphonylurea-treated patients, 2/121(2%) metformin-only treated patients, and none without diabetes, p<0.001. "Hypo clue" consultations were common: 1.37 consultations/patient/year in insulin-treated patients, 0.98/patient/year in sulphonylurea-treated, 0.97/patient/year in metformin only-treated, and 0.78/patient/year in non-diabetic patients, p=0.34. In insulin-treated patients with documented hypoglycaemia, 20/27(74%) attended on another occasion with a "hypo clue" symptom, compared to 21/52(40%) of those without hypoglycaemia, p=0.008. No significant difference in the other treatment groups. Nausea, falls and unsteadiness were the most discriminatory symptoms: 7/33(21%) with hypoglycaemia attended on another occasion with nausea compared to 14/302(5%) without hypoglycaemia, p=0.002; 10/33(30%) vs 36/302(12%) with falls, p=0.007; and 5/33(15%) vs 13/302(4%) with unsteadiness, p=0.023. CONCLUSIONS Non-specific symptoms are common in those >65 years. In insulin-treated patients at high hypoglycaemia risk, nausea, falls and unsteadiness should prompt consideration of hypoglycaemia.
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Affiliation(s)
- Suzy V Hope
- Exeter NIHR Clinical Research Facility, RILD Building, Royal Devon & Exeter Hospital, Barrack Road, Exeter, Devon EX2 5DW, UK.
| | - Phil J Taylor
- Axminster Medical Practice, St Thomas Court, Church Street, Axminster, EX13 5AG Devon, UK.
| | - Beverley M Shields
- Exeter NIHR Clinical Research Facility, RILD Building, Royal Devon & Exeter Hospital, Barrack Road, Exeter, Devon EX2 5DW, UK.
| | - Andrew T Hattersley
- Exeter NIHR Clinical Research Facility, RILD Building, Royal Devon & Exeter Hospital, Barrack Road, Exeter, Devon EX2 5DW, UK.
| | - Willie Hamilton
- Department of Primary Care, University of Exeter Medical School, St Luke's Campus, University of Exeter, Heavitree Rd, Exeter, Devon EX1 2LU, UK.
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Cheng PC, Hsu SR, Tu ST, Cheng YC, Liu YH. Body mass index influences the plasma glucose concentration during iatrogenic hypoglycemia in people with type 2 diabetes mellitus: a cross-sectional study. PeerJ 2018; 6:e4348. [PMID: 29473001 PMCID: PMC5816962 DOI: 10.7717/peerj.4348] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 01/19/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Hypoglycemia occurs in an appreciable number of individuals with type 2 diabetes mellitus (T2DM) who are receiving glycemic therapy. Iatrogenic hypoglycemia induces not only complications but also a substantial medical expense. Intervention for relevant risk factors may help avert severe hypoglycemia and enhance quality of life in at-risk individuals. This study investigates the relationship between body mass index (BMI) and plasma glucose concentration during iatrogenic hypoglycemia in people with T2DM. METHODS Enrollment criteria were people above 20 years of age, with existing diagnosis of T2DM, a documented plasma glucose level ≤70 mg/dL, and acute cognitive impairment requiring hospitalization. Participants were classified into two groups according to their BMI. Specifically, lower BMI subgroup denotes individuals whose BMI fall within lower half of the study population, and vice versa. Plasma glucose concentration, length of hospital stay, and serum electrolyte level at hospitalization were compared between these BMI subgroups. Moreover, multivariate regression analysis was performed to identify covariates associated with plasma glucose level during iatrogenic hypoglycemia. RESULTS This study enrolled 107 participants for whom 54 were assigned to a higher BMI subgroup and the remainder to a lower BMI subgroup. People with lower BMI harbored substantially reduced plasma glucose concentration during iatrogenic hypoglycemia compared to those with higher BMI (30.1 ± 9.6 mg/dL vs. 38.4 ± 12.3 mg/dL, P < 0.001). Nonetheless, the length of stay (6.2 ± 4.6 days vs. 5.7 ± 4.0 days, P = 0.77) and serum potassium level (3.7 ± 0.9 meq/L vs. 3.9 ± 0.8 meq/L, P = 0.14) were comparable between subgroups. Multivariate regression analysis identified BMI as a determinant of plasma glucose concentration in diabetic individuals with iatrogenic hypoglycemia (β coefficient: 0.72, P = 0.008). DISCUSSION In individuals with T2DM who experience severe iatrogenic hypoglycemia, BMI influences the plasma glucose level at hospitalization. People with lower BMI harbored appreciably reduced plasma glucose concentration relative to their higher BMI counterparts. In lower weight people, therefore, appropriate dosing of antidiabetic medications, frequent self-monitoring of blood glucose level and adequate nutritional support may help avert more severe hypoglycemia. Overall, BMI potentially influences the severity of iatrogenic hypoglycemia in people with T2DM.
