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Huber J, Smeikal M, Saely CH, Stingl H, Clodi M, Lechleitner M, Fasching P. [Geriatric aspects for the management of diabetes mellitus (Update 2023)]. Wien Klin Wochenschr 2023; 135:307-318. [PMID: 37101051 PMCID: PMC10133361 DOI: 10.1007/s00508-022-02124-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] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 04/28/2023]
Abstract
There is a high prevalence of diabetes mellitus in the elderly population of industrial countries. The present article provides recommendations for the screening, prevention and treatment of elderly diabetic patients according to current scientific evidence.
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Affiliation(s)
- Joakim Huber
- Abteilung für Innere Medizin mit Akutgeriatrie und Palliativmedizin, Franziskus Spital, Standort Landstraße, Landstraßer Hauptstraße 4a, 1030 Wien, Österreich
| | - Michael Smeikal
- Abteilung für Innere Medizin mit allgemeiner Geriatrie und Palliativmedizin, Haus der Barmherzigkeit, Wien, Österreich
| | - Christoph H. Saely
- Abteilung für Innere Medizin und Kardiologie/VIVIT-Institut, Landeskrankenhaus Feldkirch, Feldkirch, Österreich
| | - Harald Stingl
- Interne Abteilung, Landesklinikum Melk, Melk, Österreich
| | - Martin Clodi
- ICMR—Institute for Cardiovascular and Metabolic Research, Johannes Kepler Universität Linz (JKU Linz), 4040 Linz, Österreich
| | - Monika Lechleitner
- Interne Abteilung, Landeskrankenhaus Hochzirl – Natters, Hochzirl, Österreich
| | - Peter Fasching
- 5. Medizinische Abteilung mit Endokrinologie, Rheumatologie und Akutgeriatrie, Klinik Ottakring der Stadt Wien, Wien, Österreich
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Forbes A. Reducing the Burden of Mortality in Older People With Diabetes: A Review of Current Research. Front Endocrinol (Lausanne) 2020; 11:133. [PMID: 32256448 PMCID: PMC7089919 DOI: 10.3389/fendo.2020.00133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 02/27/2020] [Indexed: 01/09/2023] Open
Abstract
This review considers the burden of mortality observed in the older population of people with diabetes and identifies the risk factors associated with mortality hazard in this population. The mortality gap between older people with and without diabetes is enduring, with excess mortality being 10% greater than in the general population. While early mortality in men with diabetes is significantly greater than females with diabetes, the relative mortality risk in females is much higher compared to women without diabetes. Older people who have developed diabetes in middle age have significantly higher mortality hazard compared to those who develop it in old age, emphasizing the continued importance of optimizing diabetes care in all ages. To minimize mortality hazard in older age it is important to address some of the factors that convey risk, these include: comorbidity; polypharmacy; physical and mental frailty; safe glycemic targets for older people; hypoglycemia; glycemic targets; and the hypoglycemic agents. While the data to determine optimal management approaches are limited, the overall need is for a more diligent approach in assessing the needs of older people with diabetes to inform individualized care strategies and therapy goals that minimize potential hazards.
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Huber J, Smeikal M, Saely CH, Stingl H, Lechleitner M, Fasching P. Geriatrische Aspekte bei Diabetes mellitus (Update 2019). Wien Klin Wochenschr 2019; 131:236-245. [DOI: 10.1007/s00508-019-1463-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Chi MJ, Liang CK, Lee WJ, Peng LN, Chou MY, Chen LK. Association of New-Onset Diabetes Mellitus in Older People and Mortality in Taiwan: A 10-Year Nationwide Population-Based Study. J Nutr Health Aging 2017; 21:227-232. [PMID: 28112781 DOI: 10.1007/s12603-016-0751-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Older patients with diabetes mellitus are at a higher risk of developing diabetic macro- and micro-vascular complications and cardiovascular diseases than younger diabetes mellitus patients. However, older diabetes mellitus patients are very heterogeneous in their clinical characteristics, diabetes mellitus-related complications and age at disease onset. This study aimed to evaluate the all-cause mortality rates and adverse health outcomes among older adults with new-onset diabetes mellitus through a nationwide population-based study. DESIGN A retrospective cohort study. SETTING 2001-2011 data of the National Health Insurance database. POPULATION Nationally representative sample of Taiwanese adults aged 65 years and older with propensity score-matched controls. MAIN OUTCOME MEASURES All-cause mortality and adverse health outcomes. RESULTS During the study period, 45.3% of patients in the diabetes mellitus cohort and 38.8% in the non-diabetes mellitus cohort died. The adjusted relative risk for mortality in the diabetes mellitus cohort compared to the non-diabetes mellitus cohort was 1.23 (95% Confidence Interval [CI]=1.16-1.30) for males and 1.27 (95%CI=1.19-1.35) for females. During the follow-up period, 8.9% of the diabetes mellitus cohort and 5.8% of the non-diabetes mellitus cohort developed cardiovascular diseases; the diabetes mellitus cohort had an adjusted relative risk of cardiovascular complications compared to the non-diabetes mellitus cohort of 1.54 (95%CI=1.36-1.75) for men and 1.70 (95%CI=1.43-2.02) for women. The adjusted relative risk of mortality in the patients with hypoglycemia compared to non-hypoglycemia patients in the diabetes mellitus cohort was 2.33 (95%CI=1.81-3.01) for men and 2.73 (95%CI=2.10-3.52) for women after adjustment for age, Charlson comorbidity index, acute coronary syndrome, respiratory disease, cancer, infectious disease and nervous system disease at baseline. CONCLUSIONS New-onset diabetes in older adults is associated with an increased risk of mortality, and hypoglycemia is an important marker of this association. Individualized care plans stratified by age at onset, duration of disease, comorbidity and functional status, as well as hypoglycemia avoidance, would benefit the management of diabetes in older adults.
