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Santulli G, Visco V, Varzideh F, Guerra G, Kansakar U, Gasperi M, Marro A, Wilson S, Ferrante MNV, Pansini A, Pirone A, Di Lorenzo F, Tartaglia D, Iaccarino G, Macina G, Agyapong ED, Forzano I, Jankauskas SS, Komici K, Ciccarelli M, Mone P. Prediabetes Increases the Risk of Frailty in Prefrail Older Adults With Hypertension: Beneficial Effects of Metformin. Hypertension 2024; 81:1637-1643. [PMID: 38752357 PMCID: PMC11170724 DOI: 10.1161/hypertensionaha.124.23087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 04/30/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Prediabetes has garnered increasing attention due to its association with cardiovascular conditions, especially hypertension, which heightens the risk of prefrailty and frailty among older individuals. METHODS We screened elders with prefrail hypertension from March 2021 to January 2023. We assessed the correlation linking cognitive dysfunction (Montreal Cognitive Assessment score), insulin resistance (triglyceride-to-glucose index), and physical impairment (5-meter gait speed). Then, we measured the risk of developing frailty after a 1-year follow-up period, adjusting the outcome using multivariable Cox regression analysis. We also investigated the impact of administering 500 mg of metformin once daily to a subset of frail subjects for an additional 6 months. RESULTS We assessed the relationship between the triglyceride-to-glucose index and the Montreal Cognitive Assessment score, observing a significant correlation (r, 0.880; P<0.0001). Similarly, we analyzed the association between the triglyceride-to-glucose index and 5-meter gait speed, uncovering a significant link between insulin resistance and physical impairment (r, 0.809; P<0.0001). Prediabetes was found to significantly (P<0.0001) elevate the risk of frailty development compared with individuals without prediabetes by the end of the 1-year follow-up, a finding confirmed via multivariable analysis with Cox regression. Furthermore, among the subgroup of subjects who developed frailty, those who received metformin exhibited a significant decrease in frailty levels (P<0.0001). CONCLUSIONS Insulin resistance and prediabetes play substantial roles in the development of cognitive and physical impairments, highlighting their importance in managing hypertension, even before the onset of frank diabetes. Metformin, a well-established drug for the treatment of diabetes, has shown favorable effects in mitigating frailty.
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Affiliation(s)
- Gaetano Santulli
- Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Einstein – Mount Sinai Diabetes Research Center (ES-DRC), Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York City, NY, USA
- Department of Molecular Pharmacology, Einstein Institute for Neuroimmunology and Inflammation (INI), Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York City, NY, USA
- International Translational Research and Medical Education (ITME) Consortium, Academic Research Unit, Naples, Italy
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Italy
| | - Valeria Visco
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - Fahimeh Varzideh
- Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Einstein – Mount Sinai Diabetes Research Center (ES-DRC), Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York City, NY, USA
| | - Germano Guerra
- International Translational Research and Medical Education (ITME) Consortium, Academic Research Unit, Naples, Italy
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Campobasso, Italy
| | - Urna Kansakar
- Department of Molecular Pharmacology, Einstein Institute for Neuroimmunology and Inflammation (INI), Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York City, NY, USA
| | - Maurizio Gasperi
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Campobasso, Italy
| | | | - Scott Wilson
- Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Einstein – Mount Sinai Diabetes Research Center (ES-DRC), Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York City, NY, USA
| | | | | | | | - Francesco Di Lorenzo
- Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Einstein – Mount Sinai Diabetes Research Center (ES-DRC), Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York City, NY, USA
| | | | - Guido Iaccarino
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Italy
| | | | - Esther Densu Agyapong
- Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Einstein – Mount Sinai Diabetes Research Center (ES-DRC), Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York City, NY, USA
| | - Imma Forzano
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Italy
| | - Stanislovas S. Jankauskas
- Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Einstein – Mount Sinai Diabetes Research Center (ES-DRC), Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York City, NY, USA
| | - Klara Komici
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Campobasso, Italy
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - Pasquale Mone
- Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Einstein – Mount Sinai Diabetes Research Center (ES-DRC), Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York City, NY, USA
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Campobasso, Italy
- ASL Avellino, Italy
- Casa di Cura “Montevergine”, Mercogliano (Avellino), Italy
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Botoseneanu A, Markwardt S, Quiñones AR. Multimorbidity and Functional Disability among Older Adults: The Role of Inflammation and Glycemic Status - An Observational Longitudinal Study. Gerontology 2023; 69:826-838. [PMID: 36858034 PMCID: PMC10442862 DOI: 10.1159/000528648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 12/07/2022] [Indexed: 03/03/2023] Open
Abstract
INTRODUCTION Specific multimorbidity combinations, in particular those including arthritis, stroke, and cognitive impairment, have been associated with high burden of activities of daily living (ADL)-instrumental activities of daily living (IADL) disability in older adults. The biologic underpinnings of these associations are still unclear. METHODS Observational longitudinal study using data from the Health and Retirement Study (N = 8,618, mean age = 74 years, 58% female, 25% non-white) and negative binomial regression models stratified by sex to evaluate the role of inflammatory and glycemic biomarkers (high-sensitivity C-reactive protein (hs-CRP) and HbA1c) in the association between specific multimorbidity combinations (grouped around one of eight index diseases: arthritis, cancer, cognitive impairment, diabetes, heart disease, hypertension, lung disease, and stroke; assessed between 2006 and 2014) and prospective ADL-IADL disability (2 years later, 2008-2016). Results were adjusted for sociodemographic characteristics, body mass index, number of coexisting diseases, and baseline ADL-IADL score. RESULTS Multimorbidity combinations indexed by arthritis (IRR = 1.1, 95% CI = 1.01-1.20), diabetes (IRR = 1.19, 95% CI = 1.09-1.30), and cognitive impairment (IRR = 1.11, 95% CI = 1.01-1.23) among men and diabetes-indexed multimorbidity combinations (IRR = 1.07, 95% CI = 1.01-1.14) among women were associated with higher ADL-IADL scores at increasing levels of HbA1c. Across higher levels of hs-CRP, multimorbidity combinations indexed by arthritis (IRR = 1.06, 95% CI = 1.02-1.11), hypertension (IRR = 1.06, 95% CI = 1.02-1.11), heart disease (IRR = 1.06, 95% CI = 1.01-1.12), and lung disease (IRR = 1.14, 95% CI = 1.07-1.23) were associated with higher ADL-IADL scores among women, while there were no significant associations among men. CONCLUSION The findings suggest potential for anti-inflammatory management among older women and optimal glycemic control among older men with these particular multimorbidity combinations as focus for therapeutic/preventive options for maintaining functional health.
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Affiliation(s)
- Anda Botoseneanu
- Department of Health & Human Services, University of Michigan, Dearborn, MI, USA
- Institute of Gerontology, University of Michigan, Ann Arbor, MI, USA
| | - Sheila Markwardt
- School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Ana R. Quiñones
- School of Public Health, Oregon Health & Science University, Portland, OR, USA
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
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What is the relationship between falls, functional limitations, and depressive symptoms among Chinese older adults? The role of living alone. Maturitas 2023; 168:78-83. [PMID: 36521395 DOI: 10.1016/j.maturitas.2022.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 08/26/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Although the association between falls and depressive symptoms is well documented, the mechanisms underlying this association remain largely unexplored. We investigated the mediation role of functional limitations in the association between falls and depressive symptoms among Chinese older adults and determined whether the living arrangement (living alone or not) is a significant moderator of the above-mentioned mediation pathway. STUDY DESIGN Cross-sectional study. MAIN OUTCOME MEASURES Depressive symptoms were measured using the 10-item Center for Epidemiologic Studies Depression Scale short form (CESD-10), on which higher scores indicate higher levels of depressive symptoms. RESULTS We used the harmonized China Health and Retirement Longitudinal Study national baseline data (2011-2012 year) involving 7410 participants aged 60 years and over. After adjusting for covariates (e.g., age and sex), the effects of falls on depressive symptoms were seen to be mediated by functional limitations among Chinese older adults (β = 0.82, p < .001). The moderated mediation analysis, which assesses whether an indirect effect is conditional on values of a moderating variable, found that the mediation effect was contingent upon the living arrangement (β = -0.60, p = .029). Specifically, the levels of functional limitations and depressive symptoms were higher for people with falls who were living with others relative to those living alone. CONCLUSIONS These results suggest that functional limitations are an important intervening variable that links falls to depressive symptoms among Chinese older adults. Interventions to promote older adults' physical function and prevent falls are recommended to decrease the risk of depressive symptoms. These interventions can particularly benefit those who live with others.
