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Toyoshima K, Tamura Y, Murao Y, Kodera R, Oba K, Ishikawa J, Chiba Y, Araki A. Risk factor of disability as new certification of long-term care needs in older Japanese adults with diabetes mellitus: A longitudinal study. Geriatr Gerontol Int 2024; 24:1030-1038. [PMID: 39205606 DOI: 10.1111/ggi.14969] [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: 03/27/2024] [Revised: 08/05/2024] [Accepted: 08/10/2024] [Indexed: 09/04/2024]
Abstract
AIM This observational longitudinal study aimed to explore the risk factors for disabilities in older Japanese individuals with diabetes at a frailty clinic, an outpatient clinic specializing in comprehensive geriatric assessments for older patients. METHODS The outcome was the onset of disability as a new certification of long-term care needs in outpatients aged ≥65 years. Multivariable Cox regression analyses examined the independent associations between the onset of disability and the variables that reached significance in the bivariate analysis, after adjusting for age and sex, years of education, and certification of need for support. RESULTS A total of 182 participants (mean age 77.8 years, 59.9% female) were included in the study. During a mean follow-up period of 1070 days, 28 patients (15.4%) developed disabilities. Multivariable analysis showed that poor glycemic control (higher levels of glycosylated albumin and HbA1c), frailty as measured by the Clinical Frailty Scale (CFS), cognitive decline as assessed by the revised Hasegawa Dementia Scale (especially "5 object recall" and verbal fluency as assessed by the number of "vegetable names"), poor adherence to medications, and reduced muscle mass were significantly associated with the development of disability. Multivariable Cox regression analyses revealed independent and significant associations between the development of disability and HbA1c ≥7.5%, CFS ≥4, and generating vegetable names≤9. CONCLUSION In identifying older patients with diabetes who are at risk of developing disabilities, it may be useful to evaluate glycemic control, CFS, cognition, and medication adherence. Verbal fluency tests using vegetable names may serve as simple tools for assessing the risk of disability. Geriatr Gerontol Int 2024; 24: 1030-1038.
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Affiliation(s)
- Kenji Toyoshima
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Yoshiaki Tamura
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Yuji Murao
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Remi Kodera
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Kazuhito Oba
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Joji Ishikawa
- Department of Cardiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Yuko Chiba
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Atsushi Araki
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
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Guevara E, Simó-Servat A, Perea V, Quirós C, Puig-Jové C, Formiga F, Barahona MJ. Frailty Detection in Older Adults with Diabetes: A Scoping Review of Assessment Tools and Their Link to Key Clinical Outcomes. J Clin Med 2024; 13:5325. [PMID: 39274537 PMCID: PMC11396781 DOI: 10.3390/jcm13175325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 08/26/2024] [Accepted: 09/07/2024] [Indexed: 09/16/2024] Open
Abstract
Objectives: With the increasing prevalence of diabetes and frailty among older adults, there is an urgent need for precision medicine that incorporates comprehensive geriatric assessments, including frailty detection. This scoping review aims to map and synthesize the available evidence on validated tools for detecting pre-frailty and frailty in community-dwelling elderly individuals with diabetes and outpatient diabetes patients. Specifically, it addresses: (1) What validated tools are available for detecting pre-frailty and frailty in this population? (2) How are these tools associated with outcomes such as glycemic control, hypoglycemia, and metabolic phenotypes? (3) What gaps exist in the literature regarding these tools? Methods: The review followed PRISMA-ScR guidelines, conducting a systematic search across PubMed, Cochrane Library, and Web of Science. The inclusion criteria focused on studies involving individuals aged 70 years and older with diabetes, emphasizing tools with predictive capacity for disability and mortality. Results: Eight instruments met the inclusion criteria, including the Frailty Index, Physical Frailty Phenotype, and Clinical Frailty Scale. These tools varied in domains such as physical, psychological, and social aspects of frailty and their association with glycemic control, hypoglycemia, and metabolic phenotypes. The review identified significant gaps in predicting diabetes-related complications and their clinical application. Conclusions: Routine management of older adults with diabetes should incorporate frailty detection, as it is crucial for their overall health. Although widely used, the reviewed tools require refinement to address the unique characteristics of this population. Developing tailored instruments will enhance precision medicine, leading to more effective, individualized interventions for elderly individuals with diabetes.
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Affiliation(s)
- Ernesto Guevara
- Department of Geriatrics, Hospital Universitari Mútua-Terrassa, University of Barcelona, 08007 Barcelona, Spain
| | - Andreu Simó-Servat
- Department of Endocrinology, Hospital Universitari Mútua-Terrassa, University of Barcelona, 08007 Barcelona, Spain
| | - Verónica Perea
- Department of Endocrinology, Hospital Universitari Mútua-Terrassa, University of Barcelona, 08007 Barcelona, Spain
| | - Carmen Quirós
- Department of Endocrinology, Hospital Universitari Mútua-Terrassa, University of Barcelona, 08007 Barcelona, Spain
| | - Carlos Puig-Jové
- Department of Endocrinology, Hospital Universitari Mútua-Terrassa, University of Barcelona, 08007 Barcelona, Spain
| | - Francesc Formiga
- Department of Internal Medicine, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Hospital Universitari de Bellvitge, University of Barcelona, 08007 Barcelona, Spain
| | - María-José Barahona
- Department of Endocrinology, Hospital Universitari Mútua-Terrassa, University of Barcelona, 08007 Barcelona, Spain
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Yamazaki M, Takebe T, Hosokawa M, Saika T, Nakao Y, Ikeda S, Sakamoto M. Sulfonylurea prescription patterns in elderly patients with type 2 diabetes mellitus: A comprehensive analysis of real-world data from pharmacies in Japan. J Diabetes Investig 2024. [PMID: 39226073 DOI: 10.1111/jdi.14302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 07/29/2024] [Accepted: 08/15/2024] [Indexed: 09/04/2024] Open
Abstract
AIMS/INTRODUCTION The study aim was to investigate sulfonylurea prescription patterns in elderly patients (age ≥65 years) with type 2 diabetes mellitus in Japan. Sulfonylurea use among older adults has been insufficiently examined, despite the associated risks of hypoglycemia. MATERIALS AND METHODS This retrospective cross-sectional survey entailed analysis of Japanese pharmacy data, extracted from the Musubi database, for patients (age 20-100 years) prescribed sulfonylureas between November 2022 and October 2023. Dose distribution, adherence to the Diabetes Treatment Guidelines for the Elderly 2023 and coprescription of other diabetes medications were investigated. RESULTS Of the total 91,229 patients, 80.1% were prescribed glimepiride, 16.3% gliclazide and 3.6% glibenclamide. In patients aged ≥65 years, exceeding the recommended dose (>1 mg/day for glimepiride, >40 mg/day for gliclazide) was numerically higher for glimepiride (25.0%) than for gliclazide (7.8%). The most common prescribing patterns were quadruple therapy with a sulfonylurea, a dipeptidyl peptidase-4 inhibitor, an sodium-glucose transporter 2 inhibitor and a biguanide in patients aged 65 to <75 years, and dual therapy with a sulfonylurea and a dipeptidyl peptidase-4 inhibitor in patients aged ≥75 years. Unfortunately, glinide was coprescribed for 338 (0.5%) of elderly patients. Insulin was coprescribed for 3,682 (5.6%) of elderly patients. CONCLUSIONS Analysis of real-world sulfonylurea prescription data found guideline non-adherence, namely, excessive prescription of glimepiride, use of glibenclamide in elderly patients, and common coprescription with dipeptidyl peptidase-4 inhibitors. These findings might provide an opportunity to reconsider the treatment of patients with type 2 diabetes mellitus who are over-prescribed sulfonylureas to reduce residual risks, such as hypoglycemia.