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Affiliation(s)
- M-J Chi
- Prof. Liang-Kung Chen, Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan, TEL: +886-2-28757830, FAX:+886-2-28757711,
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Huber J, Smeikal M, Lechleitner M, Fasching P. [Geriatric aspects for the management of diabetes mellitus]. Wien Klin Wochenschr 2016; 128 Suppl 2:S124-30. [PMID: 27052230 DOI: 10.1007/s00508-016-0955-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
There is a high prevalence of diabetes mellitus in the elderly population of industrial countries. The present article provides recommendations for the screening, prevention and treatment of elderly diabetic patients according to current scientific evidence.
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Affiliation(s)
- Joakim Huber
- 5. Medizinische Abteilung mit Endokrinologie, Rheumatologie und Akutgeriatrie, Wilhelminenspital der Stadt Wien, Wien, Österreich.
| | - Michael Smeikal
- 5. Medizinische Abteilung mit Endokrinologie, Rheumatologie und Akutgeriatrie, Wilhelminenspital der Stadt Wien, Wien, Österreich
| | - Monika Lechleitner
- Interne Abteilung, Landeskrankenhaus Hochzirl - Natters, Hochzirl, Österreich
| | - Peter Fasching
- 5. Medizinische Abteilung mit Endokrinologie, Rheumatologie und Akutgeriatrie, Wilhelminenspital der Stadt Wien, Wien, Österreich
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6
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Twito O, Frankel M, Nabriski D. Impact of glucose level on morbidity and mortality in elderly with diabetes and pre-diabetes. World J Diabetes 2015; 6:345-351. [PMID: 25789117 PMCID: PMC4360429 DOI: 10.4239/wjd.v6.i2.345] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 10/30/2014] [Accepted: 12/31/2014] [Indexed: 02/05/2023] Open
Abstract
The prevalence of type 2 diabetes mellitus (DM) increases with age and reaches 25% in those older than age 65 years. Pre-diabetes status is also very common in the elderly, and is present in about half of those age 75 years and older. Many physicians care for elderly patients with diabetes and pre-diabetes, dealing with the challenge of controlling glucose levels and improving health with minimal adverse events. Over the last decade, research on diabetes among the elderly population has proliferated, adding new information on this topic. This review summarizes the updated medical literature on diabetes and pre-diabetes in the elderly, including the significance of pre-diabetic conditions, new-onset DM in the elderly and long-standing DM. The role of therapeutic intervention and the level of glycemic control for this population are discussed in particular.