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Affiliation(s)
- Po Chung Cheng
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua City, Taiwan
| | - Shang Ren Hsu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua City, Taiwan
| | - Shih Te Tu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua City, Taiwan
| | - Yun Chung Cheng
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu Hsiu Liu
- Department of Accounting and Information Systems, National Taichung University of Science and Technology, Taichung, Taiwan
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Adil M, Khan RA, Kalam A, Venkata SK, Kandhare AD, Ghosh P, Sharma M. Effect of anti-diabetic drugs on bone metabolism: Evidence from preclinical and clinical studies. Pharmacol Rep 2017; 69:1328-1340. [DOI: 10.1016/j.pharep.2017.05.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 04/25/2017] [Accepted: 05/22/2017] [Indexed: 12/18/2022]
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Hypoglycemia After Initiation of Basal Insulin in Patients with Type 2 Diabetes in the United States: Implications for Treatment Discontinuation and Healthcare Costs and Utilization. Adv Ther 2017; 34:2083-2092. [PMID: 28779282 PMCID: PMC5599444 DOI: 10.1007/s12325-017-0592-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Hypoglycemia and fear of hypoglycemia may contribute to basal insulin discontinuation, poor glycemic control, and increased healthcare burden in patients with type 2 diabetes (T2D). This study aimed to determine the impact of hypoglycemia soon after basal insulin initiation on treatment discontinuation and economic outcomes in patients with T2D. METHODS Hypoglycemic events within 6 months of basal insulin initiation were identified using retrospective cohort data from patients with T2D, at least 18 years of age, initiated on basal insulin therapy in the Clinformatics™ Data Mart for Multiplan claims database from January 1, 2008, through August 31, 2012. Data were adjusted for baseline characteristics. Discontinuation was established for patients with 12-month follow-up data, while discontinuation risk was assessed in the extended analysis (6- to 24-month follow-up) by Cox regression analysis. Healthcare use and costs were determined. RESULTS Of 55,608 patients, 4.5% experienced hypoglycemia within 6 months of basal insulin initiation. Patients with hypoglycemia were more likely to discontinue basal insulin within 12 months of initiation (79.0% vs. 74.2%; P < 0.001). Data, adjusted for baseline characteristics such as age, any baseline hypoglycemia, and use of oral antidiabetes drugs, showed that patients with hypoglycemia had a greater risk of discontinuation (hazard ratio 1.16; 95% confidence interval 1.03, 1.32; P = 0.0164), were more likely to have a hospitalization (41.0% vs. 24.3%; P < 0.001) or an ED visit (55.8% vs. 35.1%; P < 0.001), and had higher diabetes-related ($13,662 vs. $7506; P < 0.001) and all-cause ($30,719 vs. $19,079; P < 0.001) healthcare costs. CONCLUSIONS US patients with T2D who experienced hypoglycemia within 6 months of basal insulin initiation were more likely to discontinue treatment, accompanied by a greater healthcare burden. FUNDING Sanofi US, Inc.
