Diabetes In Older Adults Research Articles

Association of New-Onset Diabetes Mellitus in Older People and Mortality in Taiwan: A 10-Year Nationwide Population-Based Study.

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. A retrospective cohort study. 2001-2011 data of the National Health Insurance database. Nationally representative sample of Taiwanese adults aged 65 years and older with propensity score-matched controls. All-cause mortality and adverse health outcomes. 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. 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.

Risk of Diabetes in Older Adults with Co-Occurring Depressive Symptoms and Cardiometabolic Abnormalities: Prospective Analysis from the English Longitudinal Study of Ageing.

High depressive symptoms and cardiometabolic abnormalities are independently associated with an increased risk of diabetes. The purpose of this study was to assess the association of co-occurring depressive symptoms and cardiometabolic abnormalities on risk of diabetes in a representative sample of the English population aged 50 years and older. Data were from the English Longitudinal Study of Ageing. The sample comprised of 4454 participants without diabetes at baseline. High depressive symptoms were based on a score of 4 or more on the 8-item binary Centre for Epidemiologic Studies–Depression scale. Cardiometabolic abnormalities were defined as 3 or more cardiometabolic risk factors (hypertension, impaired glycemic control, systemic inflammation, low high-density lipoprotein cholesterol, high triglycerides, and central obesity). Cox proportional hazards regressions assessed the association between co-occurring depressive symptoms and cardiometabolic abnormalities with incidence of diabetes. Multiple imputation by chained equations was performed to account for missing data. Covariates included age, sex, education, income, smoking status, physical activity, alcohol consumption, and cardiovascular comorbidity. The follow-up period consisted of 106 months, during which 193 participants reported a diagnosis of diabetes. Diabetes incidence rates were compared across the following four groups: 1) no or low depressive symptoms and no cardiometabolic abnormalities (reference group, n = 2717); 2) high depressive symptoms only (n = 338); 3) cardiometabolic abnormalities only (n = 1180); and 4) high depressive symptoms and cardiometabolic abnormalities (n = 219). Compared to the reference group, the hazard ratio for diabetes was 1.29 (95% CI 0.63, 2.64) for those with high depressive symptoms only, 3.88 (95% CI 2.77, 5.44) for those with cardiometabolic abnormalities only, and 5.56 (95% CI 3.45, 8.94) for those with both high depressive symptoms and cardiometabolic abnormalities, after adjusting for socio-demographic, lifestyle and clinical variables. These findings suggest that those with high depressive symptoms and cardiometabolic abnormalities are at a particularly increased risk of type 2 diabetes.

Prediabetes and Diabetes Are Associated With Arterial Stiffness in Older Adults: The ARIC Study.

To determine whether prediabetes and diabetes in older adults are associated with arterial stiffness measured in central and peripheral arteries and to examine characteristics that modify these associations. Cohort members attending the 5th exam (2011-2013) of the Atherosclerosis Risk in Communities (ARIC) study had pulse wave velocity (PWV) measures performed at the carotid-femoral (cfPWV), brachial-ankle (baPWV), and femoral-ankle (faPWV) segments. Fasting glucose ≥126mg/dl, glycated hemoglobin (HbA1c) ≥6.5%, or currently taking diabetes medication defined diabetes. Fasting glucose 100-125mg/dl or HbA1c 5.7%-6.4% among those without diabetes defined prediabetes. Cross-sectional associations were modeled using multivariable linear regression. Among 4,279 eligible participants with cfPWV measures (mean age 75 years), 22% were African-American, 25.5% had diabetes, and 54.7% had prediabetes. Compared to those with normal glucose, cfPWV was 95.8cm/s higher (stiffer) on average for those with diabetes (for reference: being 1 year older was associated with 14.4cm/s higher cfPWV). Similar findings were seen for diabetes and baPWV, although attenuated. Interestingly, faPWV was 17.6cm/s lower for those with diabetes compared to normal glucose. There was a significant positive association between baPWV and prediabetes. Among those with diabetes, cfPWV was higher for those with albuminuria, reduced kidney function, duration of diabetes ≥10 years, and elevated HbA1c (HbA1c ≥7). Among older adults, diabetes is associated with higher central arterial stiffness and lower peripheral arterial stiffness, and prediabetes is associated with higher baPWV. Cross-sectionally, the magnitude of the effect of diabetes on central stiffness is equivalent to 6 years of arterial aging.