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Evans JMM, Eades CE, Leese GP. The risk of total mortality and cardiovascular mortality associated with impaired glucose regulation in Tayside, Scotland, UK: a record-linkage study in 214 094 people. BMJ Open Diabetes Res Care 2015; 3:e000102. [PMID: 26405556 PMCID: PMC4577610 DOI: 10.1136/bmjdrc-2015-000102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 06/03/2015] [Accepted: 06/09/2015] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE Mortality among adults of all ages diagnosed with impaired glucose regulation (IGR) in Tayside, Scotland, UK, was evaluated using routinely collected healthcare data sets. RESEARCH DESIGN AND METHODS Using record-linked data in 2003-2008, all instances of blood glucose testing in the population defined 2 cohorts of patients aged 18+years: those with IGR (whether impaired fasting glucose or impaired glucose tolerance (IGT)) according to the WHO criteria, and those who were normoglycemic. They were followed in survival analyses for mortality or cardiovascular mortality (censoring deaths that occurred within a 30-day period of testing), to derive HRs (with 95% CI) for IGR status using Cox regression, adjusted for age, sex, and an area measure of deprivation. RESULTS There were 2 372 712 tests for 214 094 patients, with 196 799 patients in the non-IGR cohort and 50 080 in the IGR cohort. During follow-up, 19 147 (9.7%) and 8397 (16.8%) patients died in 2 cohorts, respectively, with mortality rates of 33.2/1000 patient-years and 70.7/1000 patient-years. In multivariable analyses, the overall adjusted risk of mortality for IGR was 1.16 (95% CI 1.13 to 1.20). However, it was 2.59 (95% CI 2.17 to 3.10) for people aged <45 years, decreasing to 0.94 (95% CI 0.85 to 1.00) in those aged 85+years. The HRs for cardiovascular mortality were lower overall, but they followed the same pattern, with statistically significant increased risks for patients aged <64 years only. The mortality risk was highest among patients with IGT. CONCLUSIONS IGR is associated with an increased mortality risk which declines with age. It is therefore important to prioritize young people with IGR for prevention; but less important to be aggressive about risk factor modification in older people.
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Affiliation(s)
- Josie M M Evans
- School of Health Sciences, University of Stirling , Scotland , UK
| | - Claire E Eades
- School of Health Sciences, University of Stirling , Scotland , UK
| | - Graham P Leese
- Department of Diabetes and Endocrinology , Ninewells Hospital and Medical School , Dundee , UK
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Holden SE, Gale EAM, Jenkins-Jones S, Currie CJ. How many people inject insulin? UK estimates from 1991 to 2010. Diabetes Obes Metab 2014; 16:553-9. [PMID: 24410846 DOI: 10.1111/dom.12260] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 08/01/2013] [Accepted: 01/05/2014] [Indexed: 11/30/2022]
Abstract
AIMS We set out to estimate the prevalence rate of insulin use in the UK population, the total number of people in the UK who use insulin, the proportion of users with type 1 and type 2 diabetes and changes between 1991 and 2010. METHODS Patients receiving prescriptions for insulin were identified in the Clinical Practice Research Datalink and attributed a diagnosis of type 1 or type 2 diabetes. The annual prevalence of insulin use was calculated and applied to population data. RESULTS The crude prevalence rate of insulin use increased from 2.43 (95% CI 2.38-2.49) per 1000 population in 1991 to 6.71 (6.64-6.77) per 1000 in 2010. The largest change was an increase in the prevalence of insulin users with a diagnosis of type 2 diabetes from 0.67 (0.64-0.70) to 4.34 (4.29-4.39) per 1000 population. The absolute number using insulin increased from 137 000 people (121 000-155 000) in 1991 to 421 000 (400 000-444 000) in 2010. The proportion taking insulin alone (as against combination with oral agents) decreased from 97% in the first decade to 37% in the second. CONCLUSION The number of people using insulin trebled between 1991 and 2010, largely due to a considerable increase in the number of people with type 2 diabetes using insulin.
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Affiliation(s)
- S E Holden
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, The Pharma Research Centre, Cardiff Medicentre, Cardiff, UK
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Ghaem Maralani H, Tai BC, Wong TY, Tai ES, Li J, Wang JJ, Mitchell P. The prognostic role of body mass index on mortality amongst the middle-aged and elderly: a competing risk analysis. Diabetes Res Clin Pract 2014; 103:42-50. [PMID: 24382466 DOI: 10.1016/j.diabres.2013.11.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 06/25/2013] [Accepted: 11/25/2013] [Indexed: 10/25/2022]
Abstract
AIMS To determine the relationship between body mass index (BMI) including its 5-year changes and mortality, and compare the results obtained using Cox and competing risks models. METHODS Our study subjects included 2216 persons aged ≥49 years who participated in the Blue Mountains Eye Study, Australia between 1992 and 1994, and returned for further follow-up examinations between 1997 and 1999. We examined the relationship between BMI and mortality using cubic spline. The Cox and competing risks models were used to assess the associations between baseline BMI and its 5-year changes with all-cause and cause-specific mortality. RESULTS Amongst subjects aged ≤70 years, the relationship between BMI and all-cause mortality was U-shaped. For those aged >70 years, an L-shaped relationship was seen with no elevation in risk amongst the overweight/obese. Based on the competing risks model, obesity at baseline was associated with increased risk of cardiovascular death and reduction in BMI at 5-year was linked to an increase risk of cancer death amongst those aged ≤70 years. The cause-specific Cox model showed that reduction in BMI at 5-year was associated with cancer-death regardless of age, and with cardiovascular deaths among subjects aged ≤70 years. Cox regression model showed larger magnitude of effect with wider confidence interval as compared with competing risks model. CONCLUSIONS Conditions associated with obesity are more likely to affect mortality among subjects aged ≤70 years, but not among those aged over 70 years. Cox model shows larger magnitude of effect in comparison with competing risks model.