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Logue Cook RN, Brown SH, Hasson RE, Kinnett-Hopkins D, Davis MA. Is maximum grip strength a reliable predictor of hand limitations among older adults? Aging Clin Exp Res 2022; 34:2505-2514. [DOI: 10.1007/s40520-022-02191-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/23/2022] [Indexed: 11/29/2022]
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Tran Ngoc Hoang P, Kadota A, Yuichiro Y, Akiko H, Takehito H, Shohei O, Miyagawa N, Kondo K, Nagako O, Kita Y, Okayama A, Yukihiro F, Maegawa H, Miura K, Okamura T, Ueshima H. Effect of diabetes and prediabetes on the development of disability and mortality among middle-aged adult Japanese: a 22-year follow-up of NIPPON DATA90. J Diabetes Investig 2022; 13:1897-1904. [PMID: 35717665 PMCID: PMC9623524 DOI: 10.1111/jdi.13871] [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: 04/07/2022] [Revised: 05/27/2022] [Accepted: 06/15/2022] [Indexed: 11/29/2022] Open
Abstract
Aims/Introduction To examine the association between diabetes and prediabetes at baseline, and disability, mortality over a 22‐year period among middle‐aged Japanese adults. Materials and Methods Participants consisted of 1,788 adults aged 45–64 years at baseline from the cohort study National Integrated Project for Prospective Observation of Non‐communicable Disease and its Trends in the Aged 1990 (NIPPON DATA90). Disability, defined as having a decline in activities of daily living (ADL), was assessed by a modified Katz questionnaire at four time points. Disability and death without disability for 22‐year follow up were used as outcomes to test the association with a diagnosis of diabetes or prediabetes at baseline, using multinomial logistic regression. Adjusted odds ratios (ORs) were obtained from four models that contained appropriate adjustment factors, such as age, sex, smoking status, drinking status, body mass index and cardiovascular risk factors (hypertension, hypercholesterolemia, triglycerides, low serum high‐density lipoprotein), at baseline. Results In the present study, 334 participants (18.7%) reported at least one disability, and 350 (19.6%) were reported dead without observation of disability during follow up. Adjusting sex and other risk factors, participants with diabetes and prediabetes had a higher risk for disability (OR 1.43, 95% confidence interval [CI] 1.07–1.91 and OR 1.66, 95% CI 1.10–2.50, respectively) and for mortality (OR 1.56, 95% CI 1.16–2.08 and OR 1.77, 95% CI 1.18–2.65, respectively) than individuals with normal glucose tolerance. Conclusions In middle‐aged Japanese adults, individuals with diabetes and prediabetes were more likely to be associated with disability and mortality. Our findings suggest that prediabetes and diabetes in middle‐aged adults should be paid more attention, and requires more intervention to prevent disability and mortality in later life.
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Affiliation(s)
- Phap Tran Ngoc Hoang
- Department of Medicine, Shiga University of Medical science.,Non-communicable diseases (NCD) Epidemiology Research Center, Shiga University of Medical science
| | - Aya Kadota
- Non-communicable diseases (NCD) Epidemiology Research Center, Shiga University of Medical science.,NCD Epidemiology Research Center, Shiga University of Medical science, Seta Tsukinowa-cho, Otsu, Shiga, 521-0092, Japan
| | - Yano Yuichiro
- Non-communicable diseases (NCD) Epidemiology Research Center, Shiga University of Medical science
| | - Harada Akiko
- Non-communicable diseases (NCD) Epidemiology Research Center, Shiga University of Medical science
| | - Hayakawa Takehito
- Research Center for Social Studies of Health and Community, Ritsumeikan University
| | - Okamoto Shohei
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology
| | - Naoko Miyagawa
- Department of Public health, Shiga University of Medical science
| | - Keiko Kondo
- Non-communicable diseases (NCD) Epidemiology Research Center, Shiga University of Medical science
| | | | | | | | | | | | - Katsuyuki Miura
- Non-communicable diseases (NCD) Epidemiology Research Center, Shiga University of Medical science
| | - Tomonori Okamura
- Department of Preventive Medicine and Public Health, Keio University School of Medicine
| | - Hirotsugu Ueshima
- Non-communicable diseases (NCD) Epidemiology Research Center, Shiga University of Medical science
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Veugen MGJ, Onete VG, Henry RMA, Brunner-La Rocca HP, Koster A, Dagnelie PC, Schaper NC, Sep SJS, van der Kallen CJH, van Boxtel MPJ, Reesink KD, Schouten JS, Savelberg HHCM, Köhler S, Verhey FR, van den Bergh JPW, Schram MT, Stehouwer CDA. Health burden in type 2 diabetes and prediabetes in The Maastricht Study. Sci Rep 2022; 12:7337. [PMID: 35513556 PMCID: PMC9072328 DOI: 10.1038/s41598-022-11136-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 04/19/2022] [Indexed: 12/02/2022] Open
Abstract
Mortality in type 2 diabetes, is determined not only by classical complications, but also by comorbidities, and is linked to hyperglycaemia and apparent even in prediabetes. We aimed to comprehensively investigate, in a population-based cohort, health burden defined as the presence of comorbidities in addition to classical complications and cardiometabolic risk factors, in not only type 2 diabetes but also prediabetes. Such population-based study has not been performed previously. Extensive phenotyping was performed in 3,410 participants of the population-based Maastricht Study (15.0% prediabetes and 28.6% type 2 diabetes) to assess presence of 17 comorbidities, six classical complications, and ten cardiometabolic risk factors. These were added up into individual and combined sum scores and categorized. Group differences were studied with multinomial regression analyses adjusted for age and sex. Individuals with type 2 diabetes and prediabetes, as compared to normal glucose metabolism (NGM), had greater comorbidities, classical complications, cardiometabolic risk factors and combined sum scores (comorbidities sum score ≥ 3: frequencies (95% CI) 61.5% (57.6;65.4) and 41.2% (36.5;45.9) vs. 25.4% (23.5;27.4), p-trend < 0.001; classical complications ≥ 2 (26.6% (23.1;30.1; P < 0.001 vs. NGM) and 10.1% (7.8;12.7; P = 0.065 vs NGM) vs. 8.0% (6.9;9.3)); cardiometabolic risk factors ≥ 6 (39.7% (35.9;43.4) and 28.5% (24.5;32.6) vs. 14.0% (12.5;15.6); p-trend < 0.001); combined ≥ 8 (66.6% (62.7;70.5) and 48.4% (43.7;53.1) vs. 26.0%(24.1;28.0), p-trend < 0.001). Type 2 diabetes and prediabetes health burden was comparable to respectively 32 and 14 years of ageing. Our population-based study shows, independently of age and sex, a considerable health burden in both type 2 diabetes and prediabetes, which to a substantial extent can be attributed to comorbidities in addition to classical complications and cardiometabolic risk factors. Our findings emphasize the necessity of comorbidities' awareness in (pre)diabetes and for determining the exact role of hyperglycaemia in the occurrence of comorbidities.