Development and validation of a diabetes self-management instrument for older African-Americans

ABSTRACTThe objective of this study was to develop and validate a new diabetes self-management instrument for older African-Americans 65 years of age and older. The Self-Care Utility Geriatric African-American Rating (SUGAAR) was developed using the American Diabetes Association’s standards for the management of type 2 diabetes in older adults and cognitive interviews with older African-Americans. The instrument underwent extensive review by a panel of experts, two rounds of cognitive interviews, and a pilot test before it was administered in an interview format to 125 community-dwelling older African-Americans. The instrument demonstrated content validity and significant, but modest, convergent validity with items from an established diabetes self-management instrument. Social workers and health care professionals can use the SUGARR to assess diabetes self-management and to identify areas for education and support for older African-Americans with type 2 diabetes.

Relevance of nerve conduction velocity in the assessment of balance performance in older adults with diabetes mellitus

Purpose This study investigated the relationship between peripheral nerve conduction velocity (NCV) and balance performance in older adults with diabetes. Methods Twenty older adults with diabetes were recruited to evaluate the NCV of their lower limbs and balance performance. The balance assessments comprised the timed up and go (TUG) test, Berg balance scale (BBS), unipedal stance test (UST), multidirectional reach test (MDRT), maximum step length (MSL) test and quiet standing with eyes open and closed. The relationship between NCV and balance performance was evaluated by Pearson’s correlation coefficients, and the balance performances of the diabetic patients with and without peripheral neuropathy were compared by using Mann–Whitney U tests. Results The NCV in the lower limbs exhibited a moderate to strong correlation with most of the balance tests including the TUG (r = −0.435 to −0.520, p < 0.05), BBS (r = 0.406–0.554, p < 0.05), UST (r = 0.409–0.647, p < 0.05) and MSL (r = 0.399–0.585, P < 0.05). In addition, patients with diabetic peripheral neuropathy had a poorer TUG (p < 0.05), BBS (p < 0.01), UST (p < 0.05) and MSL performance (p < 0.05) compared with those without peripheral neuropathy (p < 0.05). Conclusion Our findings revealed that a decline in peripheral nerve conduction in the lower limb is not only an indication of nerve dysfunction, but may also be related to the impairment of balance performance in patients with diabetes.Implications for RehabilitationNerve conduction velocity in the lower limbs of diabetic older adults showed moderate to strong correlations with most of the results of balance tests, which are commonly used in clinics.Decline in nerve conduction velocity of the lower limbs may be related to the impairment of balance control in patients with diabetes.Diabetic older adults with peripheral neuropathy exhibited greater postural instability than those without peripheral neuropathy.

Association of Muscle Mass, Area, and Strength With Incident Diabetes in Older Adults: The Health ABC Study.

Skeletal muscle plays a key role in glucose regulation, yet the association between muscle quantity or quality and the risk of developing type 2 diabetes has not been explored. The objective of the study was to assess the association between muscle quantity and strength and incident diabetes and to explore whether this association differs by body mass index (BMI) category. Participants were 2166 older adults in the Health, Aging, and Body Composition Study who were free of diabetes at baseline (1997–1998). Computed tomography and dual-energy x-ray absorptiometry were used to measure abdominal and thigh muscle area and total body lean mass, respectively. Strength was quantified by grip and knee extensions. Incident diabetes, defined as fasting glucose of 126 mg/dL or greater, a physician's diagnosis, and/or the use of hypoglycemic medication were measured. After a median 11.3 years of follow-up, there were 265 incident diabetes cases (12.2%). In fully adjusted models, no association was found between muscle or strength measures and incident diabetes (for all, P > .05). For women, there was a significant interaction with BMI category for both abdominal and thigh muscle, such that greater muscle predicted lower risk of incident diabetes for normal-weight women (hazard ratio 0.37 [0.17–0.83] and 0.58 [0.27–1.27] per SD, respectively) and a greater risk for overweight and obese women (hazard ratio 1.23 [0.98–1.54] and 1.28 [1.00–1.64], respectively). No significant interactions by BMI category existed for strength measures or any measures for men (for all, P > .05). Greater muscle area is associated with a lower risk of incident diabetes for older normal-weight women but not for men or overweight women.