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Hazuda HP, Espinoza SE. Prevention of Falls and Frailty in Older Adults with Diabetes. CURRENT GERIATRICS REPORTS 2017. [DOI: 10.1007/s13670-017-0209-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chandran M. Clinical aspects and management of osteoporosis and fragility fractures in patients with diabetes. Osteoporos Sarcopenia 2017; 3:123-127. [PMID: 30775516 PMCID: PMC6372781 DOI: 10.1016/j.afos.2017.08.101] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 08/21/2017] [Indexed: 01/11/2023] Open
Abstract
Both diabetes and osteoporosis are assuming epidemic proportions throughout the world. Accumulating data suggest that both types 1 and 2 diabetes are associated with an increased risk of fragility fractures. This increased risk appears to be largely independent of bone mineral density (BMD) which is most often noted to be low in type 1 diabetes and normal or increased in type 2 diabetes. This review explores the clinical characteristics of bone fragility in patients with diabetes and highlights studies that have evaluated BMD and fracture prediction tools in these patients. It also briefly reviews the current management principles of osteoporosis in diabetes, with special emphasis on the impact of diabetes medications on bone health as well as explores the efficacy of currently available antiosteoporosis pharmacotherapy in the diabetic population.
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Affiliation(s)
- Manju Chandran
- Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore
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Valent F. Falls requiring visit to emergency room in a population-based cohort of diabetic patients in Italy. J Inj Violence Res 2017; 9:83-90. [PMID: 28854160 PMCID: PMC5556630 DOI: 10.5249/jivr.v9i2.859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 06/21/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The aims were to assess the frequency of falls among the diabetic adult population of the Italian Northeastern region Friuli Venezia Giulia and to identify risk factors. METHODS This was a population-based retrospective cohort study using administrative data of the regional health information system as the source of information. In a cohort of diabetics 18 years of age or more, living in the region on December 31, 2014, the occurrence of falls requiring a visit to the regional Emergency Rooms was assessed. Multivariate logistic regression was used to identify factors associated with increased risk of falling. RESULTS Of 80,162 cohort subjects, 2967 (3.7%) had at least one fall requiring a visit to ER. Factors associated with increased risk of falling were female sex, older age, prescription of a thiazolidinedione as the last antidiabetic medication in 2014, increasing number of active principles prescribed in 2014, longer diabetes duration, and prescription of certain classes of medications other than antidiabetics in 2014. CONCLUSIONS In Friuli Venezia Giulia, injurious falls are a complication of diabetes relevant from the public health viewpoint. Efforts are needed to screen diabetic patients, review their prescriptions, provide appropriate care, and implement targeted interventions to minimize the individual risk of falls.
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Affiliation(s)
- Francesca Valent
- Servizio Epidemiologico-Direzione Centrale Salute, Integrazione Sociosanitaria, Politiche Sociali e Famiglia-Regione Autonoma Friuli Venezia Giulia-Udine, Italy.
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Blevins TC, Farooki A. Bone effects of canagliflozin, a sodium glucose co-transporter 2 inhibitor, in patients with type 2 diabetes mellitus. Postgrad Med 2016; 129:159-168. [DOI: 10.1080/00325481.2017.1256747] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
| | - Azeez Farooki
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Mattishent K, Loke YK. Meta-analysis: Association between hypoglycaemia and serious adverse events in older patients. J Diabetes Complications 2016; 30:811-8. [PMID: 27083445 DOI: 10.1016/j.jdiacomp.2016.03.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 02/26/2016] [Accepted: 03/15/2016] [Indexed: 01/30/2023]
Abstract
AIMS We aimed to conduct a meta-analysis of serious adverse events (macro- and microvascular events, falls and fractures, death) associated with hypoglycaemia in older patients. METHODS We searched MEDLINE and EMBASE spanning a ten-year period up to March 2015 (with automated PubMed updates to October 2015). We selected observational studies reporting on hypoglycaemia and associated serious adverse events, and conducted a meta-analysis. We assessed study validity based on ascertainment of hypoglycaemia, adverse events and adjustment for confounders. RESULTS We included 17 studies involving 1.86 million participants. Meta-analysis of eight studies demonstrated that hypoglycemic episodes were associated with macrovascular complications, odds ratio (OR) 1.83 (95% confidence interval [CI] 1.64, 2.05), and microvascular complications in two studies OR 1.77 (95% CI 1.49, 2.10). Meta-analysis of four studies demonstrated an association between hypoglycaemia and falls or fractures, OR 1.89 (95% CI 1.54, 2.32) and 1.92 (95% CI 1.56, 2.38) respectively. Hypoglycaemia was associated with increased likelihood of death in a meta-analysis of eight studies, OR 2.04 (95% Confidence Interval 1.68, 2.47). CONCLUSION Our meta-analysis raises major concerns about a range of serious adverse events associated with hypoglycaemia. Clinicians should prioritize individualized therapy and closer monitoring strategies to avoid hypoglycaemia in susceptible older patients.