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Affiliation(s)
- Marja G J Veugen
- Department of Internal Medicine, Maastricht University Medical Centre +, P. Debyelaan 25, P.O. Box 5800, 6202AZ, Maastricht, The Netherlands.
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.
| | - Veronica G Onete
- Department of Internal Medicine, Maastricht University Medical Centre +, P. Debyelaan 25, P.O. Box 5800, 6202AZ, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Ronald M A Henry
- Department of Internal Medicine, Maastricht University Medical Centre +, P. Debyelaan 25, P.O. Box 5800, 6202AZ, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- Heart and Vascular Centre, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Hans-Peter Brunner-La Rocca
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- Department of Cardiology, Maastricht University Medical Centre +, Maastricht, the Netherlands
| | - Annemarie Koster
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
| | - Pieter C Dagnelie
- Department of Internal Medicine, Maastricht University Medical Centre +, P. Debyelaan 25, P.O. Box 5800, 6202AZ, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Nicolaas C Schaper
- Department of Internal Medicine, Maastricht University Medical Centre +, P. Debyelaan 25, P.O. Box 5800, 6202AZ, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Simone J S Sep
- Department of Internal Medicine, Maastricht University Medical Centre +, P. Debyelaan 25, P.O. Box 5800, 6202AZ, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
| | - Carla J H van der Kallen
- Department of Internal Medicine, Maastricht University Medical Centre +, P. Debyelaan 25, P.O. Box 5800, 6202AZ, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Martin P J van Boxtel
- Department of Psychiatry and Neuropsychology and MHeNS School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Koen D Reesink
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- Department of Biomedical Engineering, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Johannes S Schouten
- Department of Ophthalmology, Maastricht University Medical Centre +, Maastricht, The Netherlands
- Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Hans H C M Savelberg
- Department of Human Movement Sciences, Maastricht University, Maastricht, The Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology and MHeNS School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Frans R Verhey
- Department of Psychiatry and Neuropsychology and MHeNS School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Joop P W van den Bergh
- Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Internal Medicine, Subdivision of Endocrinology, VieCuri Medical Center, Venlo, The Netherlands
| | - Miranda T Schram
- Department of Internal Medicine, Maastricht University Medical Centre +, P. Debyelaan 25, P.O. Box 5800, 6202AZ, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- Heart and Vascular Centre, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine, Maastricht University Medical Centre +, P. Debyelaan 25, P.O. Box 5800, 6202AZ, Maastricht, The Netherlands.
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.
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Choudhury R, Park JH, Thiamwong L, Xie R, Stout JR. Objectively Measured Physical Activity Levels and Associated Factors in Older US Women During the COVID-19 Pandemic: A Cross-sectional Study (Preprint). JMIR Aging 2022; 5:e38172. [PMID: 35994346 PMCID: PMC9400844 DOI: 10.2196/38172] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/27/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Renoa Choudhury
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL, United States
| | - Joon-Hyuk Park
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL, United States
- Disability, Aging and Technology Cluster, University of Central Florida, Orlando, FL, United States
| | - Ladda Thiamwong
- College of Nursing, University of Central Florida, Orlando, FL, United States
| | - Rui Xie
- Department of Statistics and Data Science, University of Central Florida, Orlando, FL, United States
| | - Jeffrey R Stout
- School of Kinesiology and Physical Therapy, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, United States
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Shao D, Wang SS, Sun JW, Wang HP, Sun Q. Association Between Long-Term HbA1c Variability and Functional Limitation in Individuals Aged Over 50 Years: A Retrospective Cohort Study. Front Endocrinol (Lausanne) 2022; 13:847348. [PMID: 35574024 PMCID: PMC9099190 DOI: 10.3389/fendo.2022.847348] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND As mean HbA1c provides incomplete information regarding glycemic variability, there has been considerable interest in the emerging association between glycemic variability and macrovascular events and with microvascular complications and mortality in adults with and without diabetes. However, the association between long-term glycemic variability, represented by visit-to-visit HbA1c variability, and functional limitations has not been clarified in previous literature. The present study aimed to explore the longitudinal association between long-term glycemic variability, represented by visit-to-visit HbA1c variability and functional limitations. METHODS This cohort study included adults aged over 50 years who participated in the 2006 to 2016 waves of the Health and Retirement Study. Physical functions, including mobility, large muscle function, activities of daily living (ADLs), and instrumental ADLs (IADLs), were assessed at baseline and every 2 years, and HbA1c levels were assessed at baseline and every 4 years. Visit-to-visit HbA1c variability was calculated using the HbA1c variability score (HVS) during the follow-up period. Generalized estimating equation models were used to evaluate the longitudinal association between HbA1c variability and functional limitations with adjustment for a series of confounders. RESULTS A total of 5,544 participants having three HbA1c measurements from 2006 to 2016, having two or more physical function measures (including one at baseline), and age over 50 years were included in this analysis. The mean age at baseline was 66.13 ± 8.39 years. A total of 916 (16.5%) participants had an HVS = 100, and 35.1% had an HVS = 50. The highest HVS category (HVS =100) was associated with increased functional status score (β = 0.093, 95% CI: 0.021-0.165) in comparison with the lowest HVS category (HVS = 0). Sensitivity analyses using the CV and SD of HbA1c as measures of variability showed similar associations between HbA1c variability and functional limitation. An incremental increase in HbA1c-CV (β = 0.630, 95% CI: 0.127-1.132) or HbA1c-SD (β = 0.078, 95% CI: 0.006-0.150) was associated with an increase in functional limitation in the fully adjusted model. CONCLUSIONS HbA1c variability was associated with heightened difficulty in performing functional activities over time after adjusting for mean HbA1c levels and multiple demographics and comorbidities. This study provides further evidence regarding the detrimental effect of HbA1c variability and highlights the significance of steady glycemic control.
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Affiliation(s)
- Di Shao
- Centre for Health Management and Policy Research, School of Public Health, NHC Key Laboratory of Health Economics and Policy Research, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Shuang-Shuang Wang
- Centre for Health Management and Policy Research, School of Public Health, NHC Key Laboratory of Health Economics and Policy Research, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ji-Wei Sun
- Center for Reproductive Medicine, School of Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China
| | - Hai-Peng Wang
- Centre for Health Management and Policy Research, School of Public Health, NHC Key Laboratory of Health Economics and Policy Research, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qiang Sun
- Centre for Health Management and Policy Research, School of Public Health, NHC Key Laboratory of Health Economics and Policy Research, Cheeloo College of Medicine, Shandong University, Jinan, China
- *Correspondence: Qiang Sun,
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Shang Y, Fratiglioni L, Vetrano DL, Dove A, Welmer AK, Xu W. Not Only Diabetes but Also Prediabetes Leads to Functional Decline and Disability in Older Adults. Diabetes Care 2021; 44:690-698. [PMID: 33446522 PMCID: PMC7896268 DOI: 10.2337/dc20-2232] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/21/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetes is linked to functional decline, but the impact of prediabetes on physical function is unknown. We aimed to examine and compare the impact of prediabetes and diabetes on physical function and disability progression and to explore whether cardiovascular diseases (CVDs) mediate these associations. RESEARCH DESIGN AND METHODS A cohort of 2,013 participants aged ≥60 from the Swedish National Study on Aging and Care in Kungsholmen, an ongoing population-based longitudinal study, was monitored for up to 12 years. Physical function was measured with chair stand (s) and walking speed (m/s) tests, and disability was measured by summing the numbers of impaired basic and instrumental activities of daily living. Diabetes was identified through medical examinations or clinical records, medication use, or glycated hemoglobin (HbA1c) ≥6.5%. Prediabetes was defined as HbA1c ≥5.7-6.4% in participants free of diabetes. CVDs were ascertained through clinical examinations and the National Patient Register. Data were analyzed using mixed-effect models and mediation models. RESULTS At baseline, 650 (32.3%) had prediabetes and 151 had diabetes (7.5%). In multiadjusted mixed-effect models, prediabetes was associated with an increased chair stand time (β 0.33, 95% CI 0.05-0.61), a decreased walking speed (β -0.006, 95% CI -0.010 to -0.002), and an accelerated disability progression (β 0.05, 95% CI 0.01-0.08), even after controlling for the future development of diabetes. Diabetes led to faster functional decline than prediabetes. In mediation analyses, CVDs mediated 7.1%, 7.8%, and 20.9% of the associations between prediabetes and chair stand, walking speed, and disability progression, respectively. CONCLUSIONS Prediabetes, in addition to diabetes, is associated with faster functional decline and disability, independent of the future development of diabetes. This association may be in part mediated by CVDs.