Sarcopenia, Frailty, and Diabetes in Older Adults.

Populations are aging and the prevalence of diabetes mellitus is increasing tremendously. The number of older people with diabetes is increasing unexpectedly. Aging and diabetes are both risk factors for functional disability. Thus, increasing numbers of frail or disabled older patients with diabetes will increase both direct and indirect health-related costs. Diabetes has been reported as an important risk factor of developing physical disability in older adults. Older people with diabetes have lower muscle mass and weaker muscle strength. In addition, muscle quality is poorer in diabetic patients. Sarcopenia and frailty have a common soil and may share a similar pathway for multiple pathologic processes in older people. Sarcopenia is thought to be an intermediate step in the development of frailty in patients with diabetes. Thus, early detection of sarcopenia and frailty in older adults with diabetes should be routine clinical practice to prevent frailty or to intervene earlier in frail patients.

Associations of Total and Domain-Specific Sedentary Time With Type 2 Diabetes in Taiwanese Older Adults.

BackgroundThe increasing prevalence of type 2 diabetes in older adults has become a public health concern. We investigated the associations of total and domain-specific sedentary time with risk of type 2 diabetes in older adults.MethodsThe sample comprised 1046 older people (aged ≥65 years). Analyses were performed using cross-sectional data collected via computer-assisted telephone-based interviews in 2014. Data on six self-reported domains of sedentary time (Measure of Older Adults’ Sedentary Time), type 2 diabetes status, and sociodemographic variables were included in the study. Binary logistic regression analysis was performed to calculate the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for total and individual sedentary behavior components and likelihood of type 2 diabetes.ResultsA total of 17.5% of the participants reported type 2 diabetes. No significant associations were found between total sitting time and risk of type 2 diabetes, after controlling for confounding factors. After total sedentary behavior was stratified into six domains, only watching television for more than 2 hours per day was associated with higher odds of type 2 diabetes (OR 1.56; 95% CI, 1.10–2.21), but no significant associations were found between other domains of sedentary behavior (computer use, reading, socializing, transport, and hobbies) and risk of type 2 diabetes.ConclusionsThese findings suggest that, among domain-specific sedentary behavior, excessive television viewing might increase the risk of type 2 diabetes among older adults more than other forms of sedentary behavior.

Diabetes and Frailty: Two Converging Conditions?

Diabetes mellitus is a disabling, chronic cardiovascular and medical disease with a tremendous health, social and economic burden in our ageing communities. It has a prevalence of 10% to 30% in people older than 65 years of age, and more than half of all subjects with diabetes in the United States are older than 60 years of age. The main impact of diabetes in older adults stems from its effect on function, both physical and cognitive, that finally impairs their quality of life, although the impact on survival is modest. Frailty has emerged during the past 2 decades as the most powerful predictor of disability and other adverse outcomes, including mortality, disability and institutionalization in older adults. In this article we explore the relationship between diabetes and frailty, and we recognize that they are intimately related chronic medical conditions that result in huge societal and personal health burdens.

Diabetes Management and Education in Older Adults: The Development of a National Consensus of Key Research Priorities.