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Affiliation(s)
- Haleh Ghaem Maralani
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore
| | - Bee Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore.
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore; Duke-NUS Graduate Medical School, Singapore
| | - E Shyong Tai
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Jialiang Li
- Department of Statistics and Applied Probability, National University of Singapore, Singapore
| | - Jie Jin Wang
- Centre for Vision Research, University of Sydney, Sydney, Australia; Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Victoria, Australia
| | - Paul Mitchell
- Centre for Vision Research, University of Sydney, Sydney, Australia
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Twito O, Ahron E, Jaffe A, Afek S, Cohen E, Granek-Catarivas M, Klein P, Hermoni D. New-onset diabetes in elderly subjects: association between HbA1c levels, mortality, and coronary revascularization. Diabetes Care 2013; 36:3425-9. [PMID: 23877985 PMCID: PMC3816853 DOI: 10.2337/dc12-2503] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE New-onset diabetes mellitus (DM) in elderly patients is associated with increased risk of diabetes complications and mortality. It is unknown whether glycemic control in this population influences the mortality risk. RESEARCH DESIGN AND METHODS The current study was conducted using the computerized database of the Sharon-Shomron District of Clalit Health Services in Israel. Included in the study were subjects 65 years of age and above with new-onset DM. The primary outcome measures were all-cause mortality and coronary revascularization procedures with either percutaneous coronary intervention or coronary artery bypass grafting. RESULTS Participants (n = 2,994) were stratified into four groups according to their mean HbA1c levels during the follow-up period (<6.5% [48 mmol/mol], 6.5-6.99% [48-52 mmol/mol], 7-7.49% [53-57 mmol/mol], and ≥7.5% [58 mmol/mol]). During a mean follow-up of 5.54 ± 2.1 years, 1,173 (39.17%) participants died and 285 (9.51%) underwent coronary revascularization. An HbA1c level >7.5% (58 mmol/mol) was associated with a significantly increased all-cause mortality rate (hazard ratio [HR] 1.74 [95% CI 1.2-1.8], P < 0.0001). This difference remained statistically significant after a multivariate model adjusted for the conventional cardiovascular risk factors and for the use of hypoglycemic agents and statins. Kaplan-Meier survival plots revealed lower survival rates in this group of patients. Coronary revascularization rates were highest among subjects with HbA1c 6.5-6.99% (48-52 mmol/mol) (HR 1.6 [1.01-2.4], P < 0.05) and lowest in patients with HbA1c ≥7.5% (58 mmol/mol). CONCLUSIONS An HbA1c level >7.5% (58 mmol/mol) is associated with increased risk for all-cause mortality and with a lower revascularization rate in elderly patients with new-onset DM.
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Nwaneri C, Cooper H, Bowen-Jones D. Mortality in type 2 diabetes mellitus: magnitude of the evidence from a systematic review and meta-analysis. ACTA ACUST UNITED AC 2013. [DOI: 10.1177/1474651413495703] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: Type 2 diabetes is associated with an increase in age-related mortality. A systematic review and meta-analysis were performed to define the relative risks (RR) of all-cause or cause-specific mortality in type 2 diabetes and to determine gaps in current research. Methods: A comprehensive literature search was undertaken for studies (published 1990–2010) on mortality in type 2 diabetes. The study reports on the measure of mortality as defined by RR for all-cause and cause-specific mortality, heterogeneity, sensitivity analyses and biases. Results: In total 35 studies (220,689 patients; mean follow-up of 10.7 years) were eligible for inclusion: 33 studies reported increased mortality risks; 24 had full data on 95% confidence intervals (CIs), one study reported no excess mortality in men diagnosed after 65 years whereas three reported increased mortality in similar age groups in both sexes. Meta-analysis showed RR = 1.85 (95% CI 1.79–1.92) for all-cause mortality [men RR=1.57 (95% CI 1.46–1.68); women RR=2.0 (95% CI 1.89–2.12)], RR=1.76 (95% CI 1.66–1.88) for cardiovascular mortality and RR=2.26 (95% CI: 1.7-3.02) for stroke. There was no statistically significant evidence of publication bias. Conclusion: Type 2 diabetes increases mortality approximately two-fold increase and macrovascular disease is the principal cause of death.