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Affiliation(s)
- Ying Shang
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Stockholm, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Stockholm, Sweden.,Department of Geriatrics, Fondazione Policlinico "A. Gemelli" IRCCS and Catholic University of Rome, Rome, Italy
| | - Abigail Dove
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Stockholm, Sweden
| | - Anna-Karin Welmer
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden.,Functional Area Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Weili Xu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, and Stockholm University, Stockholm, Sweden .,Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
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10
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Al-Ozairi E, Alsaeed D, Alroudhan D, Voase N, Hasan A, Gill JMR, Sattar N, Welsh P, Gray CM, Boonpor J, Celis-Morales C, Gray SR. Skeletal Muscle and Metabolic Health: How Do We Increase Muscle Mass and Function in People with Type 2 Diabetes? J Clin Endocrinol Metab 2021; 106:309-317. [PMID: 33336682 DOI: 10.1210/clinem/dgaa835] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Whilst skeletal muscles' primary role is allowing movement, it has important metabolic roles, including in glycemic control. Indeed, evidence indicates that low muscle mass and function are associated with an increased risk of type 2 diabetes, highlighting its importance in the development of metabolic disease. METHODS In this mini-review, we detail the evidence highlighting the importance of muscle in type 2 diabetes and the efficacy of resistance exercise in improving glycemic control alongside our approach to increase uptake of such exercise in people with type 2 diabetes. This summary is based in the authors' knowledge of the filed supplemented by a Pubmed search using the terms "muscle," "glycemic control," "HbA1c," "type 2 diabetes," and "resistance exercise." RESULTS The main strategy to increases muscle mass is to perform resistance exercise and, although the quality of evidence is low, such exercise appears effective in reducing Glycated Haemoglobin (HbA1c) in people with type 2 diabetes. However, to increase participation we need to improve our understanding of barriers and facilitators to such exercise. Current data indicate that barriers are similar to those reported for aerobic exercise, with additional resistance exercise specific barriers of looking to muscular, increase risk of cardiovascular event, having access to specialized equipment and knowledge of how to use it. CONCLUSIONS The development of simple resistance exercises that can be performed anywhere, that use little or no equipment and are effective in reducing HbA1c will be, in our opinion, key to increasing the number of people with type 2 diabetes performing resistance exercise.
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Affiliation(s)
- Ebaa Al-Ozairi
- Clinical Research Unit, Dasman Diabetes Institute, Dasman, Kuwait City, Kuwait
- Department of Medicine, Faculty of Medicine, Kuwait University, Jabirya, Kuwait
| | - Dalal Alsaeed
- Clinical Research Unit, Dasman Diabetes Institute, Dasman, Kuwait City, Kuwait
- Ministry of Health, Kuwait City, Kuwait
| | - Dherar Alroudhan
- Clinical Research Unit, Dasman Diabetes Institute, Dasman, Kuwait City, Kuwait
| | - Nia Voase
- Clinical Research Unit, Dasman Diabetes Institute, Dasman, Kuwait City, Kuwait
| | - Amal Hasan
- Department of Immunology and Microbiology, Dasman Diabetes Institute, Dasman, Kuwait City, Kuwait
| | - Jason M R Gill
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland
| | - Paul Welsh
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland
| | - Cindy M Gray
- Institute of Health and Wellbeing, University of Glasgow, Scotland
| | - Jirapitcha Boonpor
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland
| | - Carlos Celis-Morales
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland
| | - Stuart R Gray
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland
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11
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Zhou Y. Prognostic Significance of HbA1c Level in Asian Patients with Prediabetes and Coronary Artery Disease. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2021. [DOI: 10.15212/cvia.2021.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Measuring glycosylated hemoglobin (HbA1c) is a simple way to assess patients with prediabetes ordiabetes mellitus. It has been shown that HbA1c level predicts prognosis in patients with coronary artery disease (CAD)and the incidence of diabetes mellitus. However, the prognostic significance of HbA1c level in Asian patients withprediabetes and CAD is not yet clear. Our study aimed to determine the relationship between HbA1c level and majoradverse cardiovascular events (MACE) in patients with prediabetes and CAD.Methods: We enrolled 1367 patients with prediabetes and CAD in the final analysis, and grouped them according tothe HbA1c level. Primary end points included nonfatal myocardial infarction, hospitalization for unstable angina, andischemia-driven revascularization. Cox proportional-hazards regression analysis was used to determine the relationshipbetween HbA1c level and MACE after our accounting for confounding factors.Results: A total of 1367 patients (age 58.8 ± 10.3 years; 71.6% men) were included. During 43 months of follow-up,197 patients experienced at least one primary end point event. Multivariate Cox proportional-hazards regression analysisshowed in comparison of HbA1c levels that the hazard ratio for primary end points was 4.110, with a 95% confidence interval of 2.097–6.011 (P < 0.001).Conclusions: HbA1c level positively correlated with MACE, demonstrating it is a valuable indicator for independentlypredicting MACE in Asian patients with prediabetes and CAD.
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Affiliation(s)
- Yujie Zhou
- Capital Medical University, Beijing Anzhen Hospital, Beijing,
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12
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Kvedaras M, Minderis P, Krusnauskas R, Ratkevicius A. Effects of ten-week 30% caloric restriction on metabolic health and skeletal muscles of adult and old C57BL/6J mice. Mech Ageing Dev 2020; 190:111320. [DOI: 10.1016/j.mad.2020.111320] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/20/2020] [Accepted: 07/24/2020] [Indexed: 12/17/2022]
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13
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Lange-Maia BS, Karavolos K, Avery EF, Strotmeyer ES, Karvonen-Gutierrez CA, Appelhans BM, Janssen I, Dugan SA, Kravitz HM. Contribution of common chronic conditions to midlife physical function decline: The Study of Women's Health Across the Nation. Womens Midlife Health 2020; 6:6. [PMID: 32742664 PMCID: PMC7385881 DOI: 10.1186/s40695-020-00053-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 07/13/2020] [Indexed: 12/25/2022] Open
Abstract
Background Chronic conditions are associated with worse physical function and commonly develop during midlife. We tested whether the presence of 8 chronic conditions, or the development of these conditions, is associated with declines in physical function among midlife women as they transition into early late life. Methods Participants (N = 2283) were from the Study of Women’s Health Across the Nation. Physical function was assessed at 8 visits starting at the study’s fourth clinic visit in 2000/2001 through follow-up visit 15 (2015/2017) using the Short Form-36 Physical Function subscale. Chronic conditions included diabetes, hypertension, osteoarthritis, osteoporosis, stroke, heart disease, cancer, and depressive symptoms. Repeated-measures Poisson regression modeled associations between 1) prevalent chronic conditions at analytic baseline (visit 4) and longitudinal physical function, and 2) change in physical function associated with developing a new condition. Models were adjusted with the total number of other chronic conditions at visit 4. Results In separate fully-adjusted longitudinal models, prevalent heart disease and osteoporosis were associated with 18% (IRR = 0.815, 95% confidence interval [CI]: 0.755–0.876) and 12% (IRR = 0.876, 95% CI: 0.825–0.927) worse initial physical function, respectively. Prevalent osteoarthritis was associated with approximately 6% (IRR = 0.936, 95% CI: 0.913–0.958) worse initial physical function, and a slight additional worsening over time (IRR = 0.995, 95% CI: 0.994–0.996). A 12% (IRR = 0.878, 95% CI: 0.813–0.950) decrease in physical function concurrent with stroke development was evident, as was accelerated decline in physical function concurrent with heart disease development (IRR = 0.991, 95% CI: 0.988–0.995). Conclusions Initial prevalent conditions related to the musculoskeletal system were associated with worse initial physical function, with some evidence of accelerated decline in physical function with osteoarthritis. Stroke and heart disease are less common than osteoarthritis in this age group, but the severe effects of these conditions on physical function shows the need for a greater focus on cardiovascular health during midlife. Women who develop chronic conditions during midlife may be at particular risk for poor physical function as they age, warranting disability prevention efforts focused on this population.