Diabetes in older adults is increasing in its prevalence and complexity. To date, little research has been done to inform current diabetes management, including education and support, in older adults in Canada. The objective of this interactive national workshop was to develop key research priorities for future research related to diabetes in older adults. Workshop participants comprised interprofessional healthcare providers, decision makers and policy makers from across Canada. Approximately 30 individuals attended an interactive 2-day meeting that included expert presentations and group consensus building using an electronic meeting system as well as nominal group techniques. The results of the 2-day meeting found more than 50 ideas that were summarized into 5 overall themes, with 14 subquestions, reflecting areas such as 1) identifying relevant outcomes for patients, providers and decision makers; 2) diabetes prevention; 3) the impact of diabetes on older adults and informal caregivers; 4) risk assessment tools and 5) effective models of care across a variety of healthcare settings. To date, this workshop is the first of its kind and follows suit with other international working groups and associations. The research priorities developed through consensus from this workshop set forward a research agenda for diabetes in older adults in Canada.

Graded Resistance Exercise And Type 2 Diabetes in Older adults (The GREAT2DO study): methods and baseline cohort characteristics of a randomized controlled trial.

BackgroundType 2 diabetes (T2D) is projected to affect 439 million people by 2030. Medical management focuses on controlling blood glucose levels pharmacologically in a disease that is closely related to lifestyle factors such as diet and inactivity. Physical activity guidelines include aerobic exercise at intensities or volumes potentially unreachable for older adults limited by many co-morbidities. We aim to show for the first time the efficacy of a novel exercise modality, power training (high-velocity, high-intensity progressive resistance training or PRT), in older adults with T2D as a means for improving glycemic control and targeting many associated metabolic and physiological outcomes.Eligibility criteria included community-dwelling men and women previously diagnosed with T2D who met the current definition of metabolic syndrome according to the International Diabetes Federation. Participants were randomized to a fully supervised power training intervention or sham exercise control group for 12 months. Intervention group participants performed whole body machine-based power training at 80%1RM, 3 days per week. The control group undertook the same volume of non-progressive, low-intensity training. Participants were assessed at baseline, 6 months and 12 months and followed for a further 5 years, during which time participants were advised to exercise at moderate-high intensity. Glycemic control (HbA1c) and insulin resistance as measured by the homeostatic model assessment 2 (HOMA2-IR) were the primary outcomes of the trial. Outcome assessors were blinded to group assignment and participants were blinded to the investigators’ hypothesis regarding the most effective intervention.ResultsWe recruited 103 participants (48.5 % women, 71.6 ± 5.6 years). Participants had 5.1 ± 1.8 chronic diseases, had been diagnosed with T2D for 8 ± 6 years and had a body mass index (BMI) of 31.6 ± 4.0 kg/m2. Fasting glucose and insulin were 7.3 ± 2.4 mmol/L and 10.6 ± 6.3 mU/L, respectively. HbA1c was 54 ± 12 mmol/mol. Eighty-six participants completed the 12-month assessment and follow-up is ongoing. This cohort had a lower-than-expected dropout (n = 14, 14 %) over the 12-month intervention period.ConclusionsPower training may be a feasible adjunctive therapy for improving glycemic control for the growing epidemic of T2D in older adults.Trial registrationAustralian and New Zealand Clinical Trials Registry ACTRN12606000436572 (24 September 2006).

Diabetes and ageing-induced vascular inflammation.

Diabetes and the ageing process independently increase the risk for cardiovascular disease (CVD). Since incidence of diabetes increases as people get older, the diabetic older adults represent the largest population of diabetic subjects. This group of patients would potentially be threatened by the development of CVD related to both ageing and diabetes. The relationship between CVD, ageing and diabetes is explained by the negative impact of these conditions on vascular function. Functional and clinical evidence supports the role of vascular inflammation induced by the ageing process and by diabetes in vascular impairment and CVD. Inflammatory mechanisms in both aged and diabetic vasculature include pro-inflammatory cytokines, vascular hyperactivation of nuclear factor-кB, increased expression of cyclooxygenase and inducible nitric oxide synthase, imbalanced expression of pro/anti-inflammatory microRNAs, and dysfunctional stress-response systems (sirtuins, Nrf2). In contrast, there are scarce data regarding the interaction of these mechanisms when ageing and diabetes co-exist and its impact on vascular function. Older diabetic animals and humans display higher vascular impairment and CVD risk than those either aged or diabetic, suggesting that chronic low-grade inflammation in ageing creates a vascular environment favouring the mechanisms of vascular damage driven by diabetes. Further research is needed to determine the specific inflammatory mechanisms responsible for exacerbated vascular impairment in older diabetic subjects in order to design effective therapeutic interventions to minimize the impact of vascular inflammation. This would help to prevent or delay CVD and the specific clinical manifestations (cognitive decline, frailty and disability) promoted by diabetes-induced vascular impairment in the elderly.

