Diabetes Age Research Articles

Barriers and facilitators of providing standard of care diabetes management at primary care level in geriatric population.

Geriatric population is gradually increasing and is expected to grow till 20% by 2050 from the current 8.6%, and so is diabetes prevalence and other comorbidities. To improve diabetes control, better coordination of provider, patient and health system is needed. It has been found that almost half of the diabetes patients do not achieve treatment targets. So, it is essential to assess the perceived barriers as well as facilitators from patients' and physicians' perspectives. The aim of the study was assessment of needs, care, barriers and facilitators to achieve treatment goals for patients and physicians. This observational, cross-sectional study was conducted by the Department of Geriatrics among 100 elderly diabetes patients and 50 physicians after obtaining ethical approval. All participants were interviewed based on a predefined, structured questionnaire with multiple options to grade or choose from. Polypharmacy, mobility issues and dementia were the most common geriatric issues. Hypertension (HTN), arthritis and coronary artery disease (CAD) were the commonest comorbidities. Also, 73% reported that they followed dietary advice, but only 22% accepted that they were doing exercise regularly. Moreover, 5% mentioned that they were taking alcohol, and 15% confirmed of smoking. Also, 47% of patients felt that diabetes was well controlled. Remaining 53% patients gave reasons for poor diabetes control; the most common reason was not following a proper diabetic diet plan in 42% of patients and lack of exercise as instructed was reported by 22% as the reason for their poor diabetic control. Nineteen percent of patients accepted of not measuring their blood glucose as instructed. Among urban doctors, the three most common factors were not being consistent with lifestyle interventions, followed by no regular self-monitoring of blood glucose and no regular follow-up. Top three interventions suggested were to engage or encourage the family members of patients to become involved in diabetes care, provide more convenient diabetes brochures or education materials to patients and improve multidisciplinary and multispeciality collaboration in diabetes control. Diabetes in elderly needs proactive health system and coordinated care. Doctor-patient relationship with good communication skills, family support and multidisciplinary care is needed to improve diabetes care. Health education with a focus on diet control, exercise and other lifestyle modifications are essential factors in improving diabetes care.

Diabetes and cognitive decline.

Epidemiologic studies have documented an association between diabetes and increased risk of cognitive decline in the elderly. Based on animal model studies, several mechanisms have been proposed to explain such an association, including central insulin signaling, neurodegeneration, brain amyloidosis, and neuroinflammation. Nevertheless, the exact mechanisms in humans remain poorly defined. It is reasonable, however, that many pathways may be involved in these patients leading to cognitive impairment. A major aim of clinicians is identifying early onset of neurologic signs and symptoms in elderly diabetics to improve quality of life of those with cognitive impairment and reduce costs associated with long-term complications. Several biomarkers have been proposed to identify diabetics at higher risk of developing dementia and diagnose early stage dementia. Although biomarkers of brain amyloidosis, neurodegeneration and synaptic plasticity are commonly used to diagnose dementia, especially Alzheimer disease, their role in diabetes remains unclear. The aim of this review is to explore the molecular mechanisms linking diabetes with cognitive decline and present the most important findings on the clinical use of biomarkers for diagnosing and predicting early cognitive decline in diabetics.

Efficacy and safety of sodium-glucose co-transporter 2 inhibitors in the elderly versus non-elderly patients with type 2 diabetes mellitus: a meta-analysis.

This meta-analysis was performed to compare the influence of sodium-glucose co-transporter 2 inhibitors (SGLT2i) on the efficacy and safety of elderly patients with type 2 diabetes with the young ones. PubMed, Medline, Web of Science, EMbase, and Cochrane Library were searched for literature published before March 2020 to identify studies comparing efficacy and safety of SGLT2i in elderly diabetes patients (≥65 years) and young controls (<65 years). A fixed or random-effect model was used to calculate the summary standard means difference and odds ratios. A total of 13 articles with data for 86,433 participants were included. Old patients receiving SGLT2i had a smaller reduction in hemoglobin A1c (SMD = -0.07, 95% CI -0.14 to -0.00, p = 0.044) than young ones. They had higher incidence of serious adverse events (SAEs) (OR 1.78, 95% CI 1.25-2.55, p = 0.001), AE leading to discontinuation (OR 2.34, 95%CI 1.53-3.59, p = 0.000), volume depletion (OR 2.80, 95% CI 1.82-4.32, p = 0.000) , and urinary tract infections (OR 1.37, 95% CI 1.18-1.60, p = 0.000), and renal function impairment (OR 2.61, 95% CI 1.78-3.81, p = 0.000) than young patients, and there was a opposite result in genital mycotic infections (OR 0.69, 95% CI 0.55-0.87, p = 0.002). No significant differences were recorded in the reduction of fasting blood glucose, blood pressure, body weight, and in incidence of overall AEs and fracture. In summary, relatively satisfying efficacy was observed in the elderly patients receiving SGLT2i. Although some AEs were more prevalent among older patients, the majority of them were generally mild.