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Affiliation(s)
- Chukwuemeka Nwaneri
- Department of Community Health & Wellbeing, Faculty of Health & Social Care, University of Chester, UK
- Department of Medicine, Centre for Diabetes & Endocrinology, Wirral University Teaching Hospital NHS Foundation Trust, Arrowe Park Hospital, Upton, Wirral, UK
| | - Helen Cooper
- Department of Community Health & Wellbeing, Faculty of Health & Social Care, University of Chester, UK
- Research and Development, Alder Hey Children’s NHS Foundation Trust, Eaton Road, Liverpool, UK
| | - David Bowen-Jones
- Department of Medicine, Centre for Diabetes & Endocrinology, Wirral University Teaching Hospital NHS Foundation Trust, Arrowe Park Hospital, Upton, Wirral, UK
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Huber J, Smeikal M, Lechleitner M, Fasching P. [Geriatric aspects for the management of diabetes mellitus]. Wien Klin Wochenschr 2013; 124 Suppl 2:74-8. [PMID: 23371328 DOI: 10.1007/s00508-012-0283-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
There is a high incidence of Diabetes mellitus in the elderly population of industrial countries. The present article provides recommendations for the screening, prevention and treatment of elderly diabetic patients according to current scientific evidence.
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Affiliation(s)
- Joakim Huber
- 5. Medizinische Abteilung mit Endokrinologie, Rheumatologie und Akutgeriatrie, Wilhelminenspital der Stadt Wien, Montleartstraße 37, 1160 Wien, Österreich.
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Ioacara S, Guja C, Fica S, Ionescu-Tirgoviste C. The dynamics of life expectancy over the last six decades in elderly people with diabetes. Diabetes Res Clin Pract 2013. [PMID: 23206671 DOI: 10.1016/j.diabres.2012.10.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To investigate the historical changes in survival with diabetes in elderly people with diabetes. RESEARCH DESIGN AND METHODS We analyzed 6504 deaths (44.5% males) registered in a large urban population, aged ≥65 years, and deceased between 1943 and 2009. We split the analysis into three time periods according to year of death: 1943-1965, 1966-1988 and 1989-2009. The parallel changes in the corresponding general population were available. RESULTS The mean age at diabetes onset was 70.8 ± 4.7 years, with mean disease duration at death 7.5 ± 5 years, and mean age at death 78.3 ± 5.9 years. The mean survival loss due to diabetes (expected minus observed survival) was 4.5 ± 5.1 years (4.9 ± 5.1 years for females versus 4.1 ± 5.2 years for males, p<0.001). The mean disease duration at death was 6.4 ± 5.7 years in the period 1943-1965, followed by a significant (p=0.019) rise to 7 ± 5 years in 1966-1988, and 8.3 ± 4.9 years (p<0.001) in 1989-2009. There was a significant increase in coronary heart disease and stroke, and a significant decrease in infections and end-stage renal disease as causes of death. CONCLUSIONS We found a significant increase in age at onset and survival with diabetes leading to a significant increase in age at death. Females had a higher survival loss due to diabetes compared with males.
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Affiliation(s)
- S Ioacara
- N. Paulescu National Institute of Diabetes, Nutrition and Metabolic Diseases, Bucharest, Romania.
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Regidor E, Franch J, Seguí M, Serrano R, Rodríguez-Artalejo F, Artola S. Traditional risk factors alone could not explain the excess mortality in patients with diabetes: a national cohort study of older Spanish adults. Diabetes Care 2012; 35:2503-9. [PMID: 22875228 PMCID: PMC3507605 DOI: 10.2337/dc11-1615] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Individuals with diabetes have an excess mortality compared with people without diabetes. This study used a national cohort of older Spanish adults to identify possible factors explaining the relation between diabetes and excess mortality. RESEARCH DESIGN AND METHODS A cohort of 4,008 people ≥60 years of age was selected in 2000-2001 and followed prospectively until 2008. At baseline, data were collected on diabetes and major risk factors for mortality: social network, diet, physical activity and other lifestyle factors, obesity, hypertension, dyslipidemia, and previous cardiovascular disease and cancer. Analyses were conducted with Cox regression with progressive adjustment for mortality risk factors. RESULTS In the study cohort, 667 people had diabetes. A total of 972 deaths occurred during follow-up. The hazard ratio (HR) and 95% CI for mortality in diabetic versus nondiabetic subjects, adjusted for age, marital status, education level, social class, medical consultation, and treatment with statins, angiotensin II antagonists, or aspirin, was 1.40 (1.11-1.76) in men and 1.70 (1.37-2.10) in women. Adjustment for additional risk factors produced little change in the HR. After adjustment for all risk factors, including cardiovascular disease and cancer, the mortality HR in diabetic versus nondiabetic individuals was 1.43 (1.12-1.82) in men and 1.67 (1.34-2.08) in women. The inclusion of lifestyles and diseases occurring during follow-up also produced little change in the relation between diabetes and mortality. CONCLUSIONS The excess risk of mortality in diabetic versus nondiabetic individuals cannot be explained by mortality risk factors or by the presence of cardiovascular disease or cancer.