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Affiliation(s)
- Michiko Yamazaki
- Department of Social Medical Sciences, Graduate School of Medicine, International University of Health and Welfare, Tokyo, Japan
- Patient Engagement Frontier Medical Science, KAKEHASHI Inc., Tokyo, Japan
| | - Tohru Takebe
- Patient Engagement Frontier Medical Science, KAKEHASHI Inc., Tokyo, Japan
| | - Masaya Hosokawa
- Patient Engagement Business Commercial Intelligence, KAKEHASHI Inc., Tokyo, Japan
| | - Tomoya Saika
- Patient Engagement Frontier Medical Science, KAKEHASHI Inc., Tokyo, Japan
| | | | - Shunya Ikeda
- Department of Social Medical Sciences, Graduate School of Medicine, International University of Health and Welfare, Tokyo, Japan
| | - Masaya Sakamoto
- Department of Diabetes, Metabolism & Endocrinology, International University of Health and Welfare Mita Hospital, Tokyo, Japan
- Department of Diabetes, Metabolism & Endocrinology, International University of Health and Welfare Narita Hospital, Chiba, Japan
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Gómez-Peralta F, Pinés-Corrales PJ, Santos E, Cuesta M, González-Albarrán O, Azriel S. Diabetes Management Based on the Phenotype and Stage of the Disease: An Expert Proposal from the AGORA Diabetes Collaborative Group. J Clin Med 2024; 13:4839. [PMID: 39200982 PMCID: PMC11355114 DOI: 10.3390/jcm13164839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 08/05/2024] [Accepted: 08/12/2024] [Indexed: 09/02/2024] Open
Abstract
Diabetes is a complex and rapidly growing disease with heterogeneous clinical presentations. Recent advances in molecular and genetic technologies have led to the identification of various subtypes of diabetes. These advancements offer the potential for a more precise, individualized approach to treatment, known as precision medicine. Recognizing high-risk phenotypes and intervening early and intensively is crucial. A staging system for type 1 diabetes has been proposed and accepted globally. In this article, we will explore the different methods for categorizing and classifying type 2 diabetes (T2D) based on clinical characteristics, progression patterns, risk of complications, and the use of molecular techniques for patient grouping. We, as a team of experts, will also present an easy-to-follow treatment plan and guidance for non-specialists, particularly primary care physicians, that integrates the classification and staging of diabetes. This will help ensure that the most suitable therapy is applied to the different types of T2D at each stage of the disease's progression.
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Affiliation(s)
| | - Pedro J. Pinés-Corrales
- Endocrinology and Nutrition Service, Complejo Hospitalario Universitario de Albacete, 02008 Albacete, Spain;
| | - Estefanía Santos
- Endocrinology and Nutrition Service, Complejo Hospitalario de Burgos, 09006 Burgos, Spain;
| | - Martín Cuesta
- Endocrinology and Nutrition Service, Hospital Clínico San Carlos, 28040 Madrid, Spain;
| | | | - Sharona Azriel
- Endocrinology and Nutrition Service, Hospital Universitario Infanta Sofía, 28702 San Sebastián De Los Reyes, Spain;
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Cangelosi G, Mancin S, Morales Palomares S, Pantanetti P, Quinzi E, Debernardi G, Petrelli F. Impact of School Nurse on Managing Pediatric Type 1 Diabetes with Technological Devices Support: A Systematic Review. Diseases 2024; 12:173. [PMID: 39195172 DOI: 10.3390/diseases12080173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 07/19/2024] [Accepted: 07/20/2024] [Indexed: 08/29/2024] Open
Abstract
INTRODUCTION Type 1 diabetes (T1D) is a disease that primarily occurs in pediatric populations. A school nurse (SN) can provide valuable support in the school setting for minors affected by this condition. METHODS The main objective of this study was to evaluate the impact of nursing care provided to adolescents and children with T1D using technological devices in school. Qualitative and quantitative outcomes considered in the included studies were collected and discussed. A systematic review was conducted in the PubMed, CINAHL, and Scopus databases and reported thought the PRISMA guidelines. RESULTS Eleven studies were included. The results showed that SNs need to enhance both their skills and organization to effectively manage young patients with T1D using technology. The response of both the pediatric population and their caregivers to the disease management by a SN has been positive. CONCLUSIONS The management of chronic diseases is one of the most urgent public health issues, especially for Western healthcare systems. Proper management of patients with T1D at the school level is definitely an aspect that policymakers and healthcare managers should consider to improve the quality of life of this extremely vulnerable population, particularly those using technological management T1D.
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Affiliation(s)
| | | | - Sara Morales Palomares
- Department of Pharmacy, Health and Nutritional Sciences (DFSSN), University of Calabria, 87036 Rende, Italy
| | | | | | - Giulia Debernardi
- AUSL Bologna, Ospedale Maggiore "C.A. Pizzardi", 40133 Bologna, Italy
| | - Fabio Petrelli
- School of Medicinal and Health Products Sciences, University of Camerino, 62032 Camerino, Italy
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6
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Demidowich AP, Stanback C, Zilbermint M. Inpatient diabetes management. Ann N Y Acad Sci 2024; 1538:5-20. [PMID: 39052915 DOI: 10.1111/nyas.15190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Diabetes mellitus is currently approaching epidemic proportions and disproportionately affects patients in the hospital setting. In the United States, individuals living with diabetes represent over 17 million emergency department visits and 8 million admissions annually. The management of these patients in the hospital setting is complex and differs considerably from the outpatient setting. All patients with hyperglycemia should be screened for diabetes, as in-hospital hyperglycemia portends a greater risk for morbidity, mortality, admission to an intensive care unit, and increased hospital length of stay. However, the definition of hyperglycemia, glycemic targets, and strategies to manage hyperglycemia in the inpatient setting can vary greatly depending on the population considered. Moreover, the presenting illness, changing nutritional status, and concurrent hospital medications often necessitate thoughtful consideration to adjustments of home diabetes regimens and/or the initiation of new insulin doses. This review article will examine core concepts and emerging new literature surrounding inpatient diabetes management, including glycemic targets, insulin dosing strategies, noninsulin medications, new diabetes technologies, inpatient diabetes management teams, and discharge planning strategies, to optimize patient safety and satisfaction, clinical outcomes, and even hospital financial health.
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Affiliation(s)
- Andrew P Demidowich
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Hospital Medicine, Johns Hopkins Community Physicians, Johns Hopkins Medicine, Baltimore, Maryland, USA
- Johns Hopkins Howard County Medical Center, Johns Hopkins Medicine, Columbia, Maryland, USA
| | - Camille Stanback
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Hospital Medicine, Johns Hopkins Community Physicians, Johns Hopkins Medicine, Baltimore, Maryland, USA
- Sibley Memorial Hospital, Johns Hopkins Medicine, Washington, District of Columbia, USA
| | - Mihail Zilbermint
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Hospital Medicine, Johns Hopkins Community Physicians, Johns Hopkins Medicine, Baltimore, Maryland, USA
- Suburban Hospital, Johns Hopkins Medicine, Bethesda, Maryland, USA
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7
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Kahkoska AR, Busby-Whitehead J, Jonsson Funk M, Pratley RE, Weinstock RS, Young LA, Weinstein JM. Receipt of Diabetes Specialty Care and Management Services by Older Adults With Diabetes in the U.S., 2015-2019: An Analysis of Medicare Fee-for-Service Claims. Diabetes Care 2024; 47:1181-1185. [PMID: 38776523 PMCID: PMC11208748 DOI: 10.2337/dc23-1982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 04/10/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE We characterized the receipt of diabetes specialty care and management services among older adults with diabetes. RESEARCH DESIGN AND METHODS Using a 20% random sample of fee-for-service Medicare beneficiaries aged ≥65 years, we analyzed cohorts of type 1 diabetes (T1D) or type 2 diabetes (T2D) with history of severe hypoglycemia (HoH), and all other T2D annually from 2015 to 2019. Outcomes were receipt of office-based endocrinology care, diabetes education, outpatient diabetes health services, excluding those provided in primary care, and any of the aforementioned services. RESULTS In the T1D cohort, receipt of endocrinology care and any service increased from 25.9% and 29.2% in 2015 to 32.7% and 37.4% in 2019, respectively. In the T2D with HoH cohort, receipt of endocrinology care and any service was 13.9% and 16.4% in 2015, with minimal increases. Age, race/ethnicity, residential setting, and income were associated with receiving care. CONCLUSIONS These findings suggest that many older adults may not receive specialty diabetes care and underscore health disparities.