Research Progress of Medication Compliance in Elderly Diabetic Patients

Research Progress of Medication Compliance in Elderly Diabetic Patients

Prevalence and Clinical Significance of Occult Pulmonary Infection in Elderly Patients with Type 2 Diabetes Mellitus.

The occult pulmonary infection is the most common complications in elderly patients with type 2 diabetes mellitus (T2DM). Since its etiological characteristics has not been clarified, infection control remains a serious problem for public health. To investigate the prevalence and clinical significance of occult pulmonary infection in elderly T2DM patients, in this study, 573 elderly patients cochallenged with T2DM and community-acquired pulmonary infection from January 2018 to December 2020 were selected in the hospitals and divided into occult pneumonia group (OP, n = 249) and nonoccult pneumonia group (NOP, n = 324) according to the nature of infection. Clinical medical records were analyzed retrospectively to summarize the infection characteristics of elderly diabetics with occult pneumonia. The prevalence of the cases (278/324, 85.8%) in NOP group was not higher than that in OP group (206/249, 82.7%; P > 0.05). Also, there was not significant difference in the distribution of isolated pathogens among the positive patients. The length of hospitalization and mortality of OP patients were significantly higher than those NOP patients. Multivariate logistic regression showed that advanced age, comorbidities, hypothyroidism, senile dementia, and prolonged bed rest were independent risk factors for occult pneumonia in elderly diabetic patients. Therefore, the results demonstrated that the pulmonary infection in elderly patients with diabetes mellitus is often occult. Gram-negative bacteria are the predominant pathogens and cause poor prognosis. Advanced age, comorbidities (senile dementia, hypothyroidism), and prolonged bed rest are the independent risk factors for occult pneumonia.

Comparative Observation of Therapeutic Effects of Insulin Glargine and Acarbose Tablet in Elderly Diabetic Patients

Comparative Observation of Therapeutic Effects of Insulin Glargine and Acarbose Tablet in Elderly Diabetic Patients

Relationship between Body Mass Index and Diabetic Complications in Elderly Diabetics

Abstract Background Diabetes mellitus is a group of diseases characterized by metabolic disturbances with increasing prevalence worldwide. Individuals with diabetes mellitus present with several micro- and macro vascular complications such as retinopathy, nephropathy, neuropathy, atherosclerosis and cardiovascular disease. A higher body mass index (BMI) raises the risk of having uncontrolled diabetes and complications related to it, such as heart disease, stroke, kidney failure, nervous system and eye problems. However, recent studies have reported that being overweight may confer a protective effect against all-cause mortality and on the life expectancy of diabetic patients; this has been termed the obesity paradox. The aim to explore the association between BMI and diabetic complications among elderly patients with type 2 diabetes. Methods A case-control study was conducted on 60 elderly diabetic males and females aged ≥ 60 years recruited from the inpatient wards and outpatient clinics of Mansoura university hospitals. The sample was divided into 3groups: the first group was comprised of 26 elderly diabetic patients with normal BMI. The second group was comprised of 24 overweight elderly diabetic. The third group was comprised of 10 obese elderly diabetic. Full history taking, clinical examination, BMI measurement (kg/m2) were obtained from all participants. Results The current study showed that there was insignificant differences regarding BMI between the study groups. Hyperglycemic and hypoglycemic coma were least frequent among obese cases, while neuropathy was more frequent among cases with normal BMI. But neither of these relationships was statistically significant Conclusions: Any increase in BMI above normal weight levels was not associated with an increased risk of having complications of diabetes mellitus.