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Affiliation(s)
- Enrique Regidor
- Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Madrid, Spain.
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Chen LK, Chen YM, Lin MH, Peng LN, Hwang SJ. Care of elderly patients with diabetes mellitus: a focus on frailty. Ageing Res Rev 2010; 9 Suppl 1:S18-22. [PMID: 20849981 DOI: 10.1016/j.arr.2010.08.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Accepted: 08/13/2010] [Indexed: 11/25/2022]
Abstract
The prevalence and incidence of type 2 diabetes mellitus (DM) increase with age, and its diagnosis and treatment in older people present a challenge. Applying evidence to elderly patients can be problematic, because older persons with frailty, multiple comorbidities, and functional disabilities are generally excluded from diabetes clinical trials. Frailty is characterized by multisystem decline and vulnerability to adverse health outcomes. Insulin resistance predicts frailty, and DM accelerates muscle strength loss. Geriatric diabetes care guidelines have refocused from risk factor control to geriatric syndromes. The European Diabetes Working Party guidelines for elderly type 2 DM patients consider frailty, recommending a conservative target (hemoglobin A1c <8%). Diabetic care-home residents with physical disabilities, cognitive impairment, tube feeding, and the inability to communicate pose particular challenges. Tight glycemic control for such patients increases the risk of hypoglycemia and significant functional decline; a mean hemoglobin A1c <7% did not protect them from care-home-acquired pneumonia. In conclusion, caring for elderly diabetic patients poses unique challenges. Little is known about diabetes care of elderly people with frailty, disabilities, or multiple comorbidities. The interrelationship between frailty and DM deserves further investigation. Practice guidelines for care-home residents with DM are needed to ensure quality of care.
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Barnett KN, Ogston SA, McMurdo MET, Morris AD, Evans JMM. A 12-year follow-up study of all-cause and cardiovascular mortality among 10,532 people newly diagnosed with Type 2 diabetes in Tayside, Scotland. Diabet Med 2010; 27:1124-9. [PMID: 20854379 DOI: 10.1111/j.1464-5491.2010.03075.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS To determine absolute and relative risks of all-cause and cardiovascular mortality among patients newly diagnosed with Type 2 diabetes. METHODS In an observational cohort study using record-linkage databases, based in Tayside, Scotland, UK, we identified newly diagnosed patients with Type 2 diabetes in 1993-2004. We also identified a set of non-diabetic comparators from lists of patients registered with a general practice, individually matched to the diabetic patients by sex, age and deprivation. We followed up patients for mortality and cardiovascular mortality over a 12-year period and calculated hazard ratios using Cox regression. RESULTS There were 10,532 patients with Type 2 diabetes and 21,056 non-diabetic comparators. Diabetic patients in every age/sex group had higher absolute mortality rates. Even taking deprivation into account, the hazard ratio for mortality was 1.32 (95% CI 1.25-1.40), decreasing to 1.15 (1.09-1.22) after adjusting for pre-existing cardiovascular disease. The hazard ratios for cardiovascular mortality were higher, decreasing from 1.51 (1.37-1.67) to 1.23 (1.11-1.36) after adjusting for pre-existing cardiovascular disease. The hazard ratios decreased with increasing age at diagnosis, although the difference in absolute rate of mortality increased slightly with age. Increased mortality risks were only evident 2 years after diagnosis and increased thereafter. CONCLUSIONS Patients with Type 2 diabetes have an increased risk of all-cause and cardiovascular mortality compared with non-diabetic comparators, although this is not observable immediately after diagnosis. Age at diagnosis and duration of the disease independently affect absolute and relative mortality risk.