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Affiliation(s)
- Brittney S Lange-Maia
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL USA.,Center for Community Health Equity, Rush University Medical Center, Chicago, IL USA
| | - Kelly Karavolos
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL USA
| | - Elizabeth F Avery
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL USA.,Center for Community Health Equity, Rush University Medical Center, Chicago, IL USA
| | - Elsa S Strotmeyer
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA USA
| | | | - Bradley M Appelhans
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL USA
| | - Imke Janssen
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL USA
| | - Sheila A Dugan
- Department of Physical Medicine & Rehabilitation, Rush University Medical Center, Chicago, IL USA
| | - Howard M Kravitz
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL USA.,Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL USA
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14
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Wu IC, Hsu CC, Chen CY, Chuang SC, Cheng CW, Hsieh WS, Wu MS, Liu YT, Liu YH, Tsai TL, Lin CC, Hsiung CA. Paradoxical Relationship Between Glycated Hemoglobin and Longitudinal Change in Physical Functioning in Older Adults: A Prospective Cohort Study. J Gerontol A Biol Sci Med Sci 2019; 74:949-956. [PMID: 31095709 DOI: 10.1093/gerona/gly147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Hyperglycemia with high hemoglobin A1c (HbA1c) levels is associated with significant health risks. However, the relationship between HbA1c levels and the physical functioning status in later life remains uncertain and so is the possible underlying mechanism. METHODS We conducted a prospective study of 2,565 initially well-functioning community-dwelling older adult aged 55 years and older from the Healthy Aging Longitudinal Study in Taiwan. Each participant received baseline measurements of blood HbA1c and inflammatory markers levels and repeated assessments of physical functioning over a mean follow-up period of 5.3 years. We used generalized linear mixed-effects regression to estimate the adjusted changes in the odds ratio for self-reported physical functioning impairment and Short Physical Performance Battery (SPPB) score according to baseline HbA1c levels (categorized into 0.5% increments from <5.5% to ≥7.0%). RESULTS HbA1c levels showed a U-shaped relationship with changes in the odds ratio for physical functioning impairment and SPPB score (p for quadratic term < .001). Compared with participants with an HbA1c of 5.5% to <6.0%, those with an HbA1c of <5.5% or ≥7.0% had a higher annual increase in the odds ratio for physical functioning impairment (odds ratio [95% confidence interval] per year, 1.25 [1.04-1.50] and 1.21 [1.04-1.41]) and a higher annualized decrease in SPPB score (coefficient [95% confidence interval], -0.05 [-0.10 to 0.00] and -0.04 [-0.08 to 0.00]). These relationships were nonlinear only in participants with high soluble interleukin-6 receptor levels (>48,124 pg/mL; p for interaction < .05). CONCLUSIONS High and low HbA1c levels at baseline are associated with faster physical functioning decline, particularly among individuals with elevated circulating soluble interleukin-6 receptor, a sign of enhanced interleukin-6 trans-signaling.
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Affiliation(s)
- I-Chien Wu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan.,2Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Ching-Yu Chen
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Shu-Chun Chuang
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
| | - Chiu-Wen Cheng
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
| | - Wan-Shan Hsieh
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
| | - Ming-Shiang Wu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
| | - Yen-Tze Liu
- Changhua Christian Hospital, Changhua County, Taiwan
| | - Yo-Hann Liu
- Hope Doctors Hospital, Miaoli County, Taiwan
| | - Tsung-Lung Tsai
- Puzi Hospital, Ministry of Health and Welfare, Chiayi County, Taiwan
| | | | - Chao A Hsiung
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
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15
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Lee PG, Damschroder LJ, Holleman R, Moin T, Richardson CR. Older Adults and Diabetes Prevention Programs in the Veterans Health Administration. Diabetes Care 2018; 41:2644-2647. [PMID: 30377187 PMCID: PMC6245214 DOI: 10.2337/dc18-1141] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 09/19/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate whether older veterans enrolled in two diabetes prevention programs (DPPs) in the Veterans Health Administration will have similar weight loss as younger veterans. RESEARCH DESIGN AND METHODS Post hoc analysis of data from two prospective, pragmatic, nonrandomized studies of behavioral weight management interventions that were delivered in-person (Department of Veterans Affairs [VA]-DPP) or online (Online-DPP), comparing participation and weight loss between participants aged ≥65 years (N = 120) vs. <65 years (N = 258). RESULTS Over 70% of participants in both age groups completed eight or more sessions within 6 months; a higher proportion completed eight or more sessions in the Online-DPP intervention than in the VA-DPP intervention (P < 0.05). The overall weight changes at 6 and 12 months were similar across the two age groups: ∼5 kg or 5% weight loss compared with baseline (P > 0.05). CONCLUSIONS DPPs delivered in person or online can be similarly effective in older and younger veterans. Online programs may be an important means to improve the reach of DPPs for older adults.
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Affiliation(s)
- Pearl G Lee
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI .,Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
| | - Laura J Damschroder
- Personalizing Options through Veteran Engagement (PROVE) Quality Enhancement Research Initiative (QUERI) Program, Ann Arbor Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI
| | - Robert Holleman
- Personalizing Options through Veteran Engagement (PROVE) Quality Enhancement Research Initiative (QUERI) Program, Ann Arbor Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI
| | - Tannaz Moin
- Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA.,Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.,VA Health Services Research and Development (HSR&D) Center for Healthcare Innovation, Implementation and Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
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16
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Kato S, Ando M, Kondo T, Yoshida Y, Honda H, Maruyama S. Lifestyle intervention using Internet of Things (IoT) for the elderly: A study protocol for a randomized control trial (the BEST-LIFE study). NAGOYA JOURNAL OF MEDICAL SCIENCE 2018; 80:175-182. [PMID: 29915435 PMCID: PMC5995741 DOI: 10.18999/nagjms.80.2.175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 11/17/2017] [Indexed: 12/25/2022]
Abstract
Modification of lifestyle habits, including diet and physical activity, is essential for the prevention and control of type 2 diabetes mellitus (T2DM) in elderly patients. However, individualized treatment is more critical for the elderly than for general patients. This study aimed to determine lifestyle interventions that resulted in lowering hemoglobin A1c (HbA1c) in Japanese pre- and early diabetic elderly subjects. The BEST-LIFE trial is an ongoing, open-label, 6-month, randomized (1:1) parallel group trial. Subjects with HbA1c of ≥5.6%-randomly assigned to the intervention or control group -use wearable monitoring devices loaded with Internet of things (IoT) systems that aids them with self-management and obtaining monthly remote health guidance from a public health nurse. The primary outcome is changes in HbA1c after a 6-month intervention relative to the baseline values. The secondary outcome is the change of behavior modification stages. The background, rationale, and study design of this trial are also presented. One hundred forty-five subjects have already been enrolled in this lifestyle intervention program, which will end in 2019. The BEST-LIFE trial will provide new evidence regarding the effectiveness and safety of our program on lowering HbA1c in elderly subjects with T2DM. It will also investigate whether information communication technology tools and monitoring devices loaded with IoT can support health care in elderly subjects. The trial registration number is UMIN-CTR: UMIN 000023356.