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Affiliation(s)
| | - Yoon Kong Loke
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK.
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Wu FL, Juang JH, Lin CH. Development and validation of the hypoglycaemia problem-solving scale for people with diabetes mellitus. J Int Med Res 2016; 44:592-604. [PMID: 27059292 PMCID: PMC5536707 DOI: 10.1177/0300060516636752] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 02/09/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To develop and psychometrically test a new instrument, the hypoglycaemia problem-solving scale (HPSS), which was designed to measure how well people with diabetes mellitus manage their hypoglycaemia-related problems. METHODS A cross-sectional survey design approach was used to validate the performance assessment instrument. Patients who had a diagnosis of type 1 or type 2 diabetes mellitus for at least 1 year, who were being treated with insulin and who had experienced at least one hypoglycaemic episode within the previous 6 months were eligible for inclusion in the study. RESULTS A total of 313 patients were included in the study. The initial draft of the HPSS included 28 items. After exploratory factor analysis, the 24-item HPSS consisted of seven factors: problem-solving perception, detection control, identifying problem attributes, setting problem-solving goals, seeking preventive strategies, evaluating strategies, and immediate management. The Cronbach's α for the total HPSS was 0.83. CONCLUSIONS The HPSS was verified as being valid and reliable. Future studies should further test and improve the instrument to increase its effectiveness in helping people with diabetes manage their hypoglycaemia-related problems.
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Affiliation(s)
- Fei-Ling Wu
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan
| | - Jyuhn-Huarng Juang
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Chia-Hung Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
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El-Menyar A, Mekkodathil A, Al-Thani H. Traumatic injuries in patients with diabetes mellitus. J Emerg Trauma Shock 2016; 9:64-72. [PMID: 27162438 PMCID: PMC4843569 DOI: 10.4103/0974-2700.179461] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Diabetes mellitus (DM) is associated with increased in-hospital morbidity and mortality in patients sustained traumatic injuries. Identification of risk factors of traumatic injuries that lead to hospital admissions and death in DM patients is crucial to set effective preventive strategies. We aimed to conduct a traditional narrative literature review to describe the role of hypoglycemia as a risk factor of driving and fall-related traumatic injuries. DM poses significant burden as a risk factor and predictor of worse outcomes in traumatic injuries. Although there is no consensus on the impact and clear hazards of hyperglycemia in comparison to the hypoglycemia, both extremes of DM need to be carefully addressed and taken into consideration for proper management. Moreover, physicians, patients, and concerned authorities should be aware of all these potential hazards to share and establish the right management plans.