Diabetes Management in Older Adults: Seeing the Forest for the Trees.

Diabetes is a burdensome chronic disease that affects older adults disproportionately. The Public Health Agency of Canada estimates that approximately 18% of adults aged 65 years of age and older have diabetes, and 21% of adults aged 70 years and older have diabetes (1). The unique and heterogeneous group comprising older adults presents challenges in the management of diabetes and its complications. The clinical management of diabetes has become increasingly difficult, straining even the most advanced and highquality healthcare systems (2). Thus, clinical guidelines to address diabetes management and education for diabetes in older adults are necessary. Over the past several years, 3 leading diabetes organizations, the American Diabetes Association (ADA), the Canadian Diabetes Association (CDA) and the International Diabetes Federation (IDF), published their respective guidelines for the management of diabetes in older adults; all 3 were met with some degree of applause, debate, confusion and appreciation. All 3 reported their respective recommendations for various aspects of diabetes management in older adults, including clinical management and glucose, blood pressure and cholesterol targets, as well as recommendations for education and psychosocial well-being (3–5).

Sleep Disturbances and Glucose Metabolism in Older Adults: The Cardiovascular Health Study.

OBJECTIVEWe examined the associations of symptoms of sleep-disordered breathing (SDB), which was defined as loud snoring, stopping breathing for a while during sleep, and daytime sleepiness, and insomnia with glucose metabolism and incident type 2 diabetes in older adults.RESEARCH DESIGN AND METHODSBetween 1989 and 1993, the Cardiovascular Health Study recruited 5,888 participants ≥65 years of age from four U.S. communities. Participants reported SDB and insomnia symptoms yearly through 1989–1994. In 1989–1990, participants underwent an oral glucose tolerance test, from which insulin secretion and insulin sensitivity were estimated. Fasting glucose levels were measured in 1989–1990 and again in 1992–1993, 1994–1995, 1996–1997, and 1998–1999, and medication use was ascertained yearly. We determined the cross-sectional associations of sleep symptoms with fasting glucose levels, 2-h glucose levels, insulin sensitivity, and insulin secretion using generalized estimated equations and linear regression models. We determined the associations of updated and averaged sleep symptoms with incident diabetes in Cox proportional hazards models. We adjusted for sociodemographics, lifestyle factors, and medical history.RESULTSObserved apnea, snoring, and daytime sleepiness were associated with higher fasting glucose levels, higher 2-h glucose levels, lower insulin sensitivity, and higher insulin secretion. The risk of the development of type 2 diabetes was positively associated with observed apnea (hazard ratio [HR] 1.84 [95% CI 1.19–2.86]), snoring (HR 1.27 [95% CI 0.95–1.71]), and daytime sleepiness (HR 1.54 [95% CI 1.13–2.12]). In contrast, we did not find consistent associations between insomnia symptoms and glucose metabolism or incident type 2 diabetes.CONCLUSIONSEasily collected symptoms of SDB are strongly associated with insulin resistance and the incidence of type 2 diabetes in older adults. Monitoring glucose metabolism in such patients may prove useful in identifying candidates for lifestyle or pharmacological therapy. Further studies are needed to determine whether insomnia symptoms affect the risk of diabetes in younger adults.

Energy and protein intakes and their association with a decline in functional capacity among diabetic older adults from the NuAge cohort.