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Affiliation(s)
- Anna R. Kahkoska
- Division of Endocrinology and Metabolism, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
- UNC Center for Aging and Health, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jan Busby-Whitehead
- UNC Center for Aging and Health, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Division of Geriatric Medicine, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Michele Jonsson Funk
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Ruth S. Weinstock
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, SUNY Upstate Medical University, Syracuse, NY
| | - Laura A. Young
- Division of Endocrinology and Metabolism, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Joshua M. Weinstein
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
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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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Li Q, Yuan D, Zeng G, Jiang L, Xu L, Xu J, Liu R, Song Y, Zhao X, Hui R, Gao R, Gao Z, Song L, Yuan J. The association between glycated hemoglobin levels and long-term prognosis in patients with diabetes and triple-vessel coronary disease across different age groups: A cohort study. Diabetes Res Clin Pract 2024; 213:111751. [PMID: 38906334 DOI: 10.1016/j.diabres.2024.111751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 06/13/2024] [Accepted: 06/15/2024] [Indexed: 06/23/2024]
Abstract
AIM Our study aimed to investigate the correlation between glycated hemoglobin (HbA1c) and adverse prognostic events in patients with diabetes and triple-vessel coronary disease (TVD). METHODS This study ultimately included 2051 patients with TVD and diabetes. Patients were categorized into five groups based on their HbA1c levels: < 6.0 %, 6.0-6.4 %, 6.5-6.9 %, 7.0-7.9 %, and ≥ 8.0 %. The primary endpoint was all-cause death, and the secondary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE). RESULTS The median follow-up time was 5.88 years. During this period, a total of 323 (15.7 %) all-cause deaths and 537 (26.2 %) MACCEs were recorded. The relationship between HbA1c and the risk of endpoint events showed a J-shaped pattern, with the lowest risk observed between 6.0 % and 6.4 %. Further analysis revealed a significant interaction between HbA1c and age. In the subgroup with age < 70 years, as HbA1c increased, the risk of endpoint events gradually rose. While in the subgroup with age ≥70 years, there was an L-shaped relationship between HbA1c and endpoint events, with the highest risk observed in patients with HbA1c < 6.0 %. CONCLUSION Our study revealed variations in the relationship between HbA1c levels and endpoint events among patients with TVD and diabetes of different ages. In younger patients, elevated HbA1c levels were associated with a higher risk of death and MACCE, while in older patients, excessively low HbA1c levels (HbA1c < 6 %) were linked to a higher risk of death and MACCE.
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Affiliation(s)
- Qinxue Li
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Deshan Yuan
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Guyu Zeng
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Lin Jiang
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Lianjun Xu
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jingjing Xu
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Ru Liu
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Ying Song
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xueyan Zhao
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Rutai Hui
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Runlin Gao
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Zhan Gao
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Lei Song
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
| | - Jinqing Yuan
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
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10
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Pilla SJ, Maruthur NM. Crossing the deintensification chasm for older adults with diabetes. J Am Geriatr Soc 2024; 72:1952-1954. [PMID: 38738883 PMCID: PMC11226358 DOI: 10.1111/jgs.18944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 03/25/2024] [Accepted: 04/09/2024] [Indexed: 05/14/2024]
Abstract
This editorial comments on the article by Haider et al.
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Affiliation(s)
- Scott J. Pilla
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nisa M. Maruthur
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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11
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Bilal A, Yi F, Whitaker K, Igudesman D, Pratley R, Casu A. Impaired Awareness of Hypoglycemia in Older Adults With Type 1 Diabetes: A Post Hoc Analysis of the WISDM Study. Diabetes Care 2024; 47:1202-1210. [PMID: 38713913 DOI: 10.2337/dc24-0201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/19/2024] [Indexed: 05/09/2024]
Abstract
OBJECTIVE Up to one-third of older adults with type 1 diabetes experience impaired awareness of hypoglycemia (IAH), yet the factors associated with IAH remain underexplored in older adults. RESEARCH DESIGN AND METHODS This post hoc analysis evaluated the clinical and glycemic correlates of IAH in adults ≥60 years old with type 1 diabetes in the WISDM study. IAH and normal awareness of hypoglycemia (NAH) were defined by a Clarke score of ≥4 or <4, respectively. Demographic, clinical, and glycemic metrics were compared in those with IAH and NAH at baseline and in whom IAH did or did not improve over 26 weeks, using descriptive statistics and a multiple logistic regression variable selection procedure. RESULTS Of the 199 participants (age 68.1 ± 5.7 years, 52% female), 30.6% had IAH. At baseline, participants with IAH had a longer diabetes duration and greater daytime hypoglycemia and glycemic variability, and more participants had nondetectable C-peptide levels than those with NAH. Logistic regression associated longer diabetes duration (odds ratio [OR] 1.03, 95% CI 1.01-1.05; P = 0.008) and greater daytime hypoglycemia (OR 1.31, 95% CI, 1.15-1.51; P < 0.0001) with a greater odds of IAH. A similar modeling procedure identified less daytime hypoglycemia (OR per additional percentage point 0.55, 95% CI 0.32-0.94; P = 0.029) and shorter diabetes duration (OR per additional year 0.96, 95% CI 0.91-1.004; P = 0.07) as predictors of restored awareness at 26 weeks, although the effect size for diabetes duration was not statistically significant. CONCLUSIONS In older adults with type 1 diabetes, longer diabetes duration and greater daytime hypoglycemia are drivers of IAH. Dedicated research can personalize IAH management.
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Affiliation(s)
- Anika Bilal
- Translational Research Institute, AdventHealth, Orlando, FL
| | - Fanchao Yi
- Translational Research Institute, AdventHealth, Orlando, FL
| | - Keri Whitaker
- Translational Research Institute, AdventHealth, Orlando, FL
| | | | - Richard Pratley
- Translational Research Institute, AdventHealth, Orlando, FL
- AdventHealth Diabetes Institute, Orlando, FL
| | - Anna Casu
- Translational Research Institute, AdventHealth, Orlando, FL
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12
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Messina R, Mezuk B, Rosa S, Iommi M, Fantini MP, Lenzi J, Di Bartolo P. Age of type 2 diabetes onset as a risk factor for dementia: A 13-year retrospective cohort study. Diabetes Res Clin Pract 2024; 213:111760. [PMID: 38925296 DOI: 10.1016/j.diabres.2024.111760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/13/2024] [Accepted: 06/24/2024] [Indexed: 06/28/2024]
Abstract
AIMS To examine whether age at type 2 diabetes onset is an independent predictor of dementia risk. METHODS Retrospective cohort drawn from healthcare administrative records of all inhabitants within Romagna's catchment area, Italy, with an estimated onset of type 2 diabetes in 2008-2017 and aged ≥ 55, with follow-up until 2020. Time to dementia or censoring was estimated with the Kaplan-Meier method, using diabetes onset as the time origin. Age groups were compared with the log-rank test. Multivariable competing-risks analysis was used to assess predictors of dementia. RESULTS In patients aged ≥ 75 years, dementia-free survival (DFS) declined to below 90 % within five years and linearly decreased to 68.8 % until the end of follow-up. In contrast, DFS for those aged 55-64 years showed a marginal decrease, reaching 97.4 % after 13 years. Competing-risks regression showed that individuals aged ≥ 75 and 65-74 had a significantly higher risk of dementia compared to those aged 55-64 years. Having more comorbidities at diabetes onset and initial treatment with ≥ 2 antidiabetics were clinical predictors. CONCLUSIONS Later age at onset of diabetes is strongly associated with dementia. A better understanding of the diabetes-dementia relationship is needed to inform strategies for promoting specific healthcare pathways.