Geriatric conditions and quality of life among older adults with diabetes

Background: Diabetes is a common chronic health problem with a global concern. As the aging of populations is rising, the greatest risk of diabetes is estimated to occur in the older population. Geriatric conditions (GCs) occur in higher proportions in elderly individuals with diabetes, leading to poor quality of life, higher morbidity and mortality . Aim: To describe the association between diabetes and geriatric conditions and its effect on quality of life in older adults. Methods: a cross -sectional, observational study was conducted in the geriatric department at Ain Shams University hospital. Patients with ≥ 60 years of age were included. Reported GCs included urinary incontinence (UI), falls, visual impairment (VI), hearing impairment (HI), constipation and polypharmacy. Assessment of functional status was done using activities of daily living (ADL) and instrumental activities of daily living (IADL). The quality of life (QOL) Short form 12 Questionnaire (SF12) was used to assess QOL. Results: A total of 244 patients were included; more than half were females with a mean age of 68 years. Risk of overall GCs (UI, falls, VI, HI, polypharmacy and constipation) was significantly higher among elderly diabetics than non-diabetics. Participants with DM had significa ntly poorer quality of life than those without. Conclusion: DM was associated with increased risk for GCs and lower quality of life.

Prevalence of Mental Health Disorders among Elderly Diabetics and Associated Risk Factors in Indonesia

This cross-sectional study aimed to explore mental health disorders (MHD) prevalence among elderly diabetics in Indonesia. Data were extracted from the 2018 national basic health survey in Indonesia (abbreviated as RISKESDAS). The survey involved households randomly selected from 34 provinces, 416 districts, and 98 cities in Indonesia, with 1,017,290 respondents. The number of subjects selected in this study was 2818 elderly diabetic subjects. MHD was determined by self-reporting assessment. Secondary data acquired from RISKESDAS 2018 data involved age, sex, urban–rural residence status, marital status, educational level, employment status, obesity, hypertension, heart disease, stroke, family history of MHD, and DM duration. Binary logistic regression with a backward stepwise method was used to analyze the risk factors related to MHD. MHD prevalence among elderly diabetics in Indonesia was 19.3%. Factors associated with MHD among elderly diabetics were being female (prevalence odds ratio (POR) = 1.64; 95% CI: 1.126–2.394), married (POR = 0.05; 95% CI: 0.031–0.084), less education (POR = 3.37; 95% CI: 1.598–10.355), and stroke (POR = 1.61; 95% CI: 1.183–2.269). MHD prevalence among elderly diabetics in Indonesia was 19.3%, suggesting that screening for psychological problems and educating elderly diabetic patients is essential. Unmarried female elderly diabetics with less education and stroke were altogether more likely to experience MHD.

Zinc status, insulin resistance and glycoxidative stress in elderly subjects with type 2 diabetes mellitus.

Zinc deficiencies have been reported in numerous pathologies, such as diabetes mellitus, but also in the physiological process of ageing. Similarly, the end products of glycoxidation processes, advanced glycation end products (AGEs), are damaging compounds, a myriad of reports linking them to the development and progression of several age-associated chronic diseases. The aim of the present study was to analyze the relationships between zinc status, glycoxidative stress and insulin resistance (IR) in elderly subjects with type 2 diabetes mellitus (T2DM). A group of 52 non-smoking subjects (9 men and 43 women, aged 65-83 years) were enrolled in this cross-sectional study: 27 patients with T2DM, and 25 apparently healthy control subjects. Serum zinc (Zn) levels were assessed using a commercial kit based on an end-point colorimetric method, and serum AGEs were evaluated with a fluorimetric analytic procedure. The calculated glucose-to-zinc ratio (Gly/Zn), insulin-to-zinc ratio (Ins/Zn) and insulin-zinc resistance index (HOMA-IR/Zn) were further used to study the associations between serum Zn levels, secretory function of β-pancreatic cells and AGEs. T2DM patients presented significantly higher serum insulin and Zn levels, as compared to the controls. We found a significant inverse correlation between Zn and AGEs, and a strong positive correlation between AGEs and the Gly/Zn ratio, suggesting that both Zn and AGEs are biomarkers that could reflect the persistence of hyperglycemia. We identified new surrogate biomarkers useful for the assessment of glycemic control with great potential for the development of preventive and therapeutic strategies for elderly diabetics, based on the evaluation of serum Zn levels.