Diabetic older adults (OA) are at greater risk of muscle strength (MS) loss and functional capacity (FC) decline than non-diabetics. Protein and energy intakes are important determinants of muscle mass and MS maintenance and indirectly affect FC. The study sought to determine whether low protein and energy intakes were associated with FC decline and whether this association was mediated by MS in diabetic OA over a 3-year follow-up, in secondary analyses of the Quebec Longitudinal Study on Nutrition and Successful Aging. In 172 diabetic OA (62 % men, mean age=75years), FC decline was defined as the change between SMAF (Système de Mesure de l'Autonomie Fonctionnelle) scores at baseline (T1) and 3years later (T4). Baseline adequate protein and energy intakes were set at ≥1g/kg BW and ≥30kcal/kg BW, respectively. Sex-stratified linear regressions were controlled for confounding variables. Mean body weight (BW) was 85.42±13.8 in men and 79.7±11.5 in women (p≤.001). Adequate protein intake in women was associated with lesser FC decline (mean±SE) (2.11±0.81 vs. 4.91±0.72; p=.029), while adequate energy intake was not associated with FC decline either in men or in women. In women, 1g protein/kg BW helped maintain MS, hence minimizing FC decline. These results demonstrate that protein intake is important in maintaining FC in diabetic OA, albeit with sex differences. This study provides further evidence that protein requirements may be greater than the 0.8g/kg BW currently recommended for OA. Future research in larger samples over longer follow-up is needed to confirm these results.

Sex differences in the association of fasting and postchallenge glucose levels with grip strength among older adults: the Rancho Bernardo Study

ObjectivePersons with diabetes have accelerated muscle loss. The association of fasting and postchallenge glucose levels per se to grip strength, a clinical marker of poor physical function, and potential sex...

Plasma phospholipid very-long-chain saturated fatty acids and incident diabetes in older adults: the Cardiovascular Health Study

Circulating saturated fatty acids (SFAs) are integrated biomarkers of diet and metabolism that may influence the pathogenesis of diabetes. In epidemiologic studies, circulating levels of palmitic acid (16:0) are associated with diabetes; however, very-long-chain SFAs (VLSFAs), with 20 or more carbons, differ from palmitic acid in their biological activities, and little is known of the association of circulating VLSFA with diabetes. By using data from the Cardiovascular Health Study, we examined the associations of plasma phospholipid VLSFA levels measured at baseline with subsequent incident diabetes. A total of 3179 older adults, with a mean age of 75 y at study baseline (1992-1993), were followed through 2011. We used multiple proportional hazards regression to examine the associations of arachidic acid (20:0), behenic acid (22:0), and lignoceric acid (24:0) with diabetes. Baseline levels of each VLSFA were cross-sectionally associated with lower triglyceride levels and lower circulating palmitic acid. We identified 284 incident diabetes cases during follow-up. Compared with the lowest quartile, levels of arachidic acid in the highest quartile of the fatty acid distribution were associated with a 47% lower risk of diabetes (95% CI: 23%, 63%; P-trend: <0.001), after adjustment for demographics, lifestyle factors, and clinical conditions. In analogous comparisons, levels of behenic and lignoceric acid were similarly associated with 33% (95% CI: 6%, 53%; P-trend: 0.02) and 37% (95% CI: 11%, 55%; P-trend: 0.01) lower diabetes risk, respectively. Adjustment for triglycerides and palmitic acid attenuated the associations toward the null, and only the association of arachidic acid remained statistically significant (32% lower risk for fourth vs. first quartile; P-trend: 0.04). These results suggest that circulating VLSFAs are associated with a lower risk of diabetes, and these associations may be mediated by lower triglycerides and palmitic acid. The study highlights the need to distinguish the effects of different SFAs and to explore determinants of circulating VLSFAs. This trial was registered at clinicaltrials.gov as NCT00005133.