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Affiliation(s)
- Rossella Messina
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Italy
| | - Briana Mezuk
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Italy; Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan, School of Public Health, MI, USA
| | - Simona Rosa
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Italy
| | - Marica Iommi
- Center of Epidemiology Biostatistics and Medical Information Technology, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Italy
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Italy.
| | - Paolo Di Bartolo
- Diabetes Unit, Local Healthcare Authority of Romagna, Ravenna, Italy
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13
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Xu B, Wu Q, La R, Lu L, Abdu FA, Yin G, Zhang W, Ding W, Ling Y, He Z, Che W. Is systemic inflammation a missing link between cardiometabolic index with mortality? Evidence from a large population-based study. Cardiovasc Diabetol 2024; 23:212. [PMID: 38902748 PMCID: PMC11191290 DOI: 10.1186/s12933-024-02251-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/26/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND This study sought to elucidate the associations of cardiometabolic index (CMI), as a metabolism-related index, with all-cause and cardiovascular mortality among the older population. Utilizing data from the National Health and Nutrition Examination Survey (NHANES), we further explored the potential mediating effect of inflammation within these associations. METHODS A cohort of 3029 participants aged over 65 years old, spanning six NHANES cycles from 2005 to 2016, was enrolled and assessed. The primary endpoints of the study included all-cause mortality and cardiovascular mortality utilizing data from National Center for Health Statistics (NCHS). Cox regression model and subgroup analysis were conducted to assess the associations of CMI with all-cause and cardiovascular mortality. The mediating effect of inflammation-related indicators including leukocyte, neutrophil, lymphocyte, systemic immune-inflammation index (SII), neutrophil to lymphocyte ratio (NLR) were evaluated to investigate the potential mechanism of the associations between CMI and mortality through mediation package in R 4.2.2. RESULTS The mean CMI among the enrolled participants was 0.74±0.66, with an average age of 73.28±5.50 years. After an average follow-up period of 89.20 months, there were 1,015 instances of all-cause deaths and 348 cardiovascular deaths documented. In the multivariable-adjusted model, CMI was positively related to all-cause mortality (Hazard Ratio (HR)=1.11, 95% CI=1.01-1.21). Mediation analysis indicated that leukocytes and neutrophils mediated 6.6% and 13.9% of the association of CMI with all-cause mortality. CONCLUSION Elevated CMI is positively associated with all-cause mortality in the older adults. The association appeared to be partially mediated through inflammatory pathways, indicating that CMI may serve as a valuable indicator for poor prognosis among the older population.
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Affiliation(s)
- Bin Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China
- Department of Cardiology, Zhongshan-Xuhui Hospital, Shanghai Xuhui Central Hospital, Fudan University, Shanghai, China
| | - Qian Wu
- Department of Orthopedic Surgery, Orthopedic Institute, The First Affiliated Hospital of Soochow University, 188 Shizijie Road, Suzhou, 215006, Jiangsu, China.
- Research Institute of Clinical Medicine, Jeonbuk National University Medical School, Jeonju, Republic of Korea.
| | - Rui La
- Department of Orthopedic Surgery, Orthopedic Institute, The First Affiliated Hospital of Soochow University, 188 Shizijie Road, Suzhou, 215006, Jiangsu, China
| | - Lingchen Lu
- Department of Pediatric Surgery and Rehabilitation, Kunshan Maternity and Children's Health Care Hospital, Kunshan, Jiangsu, China
| | - Fuad A Abdu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China
| | - Guoqing Yin
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China
| | - Wen Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China
| | - Wenquan Ding
- Department of Orthopedic Surgery, Orthopedic Institute, The First Affiliated Hospital of Soochow University, 188 Shizijie Road, Suzhou, 215006, Jiangsu, China
| | - Yicheng Ling
- Department of Orthopedic Surgery, Orthopedic Institute, The First Affiliated Hospital of Soochow University, 188 Shizijie Road, Suzhou, 215006, Jiangsu, China
| | - Zhiyuan He
- Department of Orthopedic Surgery, Orthopedic Institute, The First Affiliated Hospital of Soochow University, 188 Shizijie Road, Suzhou, 215006, Jiangsu, China
| | - Wenliang Che
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China.
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14
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Campos ACBF, Teixeira IG, Moraes NDS, Cadorin IDJ, Morelli PM, Lidio AV, Medeiros EB, Garcez ML, Keller GS, Kucharska E, da Rosa MI, Ceretta LB, Quevedo J, Budni J. Prevalence of cognitive impairment and associated factors in older people. J Affect Disord 2024; 355:283-289. [PMID: 38479509 DOI: 10.1016/j.jad.2024.03.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/01/2024] [Accepted: 03/10/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Older people are the fastest-growing age group, with the highest risk of cognitive impairment. This study assessed the prevalence and associated factors with cognitive impairment in community-dwelling older people. METHODS Older people were interviewed and accomplished through sociodemographic and health questionnaires. The quantitative variables were described by mean and standard deviation or median and interquartile range. The significance level adopted was 5 % (p < 0.05). The association between the quantitative variables was evaluated using the Pearson or Spearman correlation coefficients. RESULTS The research population comprised 165 long-lived adults aged ≥80. The youngest one was 80, and the oldest one was 94 years old. The participants were 84.8 ± 3.6 years old, female (63 %) with a mean of education of 2.9 ± 1.8 years. A poor performance in the Mini-Mental State Examination (MMSE) was found in 58 (35.2 %) individuals when adjusted for educational level. After adjustment for confounding factors, body mass index (BMI) (p = 0.09), total older adults' income (up to 1 minimum wage [mw], p = 0.023; over 1 to 2 mw, p = 0.023), functional disability (Moderate dependence 75 %, p = 0.038; Moderate dependence 50 %, p = 0.081; Moderate dependence 25 %, p = 0.054), and the anxiety scale (p = 0.032), remained associated with cognitive impairment. CONCLUSIONS This study showed that BMI, total older adults' income, functional disability, and anxiety are related to cognitive impairment in long-lived adults. This study has some limitations, such as the fact that it is a cross-sectional study, the reduced number of individuals, and the fact that there were no comparisons among different ages and populations.