Classification of Diabetic Walking for Senior Citizens and Personal Home Training System Using Single RGB Camera through Machine Learning

Senior citizens have increased plasma glucose and a higher risk of diabetes-related complications than young people. However, it is difficult to diagnose and manage elderly diabetics because there is no clear symptom according to current diagnostic criteria. They also dislike the invasive blood sample test. This study aimed to classify a difference in gait and physical fitness characteristics between senior citizens with and without diabetes for a non-invasive method and propose a machine-learning-based personal home-training system for training abnormal gait motions by oneself. We used a dataset for classification with 200 over 65-year-old elders who walked a flat and straight 15 m route in 3 different walking speed conditions using an inertial measurement unit and physical fitness test. Then, questionnaires for participants were included to identify life patterns. Through results, it was found that there were abnormalities in gait and physical fitness characteristics related to balance ability and walking speed. Using a single RGB camera, the developed training system for improving abnormalities enabled us to correct the exercise posture and speed in real-time. It was discussed that there are risks and errors in the training system based on human pose estimation for future works.

Features Of Verticalization In Early Rehabilitation Of Ischaemic Stroke And Diabetes Patients

The risk of stroke in diabetic patients is significantly higher than in non-diabetic patients. Appropriate studies on the prevalence and characteristics of the onset of elderly diabetes with stroke in many countries are still lacking. Effective prevention and control still face enormous challenges. Older diabetic patients with osteoporosis need sensible intervention and treatment based on an individualised comprehensive assessment.

Analysis of Clinical Effect of Nursing Intervention for Elderly Diabetic Patients

Analysis of Clinical Effect of Nursing Intervention for Elderly Diabetic Patients

Health Related Quality of Life Measurements for Diabetes: A Systematic Review.

Health-related quality of life (HRQOL) is an essential measure that is used to assess the effect of chronic disease management on the health status of an individual. Previous studies have identified various instruments used in the measuring of diabetes-specific health-related quality of life (HRQOL). The aim of this paper is to provide a systematic review of the various instruments used for the diabetes-specific measure of HRQOL, and place emphasis on its content and measurement properties. Methods Preferred Reporting Items for Systematic Reviews and Meta analyses (PRISMA) guidelines was used. A systematic search strategy was used to identify publications reporting diabetes HRQOL measures. The search terms used were: “diabetes quality of life”, “measurements”, and “instruments”. The database that was searched includes PubMed, Science Direct, CINAHL, and Medline. Articles written in the English language and published from January 1990 to December 2020 were included. Those articles that did not measure HRQOL for diabetic patients were excluded. Results: A total of seventeen instruments met the inclusion criteria and included in the review. The appraisal of diabetes scale (ADS), Audit of Diabetes-Dependent QOL measure (ADDQOL), Diabetes Health Profile (DHP), and Problem Areas in Diabetes (PAID) are more suitable for single-scale questionnaires when investigating one or more specific aspects of diabetes-specific quality of life (QOL). The ADDQOL, ADS, Diabetes Impact Measurement Scales (DIMS), Diabetes Quality of Life Clinical Trial Questionnaire (DQLCTQ-R), Malay Version of Diabetes Quality of Life (DQOL), Iranian Diabetes Quality of Life (IRDQOL), Brief Clinical Inventory, and PAID are relevant measures of HRQOL for insulin dependent diabetes mellitus (IDDM) and non-insulin dependent diabetes mellitus (NIDDM) patients. The Asian Diabetes Quality of Life AsianDQOL, The Chinese Short Version of DQOL, Elderly Diabetes Burden Scale (EDBS), Malay Version of Diabetes Quality of Life (DQOL), are relevant measures of HRQOL for NIDDM patients. Only two instruments assess for responsiveness, namely PAID and DQLCTQ-R. In PAID, the effect sizes ranged from 0.32 to 0.65 for interventions. The DQLCTQ-R four domains were responsive to clinical change in metabolic control. Based on this review ADDQOL, DSQOLS, and EDBS psychometric properties are sufficient. Conclusion: Most studies did not check for responsiveness, and future studies should prioritize responsiveness to change, which was not included in the psychometric finding of the reviewed instruments.