Ziabetus Shakari (Type 2 Diabetes Mellitus) in Elderly and its Dietary Management

Prevalence of type 2 diabetes mellitus is increasing rapidly around the world. The ageing of the overall population is a significant driver of the diabetes epidemic. Diabetes in older adults is linked to higher mortality, reduced functional status, and increased risk of institutionalization. Nutrition is an integral part of diabetes care for all ages, but there are additional considerations for older adults with diabetes. The Unani system of medicine believes that a physician is not the healer but an assistant to nature Tabiyat (physique) of the body, which is the true healer hence the diet should be in accordance with it. Diets have been mentioned according to various stages of life to maintain the digestive system at its best.

Circulating and dietary trans fatty acids and incident type 2 diabetes in older adults: the Cardiovascular Health Study.

To investigate the effects of trans fatty acids (TFAs) on type 2 diabetes mellitus (DM) by specific TFA subtype or method of assessment. In the Cardiovascular Health Study, plasma phospholipid trans (t)-16:1n9, t-18:1, and cis (c)/t-, t/c-, and t/t-18:2 were measured in blood drawn from 2,919 adults aged 74 ± 5 years and free of prevalent DM in 1992. Dietary TFA was estimated among 4,207 adults free of prevalent DM when dietary questionnaires were initially administered in 1989 or 1996. Incident DM was defined through 2010 by medication use or blood glucose levels. Risks were assessed by Cox proportional hazards. In biomarker analyses, 287 DM cases occurred during 30,825 person-years. Both t-16:1n9 (extreme quartile hazard ratio 1.59 [95% CI 1.04-2.42], P-trend = 0.04) and t-18:1 (1.91 [1.20-3.03], P-trend = 0.01) levels were associated with higher incident DM after adjustment for de novo lipogenesis fatty acids. In dietary analyses, 407 DM cases occurred during 50,105 person-years. Incident DM was positively associated with consumption of total TFAs (1.38 [1.03-1.86], P-trend = 0.02), t-18:1 (1.32 [1.00-1.76], P-trend = 0.04), and t-18:2 (1.41 [1.05-1.89], P-trend = 0.02). After further adjustment for other dietary habits, however, the associations of estimated dietary TFA with DM were attenuated, and only nonsignificant positive trends remained. Among older adults, plasma phospholipid t-16:1n9 and t-18:1 levels were positively related to DM after adjustment for de novo lipogenesis fatty acids. Estimated dietary TFA was not significantly associated with DM. These findings highlight the need for further observational, interventional, and experimental studies of the effects TFA on DM.

Determinants of new-onset diabetes in older adults–Results of a national cohort study

Diabetes mellitus is prevalent in many countries around the world, but the potential causal factors are not clearly known. We attempted to determine the risk factors for new-onset diabetes in ≥53-year old Taiwanese. We analyzed the 1999 and 2003 datasets of the Taiwan Longitudinal Survey on Aging (TLSA). We performed logistic regression analyses to determine the cross-sectional and longitudinal (1999-2003) associations of the sociodemographic, lifestyle, and health-related variables with diabetes and new-onset diabetes, respectively. We excluded those who were diabetic at baseline in the longitudinal analysis. Results of the cross-sectional analysis showed that higher weight, past betel-quid chewing, IADL dependency, hypertension, heart disease, chronic kidney disease and depressive symptoms were positively associated with diabetes while alcohol drinking was negatively associated with diabetes. Longitudinal analysis showed that excessive weight, physical inactivity, depressive symptoms, and hypertension were associated with increased likelihood of new-onset diabetes while higher physical activity was associated with reduced likelihood of new-onset diabetes. Cigarette-smoking and moderate alcohol drinking showed no clear impacts on new-onset diabetes in older Taiwanese. Results show that excessive weight, physical inactivity, hypertension and depressive symptoms are the major risk factors for new-onset diabetes for both Eastern and Western populations, whereas smoking and alcohol drinking have varying impacts among these populations. Better understanding of these relationships should be helpful for planning effective health promotion strategies for reducing the risk of new-onset diabetes in older adults.