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Affiliation(s)
| | - Iara Gonçalves Teixeira
- Laboratory of Experimental Neurology, Graduate Program in Health Sciences (PPGCS), University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - Nayara de Souza Moraes
- Laboratory of Experimental Neurology, Graduate Program in Health Sciences (PPGCS), University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - Isabela de Jesus Cadorin
- Laboratory of Experimental Neurology, Graduate Program in Health Sciences (PPGCS), University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - Patrícia Mariotto Morelli
- Laboratory of Experimental Neurology, Graduate Program in Health Sciences (PPGCS), University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - Adrielly Vargas Lidio
- Laboratory of Experimental Neurology, Graduate Program in Health Sciences (PPGCS), University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - Eduarda Behenck Medeiros
- Laboratory of Experimental Neurology, Graduate Program in Health Sciences (PPGCS), University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - Michelle Lima Garcez
- Laboratory of Experimental Neurology, Graduate Program in Health Sciences (PPGCS), University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - Gabriela Serafim Keller
- Laboratory of Experimental Neurology, Graduate Program in Health Sciences (PPGCS), University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - Ewa Kucharska
- Akademia Ignatianum w Krakowie Wydział Pedagogiczny Instytut Nauk o Wychowaniu, Krakow, Poland
| | - Maria Inês da Rosa
- Graduate Program in Public Health (PPGSCol), University of Southern Santa Catarina (UNESC), Criciúma, Santa Catarina, Brazil; Laboratory of Translational Biomedicine, Graduate Program in Health Sciences (PPGCS), University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - Luciane Bisognin Ceretta
- Graduate Program in Public Health (PPGSCol), University of Southern Santa Catarina (UNESC), Criciúma, Santa Catarina, Brazil
| | - João Quevedo
- Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA; Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA; Neuroscience Graduate Program, Graduate School of Biomedical Sciences, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA; Laboratory of Translational Psychiatry, Graduate Program in Health Science (PPGCS), University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - Josiane Budni
- Laboratory of Experimental Neurology, Graduate Program in Health Sciences (PPGCS), University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil.
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Fonseca LM, Schmidt JJ, Snoek FJ, Weinstock RS, Chaytor N, Stuckey H, Ryan CM, van Duinkerken E. Barriers and Facilitators of Self-Management in Older People with Type 1 Diabetes: A Narrative Review Focusing on Cognitive Impairment. Diabetes Metab Syndr Obes 2024; 17:2403-2417. [PMID: 38872713 PMCID: PMC11175657 DOI: 10.2147/dmso.s410363] [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: 01/22/2024] [Accepted: 05/30/2024] [Indexed: 06/15/2024] Open
Abstract
Over the past decades, life expectancy of people with type 1 diabetes has increased considerably, which brings potential challenges due to the process of aging. Cognitive aging and dementia, as well as reductions in visual acuity, hearing and dexterity, can influence the frequency and quality of daily self-management activities, including medication taking and insulin dosing, glucose self-monitoring, and healthy eating. This can increase the risk for hypo- and hyperglycemic events, which, in turn, may contribute to cognitive decline. Because there is a gap in understanding the barriers and facilitators of self-management in older adults with type 1 diabetes and the relationship to cognitive functioning, the authors 1) review the available literature on cognitive aging and type 1 diabetes, 2) describe what self-management in later adulthood entails and the cognitive functions required for effective self-management behaviors, 3) analyze the interaction between type 1 diabetes, cognition, aging, and self-management behaviors, and 4) describe the barriers and facilitators for self-management throughout the life span and how they may differ for older people. Potential evidence-based practices that could be developed for older adults with type 1 diabetes are discussed. There is need for further studies that clarify the impact of aging on T1D self-management, ultimately to improve diabetes care and quality of life.
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Affiliation(s)
- Luciana Mascarenhas Fonseca
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
- Programa Terceira Idade (PROTER, Old Age Research Group), Department and Institute of Psychiatry, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Juliana Janeiro Schmidt
- Post-Graduate Program in Neurology, Universidade Federal Do Estado Do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Frank J Snoek
- Department of Medical Psychology, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, the Netherlands
| | - Ruth S Weinstock
- Department of Medicine, Upstate Medical University, Syracuse, NY, USA
| | - Naomi Chaytor
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Heather Stuckey
- Department of Medicine, Penn State University College of Medicine, Hershey, PA, USA
| | - Christopher M Ryan
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Eelco van Duinkerken
- Post-Graduate Program in Neurology, Universidade Federal Do Estado Do Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Medical Psychology, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, the Netherlands
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Yang J, Tan H, Yu H, Li J, Cui Y, Lu Y, Liu X, Chen Q, Zhou D. Association between remote resistance exercises programs delivered by a smartphone application and skeletal muscle mass among elderly patients with type 2 diabetes- a retrospective real-world study. Front Endocrinol (Lausanne) 2024; 15:1407408. [PMID: 38919474 PMCID: PMC11196602 DOI: 10.3389/fendo.2024.1407408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 05/29/2024] [Indexed: 06/27/2024] Open
Abstract
Objective We aimed to explore the relationship between remote resistance exercise programs delivered via a smartphone application and skeletal muscle mass among elderly patients with type 2 diabetes, utilizing real-world data. Methods The resistance exercises were provided through Joymotion®, a web-based telerehabilitation smartphone application (Shanghai Medmotion Medical Management Co., Ltd). The primary outcome was the changes in skeletal muscle index (SMI) before and after the remote resistance exercises programs. The secondary outcomes were changes in skeletal muscle cross-sectional area (SMA), skeletal muscle radiodensity (SMD) and intermuscular adipose tissue (IMAT). Results A total of 101 elderly patients with type 2 diabetes were analyzed. The participants had an average age of 72.9 ± 6.11 years for males and 74.4 ± 4.39 years for females. The pre- and post-intervention SMI mean (± SE) was 31.64 ± 4.14 vs. 33.25 ± 4.22 cm2/m2 in male, and 22.72 ± 3.24 vs. 24.28 ± 3.60 cm2/m2 in female respectively (all P < 0.001). Similarly, a statistically significant improvement in SMA, IMAT, and SMD for both male and female groups were also observed respectively (P < 0.001). Multiple linear regression models showed potential confounding factors of baseline hemoglobin A1c and duration of diabetes with changes in SMI in male, while hemoglobin A1c and high density lipoprotein cholesterol with changes in SMI in female. Conclusion Remote resistance exercises programs delivered by a smartphone application were feasible and effective in helping elderly patients with type 2 diabetes to improve their skeletal muscle mass.