Impact of Vitamin D Therapy on the Progress COVID-19: Six Weeks Follow-Up Study of Vitamin D Deficient Elderly Diabetes Patients

BackgroundCoronavirus disease-19 (COVID-19) is an ongoing pandemic causing considerable fatalities worldwide. Vitamin D modulates the immune response through effects on various cells, such as: macrophages, B and T lymphocytes, neutrophils, and dendritic cells.AimTo explore whether supplementation of vitamin D, in the form of a single intramuscular cholecalciferol injection, to patients with diabetes, COVID-19, and low vitamin D levels could improve the prognosis of those patients.MethodsThis was a placebo-controlled randomized prospective study. The study has two arms as follows: the intervention arm (40 vitamin D deficient diabetes elderly patients that acquired SARS-CoV-2), compared to the control arm (16 elderly diabetes patients, with deficient vitamin D with SARS-CoV-2). Patients in the intervention arm were given vitamin D as a single intramuscular injection (200,000 IU); patients in the control arm were given placebo. The primary outcome was mortality within 6 weeks of the diagnosis of COVID-19. Clinical, laboratory, treatment, and outcome data were recorded after 6 weeks of follow-up.ResultsNo significant difference in 6 weeks mortality was observed between patients who received vitamin D and patients who received placebo (17.5% vs 18.8%, p = 0.838). Age, presence of hypertension, and chronic obstructive pulmonary disease were independent predictors of mortality at 6 weeks.ConclusionVitamin D supplementation did not reduce the severity or mortality of COVID-19 at 6 weeks. Further large scale studies are required to explore the effect of vitamin D therapy on survival in patients with diabetes mellitus who acquire COVID-19.

Observation on Prevention and Nursing Effect of Nocturnal Hypoglycemia in Elderly Diabetic Patients

Observation on Prevention and Nursing Effect of Nocturnal Hypoglycemia in Elderly Diabetic Patients

Developing a health economic model for Asians with type 2 diabetes based on the Japan Diabetes Complications Study and the Japanese Elderly Diabetes Intervention Trial

IntroductionCost-effectiveness analyses are becoming increasingly important in Japan following the introduction of a health technology assessment scheme. The study objective was to develop an economic model to evaluate the cost-effectiveness...

Exploring a possible link between insulin resistance, vaccine to SARS CoV 2 and glycaemic disturbances in diabetes mellitus, type 2

The occurrence of both hyperglycaemia and hypoglycaemia, individually and in combination is reported in the literature, occurring in various insulin resistance (IR) syndromes, both to endogenous insulin, like Hirata disease, otherwise called the Insulin Autoimmune syndrome (IAS), type A, I R, Type B, IR etc. and to exogenous administered insulin, like, exogenous insulin antibody syndrome, (EIAS), non- classical auto immune syndrome to exogenous insulin, etc. Glycaemic disturbances without IR and in non-diabetics, like idiopathic and symptomatic reactive hypoglycaemias are also described in the literature. This author, recently reported for the first time, a biphasic post - vaccinal syndrome, following vaccination for Covid 19 (Covishield), causing glycemic disturbances in an elderly diabetes mellitus type 2 (DM2) patient on insulin who had moderate IR. Insulin resistance to exogenous insulin observed in the patient, is considered crucial for the occurrence of the observed clinical syndrome as, an increase or decrease of IR, and could explain the observed glycaemic disturbances. The IR to exogenous insulin, and the vaccine to Covid 19, both have immunological basis. The immunological aspects of both IR and the Covid 19 vaccine are briefly reviewed to explore any possible interaction between the two, that could explain the observed clinical syndrome, referred to above. Also, the various underlying mechanisms for the glycaemic disturbances, in the above-mentioned IR syndromes and non-IR or r syndromes are explored as to shed some light on the mechanism of the glycaemic disturbances in the syndrome reported. A hypothesis is suggested, taking into consideration, the aforesaid observations. Apart from IR to exogenous insulin, other unidentified factors that might be causing the clinical syndrome reported, and which might account for its paucity of reporting, need to be investigated by future research.

Study on the Value of Continuing Nursing Intervention for Elderly Diabetic Patients

Study on the Value of Continuing Nursing Intervention for Elderly Diabetic Patients

Evaluation on the Application Effect of Cooperative Nursing Model in Elderly Diabetes Care

Evaluation on the Application Effect of Cooperative Nursing Model in Elderly Diabetes Care