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Affiliation(s)
- Sawako Kato
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahiko Ando
- Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - Takaaki Kondo
- Program in Radiological and Medical Laboratory Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuko Yoshida
- Innovative Research Center for Preventative Medical Engineering, Nagoya University, Nagoya, Japan
| | - Hiroyuki Honda
- Innovative Research Center for Preventative Medical Engineering, Nagoya University, Nagoya, Japan
| | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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17
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Padrós G, Ferrer A, Formiga F, Cunillera O, Badia T, Corbella X, Almeda J, Badia T, Fernández C, Ferrer A, Formiga F, Gil A, Llopart C, Megido M, Padrós G, Sarró M, Tobella A. Prevalence of Prediabetes and Associated Factors in the Oldest Old. A Cross Sectional Study in the Octabaix Cohort. INT J GERONTOL 2017. [DOI: 10.1016/j.ijge.2016.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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18
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Strauss SM, McCarthy M. Arthritis-Related Limitations Predict Insufficient Physical Activity in Adults With Prediabetes Identified in the NHANES 2011-2014. DIABETES EDUCATOR 2017; 43:163-170. [PMID: 28169593 DOI: 10.1177/0145721717691849] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Purpose The purpose of the study was to determine the extent to which arthritis-related limitations are salient in predicting less than the recommended amount of time for adults with prediabetes to spend on moderate or vigorous physical activity. Methods Data from the 2011-2014 National Health and Nutrition Examination Survey (NHANES) in the United States were used to identify the predictors of insufficient physical activity in a large sample of adults with prediabetes 20 years of age and older (n = 2536). Results When extrapolated to more than 45 million adults in the United States at least 20 years of age with prediabetes, 42.7% had insufficient physical activity. Having arthritis-related functional limitations was a significant predictor of insufficient physical activity, even after accounting for the statistically significant contributions of female sex, older age, lower education level, higher body mass index, and depression. Conclusion When educating and counseling adults with prediabetes, diabetes educators should assess for arthritis-related functional limitations when examining factors that may affect prediabetes progression. Recommendations for physical activity for those with mobility and other limitations need to be individualized within a tailored exercise program to accommodate their specific limitations.
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Affiliation(s)
- Shiela M Strauss
- New York University Rory Meyers College of Nursing, New York, NY, USA (Dr Strauss, Dr McCarthy)
| | - Margaret McCarthy
- New York University Rory Meyers College of Nursing, New York, NY, USA (Dr Strauss, Dr McCarthy)
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19
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Lee PG, Halter JB. The Pathophysiology of Hyperglycemia in Older Adults: Clinical Considerations. Diabetes Care 2017; 40:444-452. [PMID: 28325795 DOI: 10.2337/dc16-1732] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 01/20/2017] [Indexed: 02/03/2023]
Abstract
Nearly a quarter of older adults in the U.S. have type 2 diabetes, and this population is continuing to increase with the aging of the population. Older adults are at high risk for the development of type 2 diabetes due to the combined effects of genetic, lifestyle, and aging influences. The usual defects contributing to type 2 diabetes are further complicated by the natural physiological changes associated with aging as well as the comorbidities and functional impairments that are often present in older people. This paper reviews the pathophysiology of type 2 diabetes among older adults and the implications for hyperglycemia management in this population.
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Affiliation(s)
- Pearl G Lee
- Geriatric Research Education and Clinical Center, VA Ann Arbor Healthcare System, Ann Arbor, MI .,Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Jeffrey B Halter
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
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21
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Brugnara L, Murillo S, Novials A, Rojo-Martínez G, Soriguer F, Goday A, Calle-Pascual A, Castaño L, Gaztambide S, Valdés S, Franch J, Castell C, Vendrell J, Casamitjana R, Bosch-Comas A, Bordiú E, Carmena R, Catalá M, Delgado E, Girbés J, López-Alba A, Martínez-Larrad MT, Menéndez E, Mora-Peces I, Pascual-Manich G, Serrano-Ríos M, Gomis R, Ortega E. Low Physical Activity and Its Association with Diabetes and Other Cardiovascular Risk Factors: A Nationwide, Population-Based Study. PLoS One 2016; 11:e0160959. [PMID: 27532610 PMCID: PMC4988632 DOI: 10.1371/journal.pone.0160959] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 07/27/2016] [Indexed: 12/13/2022] Open
Abstract
Low physical activity (PA), or sedentary lifestyle, is associated with the development of several chronic diseases. We aimed to investigate current prevalence of sedentariness and its association with diabetes and other cardiovascular risk factors. PA was evaluated in a population-based, cross-sectional, randomly sampled study conducted in 2009-2010 in Spain. International Physical Activity Questionnaire (SF-IPAQ) was used to assess PA. 4991 individuals (median age 50 years, 57% women) were studied. Prevalence of sedentariness was 32.3% for men and 39% for women (p < 0.0001). Sex differences were particularly notable (age*sex interaction, p = 0.0024) at early and older ages. Sedentary individuals had higher BMI (28 vs. 27 kg/m2) and obesity prevalence (37 vs. 26%). Low PA was present in 44, 43, and 38% of individuals with known diabetes (KDM), prediabetes/unknown-diabetes (PREDM/UKDM), and normal glucose regulation (p = 0.0014), respectively. No difference between KDM and PREDM/UKDM (p = 0.72) was found. Variables independently associated (p < 0.05) with sedentariness were age, sex, BMI, central obesity, Mediterranean diet adherence, smoking habit, HDL-cholesterol, triglycerides and dyslipidemia. Low PA is on the rise in Spain, especially among women. Sedentariness is associated with several cardiovascular risk factors and may be responsible for the increasing prevalence of obesity and diabetes in this country.