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Affiliation(s)
- Jing Yang
- Department of Rehabilitation, The Third Affiliated Hospital of Jinzhou Medical University, Liaoning, China
| | - Hongyu Tan
- Postgraduate Training Basement, Jinzhou Medical University, Liaoning, China
| | - Haoyan Yu
- Department of Radiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jingshuo Li
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Yang Cui
- Department of Orthopedics, The Third Affiliated Hospital of Jinzhou Medical University, Liaoning, China
| | - Yuanjian Lu
- Department of Orthopedics, The Third Affiliated Hospital of Jinzhou Medical University, Liaoning, China
| | - Xin Liu
- Department of Rehabilitation, The Third Affiliated Hospital of Jinzhou Medical University, Liaoning, China
| | - Qimin Chen
- Department of Rehabilitation, The Third Affiliated Hospital of Jinzhou Medical University, Liaoning, China
| | - Daan Zhou
- Department of Rehabilitation, The Third Affiliated Hospital of Jinzhou Medical University, Liaoning, China
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Nishimura A, Masuda C, Murauchi C, Ishii M, Murata Y, Kawasaki T, Azuma M, Harashima SI. Relationship Between Frailty and Diabetic Pharmacologic Therapy in Older Adults with Type 2 Diabetes: A Cross-Sectional Study. Drugs Aging 2024; 41:531-542. [PMID: 38795310 PMCID: PMC11193829 DOI: 10.1007/s40266-024-01119-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2024] [Indexed: 05/27/2024]
Abstract
BACKGROUND Older adults with diabetes mellitus require drug treatment considering their frailty, cognitive function, and hypoglycemia. OBJECTIVE We investigated the association between diabetic pharmacologic therapy and both diabetic complications and frailty across eight diabetes-specific outpatient clinics nationwide. METHODS Participants (aged 60-80 years) who had type 2 diabetes and did not require nursing care were included in the study. Basic attributes, patient background, complications, hypoglycemic status, body weight, body composition, blood tests, grip strength, and Kihon Checklist (a frailty index) and self-care scores were obtained. Descriptive statistics, t-test, chi-square test, and regression analyses were employed for evaluation. RESULTS Overall, 417 participants were included (224 men, 193 women, mean age 70.1 ± 5.4 years, diabetes duration 14.9 ± 10.9 years, body mass index 24.5 ± 3.8, glycated hemoglobin 7.22 ± 0.98%, proportion of individuals with frailty and prefrailty, 19.9% and 41.0%, respectively). All drugs were used more frequently in prefrailty conditions. Each diabetes medication was related to complications, body composition, and frailty, as follows: sulfonylurea (lower hypoglycemia); glinide (severe hypoglycemia, retinopathy, weaker grip strength, high Kihon Checklist score, decreased physical activities); alpha-glucosidase inhibitors (no association); biguanide (high body mass index, high body fat, stronger grip strength); thiazolidinedione (decreased instrumental activities of daily living); dipeptidyl-peptidase-4 inhibitors (no association); sodium-glucose cotransporter 2 inhibitors; retinopathy, high body mass index and Kihon Checklist score, and depressive mood); glucagon-like peptide-1 receptor agonists (high body mass index and body fat and poor nutritional status); and insulin preparations (hypoglycemia, retinopathy, neuropathy, nephropathy, cardiovascular diseases, weaker grip strength, and high Kihon Checklist score and physical inactivity). CONCLUSIONS Some formulations, such as glinide, sodium-glucose cotransporter 2 inhibitors, and insulin, are associated with an increased frequency of frailty, warranting careful and individualized diabetes treatment.
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Affiliation(s)
- Akiko Nishimura
- School of Nursing, Faculty of Medicine and Graduate School of Medicine, Kagawa University, Miki-cho, Kagawa, Japan
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan
- Department of Internal Medicine and Diabetes, Goshominami Harashima Clinic, Kyoto City, Kyoto, Japan
| | - Chie Masuda
- Department of Nursing, Asahikawa City Hospital, Asahikawa City, Hokkaido, Japan
| | - Chiyo Murauchi
- Faculty of Nursing and Graduate School of Nursing, Kansai Medical University, Hirakata City, Osaka, Japan
| | - Miho Ishii
- Jonan Branch, Town Home-Visit Medical Care Clinic, Ota-ku, Tokyo, Japan
| | - Yuko Murata
- Department of Nursing, Takashima Municipal Hospital, Takashima City, Shiga, Japan
| | - Terumi Kawasaki
- Department of Nursing, Sapporo City General Hospital, Sapporo City, Hokkaido, Japan
| | - Mayumi Azuma
- School of Nursing, Faculty of Medicine and Graduate School of Medicine, Kagawa University, Miki-cho, Kagawa, Japan
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan
- Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Miyazaki City, Miyazaki, Japan
| | - Shin-Ichi Harashima
- School of Nursing, Faculty of Medicine and Graduate School of Medicine, Kagawa University, Miki-cho, Kagawa, Japan.
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan.
- Department of Internal Medicine and Diabetes, Goshominami Harashima Clinic, Kyoto City, Kyoto, Japan.
- Clinical Research Planning and Administration Division, National Hospital Organization, Kyoto Medical Center, Kyoto City, Kyoto, Japan.
- Research Center for Healthcare, Nagahama City Hospital, Nagahama City, Shiga, Japan.
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Wondimkun YA, Caughey GE, Inacio MC, Hughes GA, Air T, Jorissen RN, Hogan M, Sluggett JK. National trends in utilisation of glucose lowering medicines by older people with diabetes in long-term care facilities. Diabetes Res Clin Pract 2024; 212:111701. [PMID: 38719026 DOI: 10.1016/j.diabres.2024.111701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/26/2024] [Accepted: 05/04/2024] [Indexed: 05/13/2024]
Abstract
AIMS To examine national trends in glucose lowering medicine (GLM) use among older people with diabetes in long-term care facilities (LTCFs) during 2009-2019. METHODS A repeated cross-sectional study of individuals ≥65 years with diabetes in Australian LTCFs (n = 140,322) was conducted. Annual age-sex standardised prevalence of GLM use and number of defined daily doses (DDDs)/1000 resident-days were estimated. Multivariable Poisson or Negative binomial regression models were used to estimate adjusted rate ratios (aRRs) and 95 % confidence intervals (CIs). RESULTS Prevalence of GLM use remained steady between 2009 (63.9%, 95 %CI 63.3-64.4) and 2019 (64.3%, 95 %CI 63.9-64.8) (aRR 1.00, 95 %CI 1.00-1.00). The percentage of residents receiving metformin increased from 36.0% (95 %CI 35.3-36.7) to 43.5% (95 %CI 42.9-44.1) (aRR 1.01, 95 %CI 1.01-1.01). Insulin use also increased from 21.5% (95 %CI 21.0-22.0) to 27.0% (95 %CI 26.5-27.5) (aRR 1.02, 95 %CI 1.02-1.02). Dipeptidyl peptidase-4 inhibitor use increased from 1.0% (95 %CI 0.9-1.1) to 21.1% (95 %CI 20.7-21.5) (aRR 1.24, 95 %CI 1.24-1.25), while sulfonylurea use decreased from 34.4% (95 %CI 33.8-35.1) to 19.3% (95 %CI 18.9-19.7) (aRR 0.93, 95 %CI 0.93-0.94). Similar trends were observed in DDDs/1000 resident days. CONCLUSIONS The increasing use of insulin and ongoing use of sulfonylureas suggests a need to implement evidence-based strategies to optimise diabetes care in LTCFs.
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Affiliation(s)
- Yohanes A Wondimkun
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Hawassa University, College of Medicine and Health Sciences, Hawassa, Sidama, Ethiopia.
| | - Gillian E Caughey
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Maria C Inacio
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Georgina A Hughes
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; University of South Australia, UniSA Clinical and Health Sciences, Adelaide, South Australia, Australia
| | - Tracy Air
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Robert N Jorissen
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Michelle Hogan
- Australian Government Aged Care Quality and Safety Commission, Adelaide, South Australia, Australia
| | - Janet K Sluggett
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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19
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Sienkiewicz-Oleszkiewicz B, Hummel T. Olfactory function in diabetes mellitus. J Clin Transl Endocrinol 2024; 36:100342. [PMID: 38585386 PMCID: PMC10997837 DOI: 10.1016/j.jcte.2024.100342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/18/2024] [Accepted: 03/29/2024] [Indexed: 04/09/2024] Open
Abstract
Diabetes mellitus (DM) is an increasingly common disease in both children and adults. In addition to neuronal and/or vascular disorders, it can cause chemosensory abnormalities including olfactory deterioration. The purpose of this article is to summarize current knowledge on olfactory function in DM, highlighting the impact of co-morbidities, especially obesity, thyroid dysfunction, chronic kidney disease and COVID-19 on olfactory outcomes. Research to date mostly shows that olfactory impairment is more common in people with diabetes than in the general population. In addition, the presence of concomitant diseases is a factor increasing olfactory impairment. Such a correlation was shown for type 1 diabetes, type 2 diabetes and gestational diabetes. At the same time, not only chronic diseases, but also DM in acute conditions such as COVID-19 leads to a higher prevalence of olfactory disorders during infection. Analyzing the existing literature, it is important to be aware of the limitations of published studies. These include the small number of patients studied, the lack of uniformity in the methods used to assess the sense of smell, frequently relying on rated olfactory function only, and the simultaneous analysis of patients with different types of diabetes, often without a clear indication of diabetes type. In addition, the number of available publications is small. Certainly, further research in this area is needed. From a practical point of view decreased olfactory performance may be an indicator for central neuropathy and an indication for assessing the patient's nutritional status, examining cognitive function, especially in older patients and performing additional diagnostic tests, such as checking thyroid function, because all those changes were correlated with smell deterioration.