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Affiliation(s)
- Ayman El-Menyar
- Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar; Department of Surgery, Trauma Surgery Section, Clinical Research, Hamad General Hospital, Doha, Qatar; Department of Internal Medicine, Ahmed Maher Teaching Hospital, Cairo, Egypt
| | - Ahammed Mekkodathil
- Department of Surgery, Trauma Surgery Section, Clinical Research, Hamad General Hospital, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
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Efficacy and Acceptability of Glycemic Control of Glucagon-Like Peptide-1 Receptor Agonists among Type 2 Diabetes: A Systematic Review and Network Meta-Analysis. PLoS One 2016; 11:e0154206. [PMID: 27158818 PMCID: PMC4861281 DOI: 10.1371/journal.pone.0154206] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 04/11/2016] [Indexed: 12/26/2022] Open
Abstract
Objective To synthesize current evidence of the impact of Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) on hypoglycemia, treatment discontinuation and glycemic level in patients with type 2 diabetes. Design Systematic review and network meta-analysis. Data Sources Literature search (Medline, Embase, the Cochrane library), website of clinical trial, bibliographies of published systematic reviews. Eligibility Criteria Randomized controlled trials with available data comparing GLP-1 RAs with placebo or traditional anti-diabetic drugs in patients with type 2 diabetes. Data Synthesis Traditional pairwise meta-analyses within DerSimonian-Laird random effects model and network meta-analysis within a Bayesian framework were performed to calculate odds ratios for the incidence of hypoglycemia, treatment discontinuation, HbA1c<7.0% and HbA1c<6.5%. Ranking probabilities for all treatments were estimated to obtain a treatment hierarchy using the surface under the cumulative ranking curve (SUCRA) and mean ranks. Results 78 trials with 13 treatments were included. Overall, all GLP-1 RAs except for albiglutide increased the risk of hypoglycemia when compared to placebo. Reduction in the incidence of hypoglycemia was found for all GLP-1 RAs versus insulin (except for dulaglutide) and sulphonylureas. For the incidence of treatment discontinuation, increase was found for exenatide, liraglutide, lixisenatide and taspoglutide versus placebo, insulin and sitagliptin. For glycemic level, decrease was found for all GLP-1 RAs versus placebo. Dulaglutide, exenatide long-acting release (exe_lar), liraglutide and taspoglutide had significant lowering effect when compared with sitagliptin (HbA1c<7.0%) and insulin (HbA1c<6.5%). Finally, according to SUCRAs, placebo, thiazolidinediones and albiglutide had the best decrease effect on hypoglycemia; sulphanylureas, sitagliptin and insulin decrease the incidence of treatment discontinuation most; exe_lar and dulaglutide had the highest impact on glycemic level among 13 treatments. Conclusions Among 13 treatments, GLP-1 RAs had a significant reduction with glycemic level but a slight increase effect on hypoglycemia and treatment discontinuation. While albiglutide had the best decrease effect on hypoglycemia and treatment discontinuation among all GLP-1 RAs. However, further evidence is necessary for more conclusive inferences on mechanisms underlying the rise in hypoglycemia.
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Chiba Y, Kimbara Y, Kodera R, Tsuboi Y, Sato K, Tamura Y, Mori S, Ito H, Araki A. Risk factors associated with falls in elderly patients with type 2 diabetes. J Diabetes Complications 2015; 29:898-902. [PMID: 26122285 DOI: 10.1016/j.jdiacomp.2015.05.016] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 05/13/2015] [Accepted: 05/26/2015] [Indexed: 12/25/2022]
Abstract
AIMS This study investigated risk factors of falls in elderly patients with type 2 diabetes mellitus. METHODS A total of 211 patients aged ≧60years (168 diabetic patients and 43 non-diabetic control subjects) were studied. Factors associated with falls in the past year were retrospectively examined using multiple logistic regression analysis. RESULTS The prevalence of patients who had a history of falls in the past year was twice as high as in diabetic patients compared in control subjects (36.9% vs. 18.6%, P<0.05). When diabetic patients were exclusively analyzed, the presence of any level of hypoglycemia and the Timed Up and Go test (TUG) scores correlated with patients' falls. The presence of hypoglycemia (OR 3.62, 95% CI: 1.242-10.534, P=0.018), cognitive impairment (OR 3.63, 95% CI: 1.227-10.727, P=0.020), and high Fall Risk Index scores (OR 1.2, 95% CI: 1.010-1.425, P=0.039) was independently correlated with the presence of multiple falls. When the diabetic patients were divided into three groups according to the frequency of hypoglycemia episodes, the prevalence of falls increased as the frequency of hypoglycemia increased. CONCLUSION Hypoglycemia was a risk factor of falls in elderly type 2 diabetic patients.