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Affiliation(s)
- Laura Brugnara
- CIBERDEM—Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders, Madrid, Spain
- IDIBAPS—August Pi i Sunyer Biomedical Research Institute / Hospital Clínic de Barcelona, Barcelona, Spain
| | - Serafín Murillo
- CIBERDEM—Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders, Madrid, Spain
- IDIBAPS—August Pi i Sunyer Biomedical Research Institute / Hospital Clínic de Barcelona, Barcelona, Spain
| | - Anna Novials
- CIBERDEM—Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders, Madrid, Spain
- IDIBAPS—August Pi i Sunyer Biomedical Research Institute / Hospital Clínic de Barcelona, Barcelona, Spain
| | - Gemma Rojo-Martínez
- CIBERDEM—Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders, Madrid, Spain
- Hospital Universitario Carlos Haya, Department of Endocrinology and Nutrition, Málaga, Spain
| | - Federico Soriguer
- CIBERDEM—Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders, Madrid, Spain
- Hospital Universitario Carlos Haya, Department of Endocrinology and Nutrition, Málaga, Spain
| | - Albert Goday
- Hospital del Mar, Department of Endocrinology and Nutrition, Barcelona, Spain
| | | | - Luis Castaño
- CIBERDEM—Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders, Madrid, Spain
- Hospital Universitario de Cruces, UPV-EHU, Diabetes Research Group, Baracaldo, Spain
| | - Sonia Gaztambide
- CIBERDEM—Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders, Madrid, Spain
- Hospital Universitario de Cruces, UPV-EHU, Diabetes Research Group, Baracaldo, Spain
| | - Sergio Valdés
- CIBERDEM—Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders, Madrid, Spain
- Hospital Universitario Carlos Haya, Department of Endocrinology and Nutrition, Málaga, Spain
| | - Josep Franch
- EAP Raval Sud, Institut Català de la Salut, Red GEDAPS, IDIAP, Barcelona, Spain
| | - Conxa Castell
- Public Health Division, Autonomous Government of Catalonia, Barcelona, Spain
| | - Joan Vendrell
- CIBERDEM—Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders, Madrid, Spain
- Department of Endocrinology and Nutrition, Hospital Universitario Joan XXIII, Tarragona, Spain
| | - Roser Casamitjana
- CIBERDEM—Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders, Madrid, Spain
- IDIBAPS—August Pi i Sunyer Biomedical Research Institute / Hospital Clínic de Barcelona, Barcelona, Spain
| | - Anna Bosch-Comas
- CIBERDEM—Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders, Madrid, Spain
- IDIBAPS—August Pi i Sunyer Biomedical Research Institute / Hospital Clínic de Barcelona, Barcelona, Spain
| | - Elena Bordiú
- Hospital Universitario San Carlos, Madrid, Spain
| | - Rafael Carmena
- CIBERDEM—Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders, Madrid, Spain
- Department of Medicine and Endocrinology, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Miguel Catalá
- CIBERDEM—Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders, Madrid, Spain
- Department of Medicine and Endocrinology, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Elias Delgado
- Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias, Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, Oviedo, Spain
| | | | | | - Maria Teresa Martínez-Larrad
- CIBERDEM—Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders, Madrid, Spain
- CIBEROBN—Spanish Biomedical Research Centre in Physiopathology of Obesity
| | - Edelmiro Menéndez
- Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias, Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, Oviedo, Spain
| | | | - Gemma Pascual-Manich
- CIBERDEM—Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders, Madrid, Spain
- IDIBAPS—August Pi i Sunyer Biomedical Research Institute / Hospital Clínic de Barcelona, Barcelona, Spain
| | - Manuel Serrano-Ríos
- CIBERDEM—Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Ramon Gomis
- CIBERDEM—Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders, Madrid, Spain
- IDIBAPS—August Pi i Sunyer Biomedical Research Institute / Hospital Clínic de Barcelona, Barcelona, Spain
| | - Emilio Ortega
- CIBEROBN—Spanish Biomedical Research Centre in Physiopathology of Obesity
- Department of Endocrinology and Nutrition, ICMDM, Hospital Clinic Barcelona
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Demographic, lifestyle, and health characteristics of older adults with prediabetes in England. Prev Med 2015; 77:74-9. [PMID: 25976519 DOI: 10.1016/j.ypmed.2015.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 03/19/2015] [Accepted: 05/05/2015] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To describe the demographic, lifestyle, and health characteristics of older adults with prediabetes compared to those with normal glucose levels or diabetes. METHOD Participants were from the English Longitudinal Study of Aging 2004-2005 (n=4168). Statistical analyses examined differences between people with prediabetes and 1) people with normal glucose levels and 2) people with diabetes. Design-based F-statistics and t-tests tested differences for each characteristic individually and multinomial logistic regression examined adjusted associations. Survey weighting and cluster information was used to generalize to the older English population. RESULTS Compared to people with normal glucose levels, people with prediabetes were older (RR=1.05 95% CI 1.04-1.07), more likely to be employed (RR=1.27 95% CI 1.01-1.60), more likely to smoke (RR=2.21 95% CI 1.74-2.80), and had higher BMIs (RR=1.08 95% CI 1.06-1.10). Compared to people with diabetes, people with prediabetes were more likely to be women (RR=2.12 95% CI 1.57-2.86), more likely to be employed (RR=1.54 95% CI 1.02-2.33), had lower BMIs (RR=0.95 95% CI 0.93-0.98), were less likely to have a cardiovascular condition (RR=0.34 95% CI 0.24-0.47), and had higher self-rated health (χ(2)=26.08, p<0.001). CONCLUSION Older adults with prediabetes have a unique set of characteristics that may inform prevention or intervention schemes.
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Caspersen CJ, Thomas GD, Beckles GLA, Bullard KM. Secular changes in prediabetes indicators among older-adult Americans, 1999-2010. Am J Prev Med 2015; 48:253-63. [PMID: 25601724 PMCID: PMC4618492 DOI: 10.1016/j.amepre.2014.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 09/15/2014] [Accepted: 10/01/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Sex-specific prediabetes estimates are not available for older-adult Americans. PURPOSE To estimate prediabetes prevalence, using nationally representative data, in civilian, non-institutionalized, older U.S. adults. METHODS Data from 7,995 participants aged ≥50 years from the 1999-2010 National Health and Nutrition Examination Surveys were analyzed in 2013. Prediabetes was defined as hemoglobin A1c=5.7%-6.4% (39-47 mmol/mol [HbA1c5.7]), fasting plasma glucose of 100-125 mg/dL (impaired fasting glucose [IFG]), or both. Crude and age-adjusted prevalences for prediabetes, HbA1c5.7, and IFG by sex and three age groups were calculated, with additional adjustment for sex, age, race/ethnicity, poverty status, education, living alone, and BMI. RESULTS From 1999 to 2005 and 2006 to 2010, prediabetes increased for adults aged 50-64 years (38.5% [95% CI=35.3, 41.8] to 45.9% [42.3, 49.5], p=0.003) and 65-74 years (41.3% [37.2, 45.5] to 47.9% [44.5, 51.3]; p=0.016), but not significantly for adults aged ≥75 years (45.1% [95% CI=41.1, 49.1] to 48.9% [95% CI=45.2, 52.6]; p>0.05). Prediabetes increased significantly for women in the two youngest age groups, and HbA1c5.7 for both sexes (except men aged ≥75 years), but IFG remained stable for both sexes. Men had higher prevalences than women for prediabetes and IFG among adults aged 50-64 years, and for IFG among adults aged ≥75 years. Across demographic subgroups, adjusted prevalence gains for both sexes were similar and most pronounced for HbA1c5.7, virtually absent for IFG, but greater for women than men for prediabetes. CONCLUSIONS Given the large, growing prediabetes prevalence and its anticipated burden, older adults, especially women, are likely intervention targets.
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Affiliation(s)
- Carl J Caspersen
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia.
| | - G Darlene Thomas
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Gloria L A Beckles
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Kai McKeever Bullard
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
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Buysschaert M, Medina JL, Bergman M, Shah A, Lonier J. Prediabetes and associated disorders. Endocrine 2015; 48:371-93. [PMID: 25294012 DOI: 10.1007/s12020-014-0436-2] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 09/20/2014] [Indexed: 12/14/2022]
Abstract
Prediabetes represents an elevation of plasma glucose above the normal range but below that of clinical diabetes. Prediabetes includes individuals with IFG, IGT, IFG with IGT and elevated HbA1c levels. Insulin resistance and β-cell dysfunction are characteristic of this disorder. The diagnosis of prediabetesis is vital as both IFG and IGT are indeed well-known risk factors for type 2 diabetes with a greater risk in the presence of combined IFG and IGT. Furthermore, as will be illustrated in this review, prediabetes is associated with associated disorders typically only considered in with established diabetes. These include cardiovascular disease, periodontal disease, cognitive dysfunction, microvascular disease, blood pressure abnormalities, obstructive sleep apnea, low testosterone, metabolic syndrome, various biomarkers, fatty liver disease, and cancer. As the vast majority of individuals with prediabetes are unaware of their diagnosis, it is therefore vital that the associated conditions are identified, particularly in the presence of mild hyperglycemia, so they may benefit from early intervention.