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Affiliation(s)
- Beata Sienkiewicz-Oleszkiewicz
- Department of Clinical Pharmacology, Faculty of Pharmacy, Wroclaw Medical University, ul. Borowska 211a, 50-556 Wrocław, Poland
- Smell and Taste Clinic, Department of Otorhinolaryngology, Technical University Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Thomas Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, Technical University Dresden, Fetscherstr. 74, 01307 Dresden, Germany
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20
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Morales-Rodriguez DP, González-Cantú A, Garza-Silva A, Rivera-Cavazos A, Fernández-Chau IF, Cepeda-Medina AB, Sanz-Sánchez MA, Del Rio-Parra GF, Torres-Fuentes MA, Rodriguez-Puente MA, Romero-Ibarguengoitia ME. Effect of the SARS-CoV-2 pandemic on metabolic control in patients with type 2 diabetes: a 5-year cohort follow-up managed by a dynamic multidisciplinary team in Northeastern Mexico. Diabetol Metab Syndr 2024; 16:94. [PMID: 38664823 PMCID: PMC11044561 DOI: 10.1186/s13098-024-01318-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The SARS-CoV-2 pandemic brought a radical shift in the healthcare system and suboptimal care for vulnerable patients, such as those with Type 2 Diabetes Mellitus (T2D). Therefore, we compared metabolic control and macro/microvascular complications of patients with T2D before and throughout the three-year SARS-CoV-2 pandemic. RESEARCH DESIGN AND METHODS A retrospective observational cohort of subjects with T2D studied from 2018 to 2022 in Northern Mexico was treated by a dynamic multidisciplinary team. Levels of Glycated hemoglobin (HbA1c), fasting serum glucose (FG), LDL-Cholesterol (LDL-C), blood pressure (BP), albuminuria, triglycerides, Body Mass Index (BMI), and FIB-4 score, micro and macrovascular complications were evaluated. RESULTS A total of 999 patients were studied, 51.7% males with a mean (SD) age of 60.1 (12.7) years. Adequate glycemic control based on HbA1c increased by 15.2% and 42.3% in FSG (p < 0.001) between the beginning 2018 and the end of 2022. LDL-C control decreased by 5.1% between 2018 and 2022 (p < 0.001). Systolic BP control decreased by 2.6% (p < 0.001), whereas diastolic BP control increased by 1.8% (p = 0.01) between 2018 and 2022. Albuminuria control increased by 8.5% (p = 0.002). When comparing the Area Under the Curve (AUC) of metabolic parameters between patients who developed SARS-CoV-2 vs. those who did not, AUC was statistically higher in those who developed SARS-CoV-2 (p < 0.05). Diabetic neuropathy was the most prevalent microvascular complication (n = 35; 3.6%); ischemic heart disease was the most frequent macrovascular complication (n = 11;1.1%). CONCLUSIONS A multidisciplinary dynamic team that adapts to the pandemic SARS-CoV-2 maintains and increases metabolic control in subjects with type 2 diabetes in Mexico. This represents a low percentage of chronic complications. The AUC of metabolic parameters of subjects with SARS-CoV-2 infection is higher, reflecting more variability in metabolic control.
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Affiliation(s)
- Devany Paola Morales-Rodriguez
- Reseach Deparment, Hospital Clinica Nova de Monterrey, San Nicolas de los Garza, Nuevo Leon, Mexico
- Medical School, Vicerrectoria de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Arnulfo González-Cantú
- Reseach Deparment, Hospital Clinica Nova de Monterrey, San Nicolas de los Garza, Nuevo Leon, Mexico
- Medical School, Vicerrectoria de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Arnulfo Garza-Silva
- Reseach Deparment, Hospital Clinica Nova de Monterrey, San Nicolas de los Garza, Nuevo Leon, Mexico
| | - Andrea Rivera-Cavazos
- Reseach Deparment, Hospital Clinica Nova de Monterrey, San Nicolas de los Garza, Nuevo Leon, Mexico
| | - Iván Francisco Fernández-Chau
- Reseach Deparment, Hospital Clinica Nova de Monterrey, San Nicolas de los Garza, Nuevo Leon, Mexico
- Medical School, Vicerrectoria de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Andrea Belinda Cepeda-Medina
- Reseach Deparment, Hospital Clinica Nova de Monterrey, San Nicolas de los Garza, Nuevo Leon, Mexico
- Medical School, Vicerrectoria de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Miguel Angel Sanz-Sánchez
- Reseach Deparment, Hospital Clinica Nova de Monterrey, San Nicolas de los Garza, Nuevo Leon, Mexico
- Medical School, Vicerrectoria de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | | | - María Angelina Torres-Fuentes
- Medical School, Vicerrectoria de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Miguel Assael Rodriguez-Puente
- Medical School, Vicerrectoria de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Maria Elena Romero-Ibarguengoitia
- Reseach Deparment, Hospital Clinica Nova de Monterrey, San Nicolas de los Garza, Nuevo Leon, Mexico.
- Medical School, Vicerrectoria de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico.
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21
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Lorber DL, ElSayed NA, Bannuru RR, Shah V, Puisis M, Crandall J, Fech-Baughman S, Wakeen B, Dantone JJ, Hunter-Buskey R, Moritsugu K, Wang E, Desimone M, Weinstock R, Fischer A, Sherman J, Eber G, Shefelman W. Diabetes Management in Detention Facilities: A Statement of the American Diabetes Association. Diabetes Care 2024; 47:544-555. [PMID: 38527114 DOI: 10.2337/dci24-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 01/17/2024] [Indexed: 03/27/2024]
Abstract
This statement provides guidance for diabetes care in detention facilities. It focuses on areas where the processes for delivery of care to people with diabetes in detention facilities may differ from those in the community, and key points are made at the end of each section. Areas of emphasis, which inform multiple aspects discussed in this statement, include 1) timely identification or diagnosis of diabetes treatment needs and continuity of care (at reception/intake, during transfers, and upon discharge), 2) nutrition and physical activity, 3) timely access to diabetes management tools (insulin, blood glucose monitoring, tracking data, current diabetes management technologies, etc.), and 4) treatment of the whole person with diabetes (self-management education, mental health support, monitoring and addressing long-term complications, specialty care, etc.).