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Affiliation(s)
- K N Barnett
- Division of Clinical and Population Sciences and Education, University of Dundee, UK
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Peng LN, Lin MH, Lai HY, Hwang SJ, Chen LK, Chiou ST. Risk factors of new onset diabetes mellitus among elderly Chinese in rural Taiwan. Age Ageing 2010; 39:125-8. [PMID: 19897541 DOI: 10.1093/ageing/afp193] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Li-Ning Peng
- Department of Family Medicine, Taipei Veterans General Hospital, Taiwan
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Banerjea R, Pogach LM, Smelson D, Sambamoorthi U. Mental Illness and Substance Use Disorders among Women Veterans with Diabetes. Womens Health Issues 2009; 19:446-56. [DOI: 10.1016/j.whi.2009.07.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2008] [Revised: 07/24/2009] [Accepted: 07/24/2009] [Indexed: 01/22/2023]
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Hansen LJ, Olivarius NDF, Siersma V. 16-year excess all-cause mortality of newly diagnosed type 2 diabetic patients: a cohort study. BMC Public Health 2009; 9:400. [PMID: 19878574 PMCID: PMC2777164 DOI: 10.1186/1471-2458-9-400] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2009] [Accepted: 10/31/2009] [Indexed: 01/22/2023] Open
Abstract
Background Studies have shown that type 2 diabetic patients have higher all-cause mortality than people without diabetes, but it is less clear how diabetes affects mortality in elderly patients and to what degree mortality differs between diabetic men and women. The aim of the present study is to investigate the age- and sex-specific all-cause mortality pattern in patients with type 2 diabetes in comparison with the Danish background population. Methods Population-based cohort study of 1323 patients, diagnosed with clinical type 2 diabetes in 1989-92 and followed for 16 years. Median (interquartile range) age at diagnosis was 65.3 (55.8-73.6) years. The age- and sex-specific hazard rates were estimated for the cohort using the life table method and compared with the expected hazard rates calculated with Danish register data from the general population. Results In comparison with the general population, diabetic patients had a 1.5-2.5 fold higher risk of dying depending on age. The over-mortality was higher for men than for women. It decreased with age in both sexes, and among patients over 80 years at diagnosis the difference between the observed and the expected survival was small. Conclusion We found an excess mortality of type 2 diabetic patients compared with the background population in all age groups. The excess mortality was most pronounced in men and in young patients.
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Affiliation(s)
- Lars J Hansen
- Department of Public Health, The Research Unit for General Practice and Section of General Practice, University of Copenhagen, Copenhagen, Denmark.
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Lutgers HL, Gerrits EG, Sluiter WJ, Ubink-Veltmaat LJ, Landman GWD, Links TP, Gans ROB, Smit AJ, Bilo HJG. Life expectancy in a large cohort of type 2 diabetes patients treated in primary care (ZODIAC-10). PLoS One 2009; 4:e6817. [PMID: 19714245 PMCID: PMC2729379 DOI: 10.1371/journal.pone.0006817] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Accepted: 07/22/2009] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Most longitudinal studies showed increased relative mortality in individuals with type 2 diabetes mellitus until now. As a result of major changes in treatment regimes over the past years, with more stringent goals for metabolic control and cardiovascular risk management, improvement of life expectancy should be expected. In our study, we aimed to assess present-day life expectancy of type 2 diabetes patients in an ongoing cohort study. METHODOLOGY AND PRINCIPAL FINDINGS We included 973 primary care type 2 diabetes patients in a prospective cohort study, who were all participating in a shared care project in The Netherlands. Vital status was assessed from May 2001 till May 2007. Main outcome measurement was life expectancy assessed by transforming actual survival time to standardised survival time allowing adjustment for the baseline mortality rate of the general population. At baseline, mean age was 66 years, mean HbA(1c) 7.0%. During a median follow-up of 5.4 years, 165 patients died (78 from cardiovascular causes), and 17 patients were lost to follow-up. There were no differences in life expectancy in subjects with type 2 diabetes compared to life expectancy in the general population. In multivariate Cox regression analyses, concentrating on the endpoints 'all-cause' and cardiovascular mortality, a history of cardiovascular disease: hazard ratio (HR) 1.71 (95% confidence interval (CI) 1.23-2.37), and HR 2.59 (95% CI 1.56-4.28); and albuminuria: HR 1.72 (95% CI 1.26-2.35), and HR 1.83 (95% CI 1.17-2.89), respectively, were significant predictors, whereas smoking, HbA(1c), systolic blood pressure and diabetes duration were not. CONCLUSIONS This study shows a normal life expectancy in a cohort of subjects with type 2 diabetes patients in primary care when compared to the general population. A history of cardiovascular disease and albuminuria, however, increased the risk of a reduction of life expectancy. These results show that, in a shared care environment, a normal life expectancy is achievable in type 2 diabetes patients.