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Affiliation(s)
- Martin Buysschaert
- Department of Endocrinology and Diabetology, University Clinic Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
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Zhang W, Shen S, Wang W, Zhou C, Xu L, Qiu J, Wang J, Meng X, Liang Y, Niu K, Guo Q. Poor lower extremity function was associated with pre-diabetes and diabetes in older chinese people. PLoS One 2014; 9:e115883. [PMID: 25531769 PMCID: PMC4274122 DOI: 10.1371/journal.pone.0115883] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 12/02/2014] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To determine whether a relationship exists between performance-based physical assessments and pre-diabetes/diabetes in an older Chinese population. METHODS Our study population comprised 976 subjects (mean ± SD age: 67.6±6.0 years; 44.5% men) from the Hangu area of Tianjin, China. Diabetes was defined by self-reporting of a physician's diagnosis, or a fasting plasma glucose level ≥126 mg/dL; and pre-diabetes was defined as a fasting plasma glucose level ≥100 mg/dL and <126 mg/dL. RESULTS When all other variables were adjusted for, men needing longer to finish a Timed Up and Go Test and a decreased usual walking speed had higher odds of pre-diabetes (P for trend = 0.007 and 0.008, respectively) and diabetes (P for trend = 0.012 and 0.014, respectively). However, women needing longer to finish the test and a decreased usual walking speed had a higher odds of diabetes (P for trend = 0.020 and 0.034, respectively) but not of pre-diabetes. There was no apparent association between grip strength and pre-diabetes/diabetes in both sexes. CONCLUSIONS In this study, poor lower extremity function was associated with pre-diabetes/diabetes in older people.
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Affiliation(s)
- Wen Zhang
- Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
| | - Suxing Shen
- Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
| | - Wei Wang
- Department of Rehabilitation, Tianjin Medical University General Hospital, Tianjin, China
| | - Chunling Zhou
- Community Service Center, Chadian Street, Binhai New Area, Tianjin, China
| | - Limin Xu
- Department of Rehabilitation, Tianjin Medical University General Hospital, Tianjin, China
| | - Jiahe Qiu
- Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
| | - Jiaqi Wang
- Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
| | - Xiangxue Meng
- Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
| | - Yixiong Liang
- Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
| | - Kaijun Niu
- Nutritional Epidemiology Institute, Tianjin Medical University, Tianjin, China
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Qi Guo
- Department of Rehabilitation and Sports Medicine, Tianjin Medical University, Tianjin, China
- Department of Rehabilitation Medicine, TEDA International Cardiovascular Hospital, Cardiovascular Clinical College of Tianjin Medical University, TEDA, Tianjin, China
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Fishman EI. Incident Diabetes and Mobility Limitations: Reducing Bias Through Risk-set Matching. J Gerontol A Biol Sci Med Sci 2014; 70:860-5. [PMID: 25414516 DOI: 10.1093/gerona/glu212] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 10/10/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Increased prevalence of diabetes in the U.S. population could contribute substantially to increases in disability at older ages. Previous studies have examined the association between prevalent diabetes and various impairments and disabilities. Methods considering incident, rather than prevalent, diabetes as the exposure of interest can reduce bias in estimates of these associations. METHODS Risk-set matching, a type of propensity score matching meant to handle time-varying exposures, was used to estimate the relationship between incident diabetes and mobility limitations among adults in the Health and Retirement Study. This approach ensures that covariates precede diabetes onset rather than follow it. RESULTS Individuals who were diagnosed with diabetes during the study period accumulated more subsequent mobility limitations than were accumulated by matched controls. Among observationally similar pairs of individuals, those who developed diabetes reported an average of 24.9% more mobility limitations at study exit than those who did not. CONCLUSIONS The magnitude of the relationship between diabetes and limitations estimated in this article is smaller than that presented in previous studies, but the method presented here is likely to provide a less-biased estimate of the association between diabetes and accumulation of mobility limitations.
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Affiliation(s)
- Ezra I Fishman
- Population Studies Center, University of Pennsylvania, Philadelphia.
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Farni K, Shoham DA, Cao G, Luke AH, Layden J, Cooper RS, Dugas LR. Physical activity and pre-diabetes-an unacknowledged mid-life crisis: findings from NHANES 2003-2006. PeerJ 2014; 2:e499. [PMID: 25177530 PMCID: PMC4145065 DOI: 10.7717/peerj.499] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 07/11/2014] [Indexed: 12/04/2022] Open
Abstract
The prevalence of pre-diabetes (PD) among US adults has increased substantially over the past two decades. By current estimates, over 34% of US adults fall in the PD category, 84% of whom meet the American Diabetes Association’s criteria for impaired fasting glucose (IFG). Low physical activity (PA) and/or sedentary behavior are key drivers of hyperglycemia. We examined the relationship between PD and objectively measured PA in NHANES 2003–2006 of 20,470 individuals, including 7,501 individuals between 20 and 65 yrs.We excluded all participants without IFG measures or adequate accelerometry data (final N = 1,317). Participants were identified as PD if FPG was 100–125 mg/dL (5.6–6.9 mmol/L). Moderate and vigorous PA in minutes/day individuals were summed to create the exposure variable “moderate-vigorous PA” (MVPA). The analysis sample included 884 normoglycemic persons and 433 with PD. There were significantly fewer PD subjects in the middle (30.3%) and highest (24.6%) tertiles of PA compared to the lowest tertile (35.5%). After adjusting for BMI, participants were 0.77 times as likely to be PD if they were in the highest tertile compared to the lowest PA tertile (p < 0.001). However, these results were no longer significant when age and BMI were held constant. Univariate analysis revealed that physical activity was associated with decreased fasting glucose of 0.5 mg/dL per minute of MVPA, but multivariate analysis adjusting for age and BMI was not significant. Overall, our data suggest a negative association between measures of PA and the prevalence of PD in middle-aged US adults independent of adiposity, but with significant confounding influence from measures of BMI and age.
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Affiliation(s)
- Kathryn Farni
- Stritch School of Medicine, Loyola University Chicago , Maywood, IL , USA
| | - David A Shoham
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago , Maywood, IL , USA
| | - Guichan Cao
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago , Maywood, IL , USA
| | - Amy H Luke
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago , Maywood, IL , USA
| | - Jennifer Layden
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago , Maywood, IL , USA
| | - Richard S Cooper
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago , Maywood, IL , USA
| | - Lara R Dugas
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago , Maywood, IL , USA
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Abstract
The aging of the U.S. population is leading to an increasing number of surgical procedures performed on older adults. At the same time, the quality of medical care is being more closely scrutinized. Surgical site infection is a widely-assessed outcome. Evidence suggests that strict perioperative serum glucose control among patients with or without diabetes can lower the risk of these infections, but it is unclear whether this control should be applied to older surgical patients. In this clinical review, we discuss current research on perioperative serum glucose management for cardiothoracic, orthopedic, and general/colorectal surgery. In addition, we summarize clinical recommendations and quality-of-care process indicators provided by surgical, diabetes, and geriatric medical organizations.
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Bushman B. Promoting Exercise as Medicine for Prediabetes and Prehypertension. Curr Sports Med Rep 2014; 13:233-9. [DOI: 10.1249/jsr.0000000000000066] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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30
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Bergman M. Inadequacies of current approaches to prediabetes and diabetes prevention. Endocrine 2013; 44:623-33. [PMID: 23881341 DOI: 10.1007/s12020-013-0017-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 07/10/2013] [Indexed: 12/20/2022]
Abstract
In view of the global shift from communicable to chronic, non-communicable diseases including obesity, prediabetes, and type 2 diabetes mellitus, the increasing prevalence of the latter creates a considerable challenge to the clinician and public health infrastructure. Despite the substantial research efforts in the last 10-15 years highlighting the considerable benefit of lifestyle modification in thwarting the insidious progression to diabetes and its complications, many individuals will ineluctably progress even when initially responsive. Furthermore, the vast majority of individuals with prediabetes remain undiagnosed and untreated. Therefore, the responsibilities of the medical and public health communities involve identifying new methods for screening and identifying those at risk as well as refining therapeutic approaches availing as many high-risk individuals as possible to novel treatment modalities.
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Affiliation(s)
- Michael Bergman
- Division of Endocrinology and Metabolism, NYU Diabetes and Endocrine Associates, NYU School of Medicine, 530 First Avenue, Schwartz East, Suite 5E, New York, NY, 10016, USA,
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