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Affiliation(s)
- Daniel L Lorber
- Lang Center for Research and Education at New York Hospital Queens, Queens, NY
| | - Nuha A ElSayed
- American Diabetes Association, Arlington, VA
- Harvard Medical School, Boston, MA
| | | | - Viral Shah
- University of Colorado Anschutz Medical Campus, Aurora, CO
| | | | | | | | | | - Jo Jo Dantone
- Nutrition Education Resources, Inc., Frances Place, LA
| | - Robin Hunter-Buskey
- Immigration Health Service Corps, U.S. Department of Homeland Security, Washington, DC
| | | | - Emily Wang
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT
| | | | | | | | | | - Gabe Eber
- Center for Public Health & Human Rights, Johns Hopkins School of Public Health, Rockville, MD
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22
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Renda S, Freeman J. You may delay, but time will not. Beta cells lost are never found again: a case for timely initiation of basal insulin in type 2 diabetes. Postgrad Med 2024; 136:150-161. [PMID: 38465574 DOI: 10.1080/00325481.2024.2328511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 03/04/2024] [Indexed: 03/12/2024]
Abstract
Since its first use just over a century ago, insulin treatment has evolved dramatically, such that the molecules are physiologic in nature, and treatment can now closely resemble the natural hormone response over 24 hours. Newer, longer-acting basal insulin analogs have provided insulin therapies with improved characteristics and, therefore, ease of use, and can readily be incorporated as part of routine treatment for type 2 diabetes (T2D), but evidence suggests that insulin remains underused in people with T2D. We review the barriers to initiation of basal insulin and the education needed to address these barriers, and we provide practical pointers, supported by evidence, for primary care physicians and advanced practice providers to facilitate timely initiation of basal insulin in the people with T2D who will benefit from such treatment.
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Affiliation(s)
- Susan Renda
- Johns Hopkins Comprehensive Diabetes Center, Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Jeffrey Freeman
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
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23
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Guo L, Xiao X. Guideline for the Management of Diabetes Mellitus in the Elderly in China (2024 Edition). Aging Med (Milton) 2024; 7:5-51. [PMID: 38571669 PMCID: PMC10985780 DOI: 10.1002/agm2.12294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/08/2024] [Accepted: 02/08/2024] [Indexed: 04/05/2024] Open
Abstract
With the deepening of aging in China, the prevalence of diabetes in older people has increased noticeably, and standardized diabetes management is critical for improving clinical outcomes of diabetes in older people. In 2021, the National Center of Gerontology, Chinese Society of Geriatrics, and Diabetes Professional Committee of Chinese Aging Well Association organized experts to write the first guideline for diabetes diagnosis and treatment in older people in China, the Guideline for the Management of Diabetes Mellitus in the Elderly in China (2021 Edition). The guideline emphasizes that older patients with diabetes are a highly heterogeneous group requiring comprehensive assessment and stratified and individualized management strategies. The guideline proposes simple treatments and de-intensified treatment strategies for older patients with diabetes. This edition of the guideline provides clinicians with practical and operable clinical guidance, thus greatly contributing to the comprehensive and full-cycle standardized management of older patients with diabetes in China and promoting the extensive development of clinical and basic research on diabetes in older people and related fields. In the past 3 years, evidence-based medicine for older patients with diabetes and related fields has further advanced, and new treatment concepts, drugs, and technologies have been developed. The guideline editorial committee promptly updated the first edition of the guideline and compiled the Guideline for the Management of Diabetes Mellitus in the Elderly in China (2024 Edition). More precise management paths for older patients with diabetes are proposed, for achieving continued standardization of the management of older Chinese patients with diabetes and improving their clinical outcomes.
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Affiliation(s)
- Lixin Guo
- National Center of Gerontology, Chinese Society of Geriatrics, Diabetes Professional Committee of Chinese Aging Well AssociationBeijingChina
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Xinhua Xiao
- National Center of Gerontology, Chinese Society of Geriatrics, Diabetes Professional Committee of Chinese Aging Well AssociationBeijingChina
- Department of EndocrinologyPeking Union Medical College Hospital, Chinese Academy of Medical SciencesBeijingChina
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24
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Naito A, Nagatomo Y, Kawai A, Yukino-Iwashita M, Nakazawa R, Taruoka A, Takefuji A, Yasuda R, Toya T, Ikegami Y, Masaki N, Ido Y, Adachi T. The Safety and Efficacy of Sodium-Glucose Cotransporter-2 Inhibitors for Patients with Sarcopenia or Frailty: Double Edged Sword? J Pers Med 2024; 14:141. [PMID: 38392575 PMCID: PMC10890336 DOI: 10.3390/jpm14020141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 02/24/2024] Open
Abstract
Sodium-glucose cotransporter-2 inhibitors (SGLT-2is) show cardiovascular protective effects, regardless of the patient's history of diabetes mellitus (DM). SGLT2is suppressed cardiovascular adverse events in patients with type 2 DM, and furthermore, SGLT-2is reduced the risk of worsening heart failure (HF) events or cardiovascular death in patients with HF. Along with these research findings, SGLT-2is are recommended for patients with HF in the latest guidelines. Despite these benefits, the concern surrounding the increasing risk of body weight loss and other adverse events has not yet been resolved, especially for patients with sarcopenia or frailty. The DAPA-HF and DELIVER trials consistently showed the efficacy and safety of SGLT-2i for HF patients with frailty. However, the Rockwood frailty index that derived from a cumulative deficit model was employed for frailty assessment in these trials, which might not be suitable for the evaluation of physical frailty or sarcopenia alone. There is no fixed consensus on which evaluation tool to use or its cutoff value for the diagnosis and assessment of frailty in HF patients, or which patients can receive SGLT-2i safely. In this review, we summarize the methodology of frailty assessment and discuss the efficacy and safety of SGLT-2i for HF patients with sarcopenia or frailty.
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Affiliation(s)
- Ayami Naito
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan
| | - Akane Kawai
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan
| | | | - Ryota Nakazawa
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan
| | - Akira Taruoka
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan
| | - Asako Takefuji
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan
| | - Risako Yasuda
- Department of Intensive Care, National Defense Medical College, Tokorozawa 359-8513, Japan
| | - Takumi Toya
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan
| | - Yukinori Ikegami
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan
| | - Nobuyuki Masaki
- Department of Intensive Care, National Defense Medical College, Tokorozawa 359-8513, Japan
| | - Yasuo Ido
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan
| | - Takeshi Adachi
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan
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25
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Vonna A, Salahudeen MS, Peterson GM. Medication-Related Hospital Admissions and Emergency Department Visits in Older People with Diabetes: A Systematic Review. J Clin Med 2024; 13:530. [PMID: 38256662 PMCID: PMC10817070 DOI: 10.3390/jcm13020530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/05/2024] [Accepted: 01/15/2024] [Indexed: 01/24/2024] Open
Abstract
Limited data are available regarding adverse drug reactions (ADRs) and medication-related hospitalisations or emergency department (ED) visits in older adults with diabetes, especially since the emergence of newer antidiabetic agents. This systematic review aimed to explore the nature of hospital admissions and ED visits that are medication-related in older adults with diabetes. The review was conducted according to the PRISMA guidelines. Studies in English that reported on older adults (mean age ≥ 60 years) with diabetes admitted to the hospital or presenting to ED due to medication-related problems and published between January 2000 and October 2023 were identified using Medline, Embase, and International Pharmaceutical Abstracts databases. Thirty-five studies were included. Medication-related hospital admissions and ED visits were all reported as episodes of hypoglycaemia and were most frequently associated with insulins and sulfonylureas. The studies indicated a decline in hypoglycaemia-related hospitalisations or ED presentations in older adults with diabetes since 2015. However, the associated medications remain the same. This finding suggests that older patients on insulin or secretagogue agents should be closely monitored to prevent potential adverse events, and newer agents should be used whenever clinically appropriate.
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Affiliation(s)
- Azizah Vonna
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart 7005, Australia; (M.S.S.); (G.M.P.)
- Department of Pharmacy, Faculty of Mathematics and Natural Sciences, Universitas Syiah Kuala, Banda Aceh 23111, Aceh, Indonesia
| | - Mohammed S. Salahudeen
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart 7005, Australia; (M.S.S.); (G.M.P.)
| | - Gregory M. Peterson
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart 7005, Australia; (M.S.S.); (G.M.P.)
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