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Affiliation(s)
- Yuko Chiba
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, 35-2, Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan.
| | - Yoshiyuki Kimbara
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, 35-2, Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Remi Kodera
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, 35-2, Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Yuki Tsuboi
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, 35-2, Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Ken Sato
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, 35-2, Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Yoshiaki Tamura
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, 35-2, Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Seijiro Mori
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, 35-2, Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Hideki Ito
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, 35-2, Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Atsushi Araki
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital, 35-2, Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
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Hao W, Tashiro S, Hasegawa T, Sato Y, Kobayashi T, Tando T, Katsuyama E, Fujie A, Watanabe R, Morita M, Miyamoto K, Morioka H, Nakamura M, Matsumoto M, Amizuka N, Toyama Y, Miyamoto T. Hyperglycemia Promotes Schwann Cell De-differentiation and De-myelination via Sorbitol Accumulation and Igf1 Protein Down-regulation. J Biol Chem 2015; 290:17106-15. [PMID: 25998127 DOI: 10.1074/jbc.m114.631291] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Indexed: 01/20/2023] Open
Abstract
Diabetes mellitus (DM) is frequently accompanied by complications, such as peripheral nerve neuropathy. Schwann cells play a pivotal role in regulating peripheral nerve function and conduction velocity; however, changes in Schwann cell differentiation status in DM are not fully understood. Here, we report that Schwann cells de-differentiate into immature cells under hyperglycemic conditions as a result of sorbitol accumulation and decreased Igf1 expression in those cells. We found that de-differentiated Schwann cells could be re-differentiated in vitro into mature cells by treatment with an aldose reductase inhibitor, to reduce sorbitol levels, or with vitamin D3, to elevate Igf1 expression. In vivo DM models exhibited significantly reduced nerve function and conduction, Schwann cell de-differentiation, peripheral nerve de-myelination, and all conditions were significantly rescued by aldose reductase inhibitor or vitamin D3 administration. These findings reveal mechanisms underlying pathological changes in Schwann cells seen in DM and suggest ways to treat neurological conditions associated with this condition.
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Affiliation(s)
- Wu Hao
- From the Departments of Orthopedic Surgery
| | | | - Tomoka Hasegawa
- the Department of Developmental Biology of Hard Tissue, Hokkaido University Graduate School of Dental Medicine, Kita 13 Nishi 7, Kita-ku, Sapporo, 060-8586, Japan
| | - Yuiko Sato
- From the Departments of Orthopedic Surgery, Musculoskeletal Reconstruction and Regeneration Surgery
| | - Tami Kobayashi
- From the Departments of Orthopedic Surgery, Integrated Bone Metabolism and Immunology, and
| | | | | | | | | | - Mayu Morita
- Dentistry and Oral Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo 160-8582 and
| | | | | | | | | | - Norio Amizuka
- the Department of Developmental Biology of Hard Tissue, Hokkaido University Graduate School of Dental Medicine, Kita 13 Nishi 7, Kita-ku, Sapporo, 060-8586, Japan
| | | | - Takeshi Miyamoto
- From the Departments of Orthopedic Surgery, Integrated Bone Metabolism and Immunology, and
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Zarowitz B, Allen C, O’Shea T, Dalal MR, Haumschild M, DiGenio A. Type 2 diabetes mellitus treatment patterns in US nursing home residents. Postgrad Med 2015; 127:429-37. [DOI: 10.1080/00325481.2015.1035621] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | - Carrie Allen
- 1 Omnicare Senior Health Outcomes, Inc., Cincinnati, OH, USA
| | - Terrence O’Shea
- 1 Omnicare Senior Health Outcomes, Inc., Cincinnati, OH, USA
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