Mortality and Cardiovascular Complications in Older Complex Chronic Patients with Type 2 Diabetes.

J L Clua-Espuny,W Campo-Tamayo,E Muria-Subirats,M L L Queralt-Tomas,M A González-Henares,J Lucas-Noll,A Panisello-Tafalla

doi:10.1155/2017/6078498

Abstract

Aims/Introduction Determining the prevalence of diabetes and its cardiovascular complications and all-cause mortality in older chronic complex patients. Materials and Methods We carried out a multicenter retrospective study and included a randomized sample of 932 CCP people. We assessed the prevalence of diabetes according to World Health Organization criteria. Data included demographics and functional, comorbidity, cognitive, and social assessment. Results The prevalence of diabetes was 53% and average age 81.16 ± 8.93 years. There were no significant differences in the survival of CCP patients with or without DM, with or without ischaemic cardiopathy, and with or without peripheral vascular disease. The prognostic factors of all-cause mortality in patients with DM were age ≥ 80 years [HR 1.47, 95% CI 1.02–2.13, p 0.038], presence of heart failure [HR 1.73, 95% CI 1.25–2.38, p 0.001], Charlson score [HR 1.20, 95% CI 1.06–1.36, p 0.003], presence of cognitive impairment [HR 1.73, 95% CI 1.24–2.40, p 0.001], and no treatment with statins [HR 1.49, 95% CI 1.08–2.04, p 0.038]. Conclusions We found high prevalence of DM among CCP patients and the relative importance of traditional risk factors seemed to wane with advancing age. Recommendations may include relaxing treatment goals, providing family/patient education, and enhanced communication strategies.

Highlights

The World Health Organization [1] has reported an increase in the ageing population living with major chronic diseases such as diabetes, dementia, cardiovascular disease, and certain cancers, with most of the increase in developing countries
Diabetes had been diagnosed in 53% of the CCP population, with an average age of 81.16 ± 8.93 years, significantly younger (p < 0.001) than those CCP without DM, but with a higher cardiovascular risk (p 0.015), a higher risk of stroke (p < 0.001), more chronic conditions (p < 0.001), and a higher number of prescribed drugs (p < 0.001), but a higher Barthel score (p 0.003) and lower prevalence of cognitive impairment (p 0.001)
There was a steady increase in the prevalence of cardiovascular comorbidities such as atrial fibrillation and heart failure, cognitive impairment, loss of autonomy in basic daily activities, increased fall risk, and the all-cause mortality rates associated with ageing

Summary

Introduction

The World Health Organization [1] has reported an increase in the ageing population living with major chronic diseases such as diabetes, dementia, cardiovascular disease, and certain cancers, with most of the increase in developing countries. Type-2 diabetes is one of the most common chronic diseases affecting older people and its prevalence increases with age. Several publications have described the spectrum of comorbidities and functional impairment in ageing populations [5,6,7]. They emphasize a number of key features such as the emergence of cognitive dysfunction and frailty that can worsen adverse outcomes of diabetes such as emergency visits, increased fall risk, and mortality. The main goal of this study was to determine the prevalence of diabetes and its cardiovascular complications and all-cause mortality in complex chronic patients

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Conclusion