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Affiliation(s)
- Helen L. Lutgers
- Department of Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Wim J. Sluiter
- Department of Endocrinology, University Medical Center Groningen, Groningen, the Netherlands
| | | | | | - Thera P. Links
- Department of Endocrinology, University Medical Center Groningen, Groningen, the Netherlands
- Department of Medicine, University of Groningen, Groningen, the Netherlands
| | - Reinold O. B. Gans
- Department of Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands
- Department of Medicine, University of Groningen, Groningen, the Netherlands
| | - Andries J. Smit
- Department of Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands
- Department of Medicine, University of Groningen, Groningen, the Netherlands
| | - Henk J. G. Bilo
- Department of Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands
- Diabetes Center, Isala Clinics, Zwolle, the Netherlands
- Department of Medicine, University of Groningen, Groningen, the Netherlands
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Chen LK, Peng LN, Lin MH, Lai HY, Hwang SJ, Chiou ST. Predicting New Onset Diabetes Mellitus in Older Taiwanese: Metabolic Syndrome or Impaired Fasting Glucose? J Atheroscler Thromb 2009; 16:627-32. [DOI: 10.5551/jat.794] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Barnett KN, McMurdo MET, Ogston SA, Morris AD, Evans JMM. Mortality in people diagnosed with type 2 diabetes at an older age: a systematic review. Age Ageing 2006; 35:463-8. [PMID: 16679336 DOI: 10.1093/ageing/afl019] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To review all published observational studies reporting on all-cause mortality in patients with type 2 diabetes to determine the degree of increased mortality when diagnosed at an older age. DESIGN Systematic literature search. SETTING The review included studies carried out in populations from Germany, United Kingdom, United States, Japan, Italy, Western Australia, Netherlands and Sweden. MEASUREMENTS Medline, CINAHL, EMBASE, National Research Register and Cochrane Reviews were systematically searched from 1975 to 2004. We identified observational studies that reported overall mortality for people diagnosed with type 2 diabetes when they were over the age of 60, compared with a non-diabetic population. Outcome measures were expressed as risk ratios or relative risks. RESULTS Among 14 eligible studies, one study reported reduced mortality for patients diagnosed with type 2 diabetes over the age of 60, whereas another found virtually no increased risk of mortality. However, 7 of the 14 studies reported increased mortality in all patients diagnosed when older, and 5 studies for certain subgroups only. A meta-analysis showed the combined relative risks (with 95% CI) of increased mortality for men diagnosed between the ages of 60 and 70 to be 1.38 (1.08-1.76) and 1.13 (0.88-1.45) for men diagnosed aged 70 years or older. A similar pattern was found for the same age groups for women, with combined relative risks of 1.40 (1.10-1.79) and 1.19 (0.93-1.52) respectively. CONCLUSION Increased mortality associated with a diagnosis of type 2 diabetes at an older age is lower than that reported for the general older diabetic population.
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Affiliation(s)
- Karen N Barnett
- Section of Public Health, Division of Community Health Sciences, University of Dundee, The Mackenzie Building, Kirsty Semple Way, Dundee DD2 4BF, UK.
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Tseng CL, Sambamoorthi U, Rajan M, Tiwari A, Frayne S, Findley P, Pogach L. Are there gender differences in diabetes care among elderly Medicare enrolled veterans? J Gen Intern Med 2006; 21 Suppl 3:S47-53. [PMID: 16637945 PMCID: PMC1513166 DOI: 10.1111/j.1525-1497.2006.00374.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine gender differences in diabetes care process measures and intermediate outcomes among veteran clinic users. DESIGN A retrospective cohort study using Veterans Health Administration (VHA) and Medicare files of VHA clinic users with diabetes. Diabetes care process measures were tests for hemoglobin A1c (HbA1c), low-density lipoprotein (LDL-C) values, and eye exams. Intermediate outcomes were HbA1c and LDL-C values below recommended thresholds. Chi-square tests and logistic regressions were used to assess gender differences. PARTICIPANTS Study population included 3,225 women and 231,922 men veterans with diabetes, enrolled in Medicare fee-for-service and alive at the end of fiscal year 2000. RESULTS Overall, there were no significant gender differences in HbA1c or LDL-C testing. However, women had higher rates in these process measures than men among the non-African American minorities. Women were more likely to have completed eye exams (odds ratio [OR]=1.11; 99% confidence interval [CI]=1.10, 1.23) but were less likely to have LDL-C under 130 mg/dL (OR=0.77; 99% CI=0.69, 0.87). CONCLUSIONS Among VHA patients with diabetes, clinically significant gender inequality was not apparent in most of diabetes care measures. However, there was evidence of better care among nonwhite and non-African American women than their male counterparts. Further research on interaction of race and gender on diabetes care is needed. This includes evaluation of integrated VHA women's health programs as well as cultural issues. Lower LDL-C control among women suggests areas of unmet needs for women and opportunities for future targeted quality improvement interventions at system and provider levels.
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Affiliation(s)
- Chin-Lin Tseng
- Center for Health Care Knowledge and Management, VA New Jersey Health Care System, East Orange, NJ 07018, USA.
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Current literature in diabetes. Diabetes Metab Res Rev 2005; 21:475-82. [PMID: 16114072 DOI: 10.1002/dmrr.587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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