Elderly Type 2 Diabetes Mellitus Research Articles

Correlation Between Blood Urea Nitrogen and Short- and Long-Term Glycemic Variability in Elderly Patients with Type 2 Diabetes Mellitus Who Were hospitalized:A Retrospective Study.

Type 2 diabetes mellitus (T2DM) is a metabolic disease characterized by insulin resistance and progressively impaired insulin secretion resulting in dynamic fluctuations in glucose levels.High blood urea nitrogen (BUN) levels have been linked to decreased insulin sensitivity, suppressed insulin synthesis and increased risk of incident diabetes mellitus in humans as well as insulin use in patients with T2DM.This study characterize the association between BUN levels and short-term and long-term glycemic variability(GV) in the elderly patients with T2DM who were hospitalized. A total of 927 elderly patients with T2DM were included in the study. The short-term GV was quantified using parameters such as standard deviation (SD), coefficient of variation (CV), time in range (TIR), and mean amplitude of glycemic excursions (MAGE), based on multi-point fingertip blood glucose monitoring. The long-term GV was quantified using parameters such as SD, CV, variation independent of the mean (VIM), and average successive variability (ARV), based on fasting blood glucose(FPG). The relationship between BUN levels and short-term and long-term GV in elderly T2DM who were hospitalized was explored using methods such as Spearman correlation coefficient, linear regression analysis, logistic regression analysis, and interaction tests. In elderly patients with T2DM were hospitalized, there is a significant correlation between BUN levels and both short-term and long-term GV. BUN is negatively correlated with the GV parameter TIR (r=-0.12, P=0.000), and positively correlated with SD (r=0.12, P=0.000), CV (r=0.07, P=0.026), MAGE (r=0.11, P=0.001), FPG-SD (r=0.08, P=0.013), and FPG-CV (r=0.08, P=0.014).Furthermore, the association remains consistent across different age, gender, BMI, and haemoglobin A1c (HbA1c) subgroups (P interaction > 0.05). In elderly patients with T2DM were hospitalized, BUN levels were positively associated with GV.Therefore, monitoring BUN levels were beneficial in assessing the degree of GV.

Relationships Between the Apolipoprotein Levels and Sarcopenia in Inpatients with Type 2 Diabetes Mellitus: A Cross-Sectional Study.

Apolipoprotein (Apo) may be associated with sarcopenia in elderly inpatients with type 2 diabetes mellitus (T2DM), but fewer studies are available. In this study, we explored the association of ApoA1, ApoB, and ApoB/ApoA1 with sarcopenia and compared the predictive role of Apo indicators for sarcopenia in an elderly T2DM. To investigate the relationships between the Apo and sarcopenia in elderly inpatients with T2DM. This study included 253 inpatients with T2DM (mean age of 70.11±5.44 years, 32.8% male). The inpatients were divided into the sarcopenic group (n = 100) and non-sarcopenic group (n = 153). The associations among the Apo and sarcopenia were assessed using multivariate analyses. Inpatients in the sarcopenia group showed lower ApoA1 levels than those in the non-sarcopenia group (1.25±0.21 vs 1.36±0.20 g/L, P < 0.05) and showed higher ApoB/ApoA1 and ApoB levels than those in the non-sarcopenia group (0.82±0.27 vs 0.69±0.19 g/L, P < 0.05;1.00±0.32 vs 0.93±0.24 g/L, P < 0.05, respectively). After adjusting for age and BMI, the logistic regression model indicated that ApoA1 was a protective factor for elderly inpatients with T2DM sarcopenia.(OR =0.079,95% CI: 0.021~0.306, P < 0.05);ApoB and AopB/AopA1 were risk factors for elderly inpatients with T2DM sarcopenia.(OR =3.578,95% CI:1.318~9.715, P < 0.05;OR =16.440,95% CI:4.437~60.427, P < 0.05, respectively). AopB/AopA1 provided an AUC value of 0.765 in elderly men.(95% CI: 0.665~0.866, P<0.05). ApoA1, AopB, and AopB/AopA1 are associated with sarcopenia in elderly inpatients with T2DM, and AopB/AopA1 may be a potential predictor of sarcopenia in elderly men with T2DM.

Correlation between fat-to-muscle mass ratio and cognitive impairment in elderly patients with type 2 diabetes mellitus: a cross-sectional study

BackgroundFat to muscle mass ratio (FMR), a novel index integrating fat and muscle composition, has garnered attention in age-related conditions such as type 2 diabetes mellitus (T2DM) and neurodegenerative diseases. Despite this research on the relationship between FMR and cognitive impairment (CI) in T2DM remains scarce. This study aimed to investigate the sex-specific association between FMR and CI in elderly T2DM patients.MethodsA total of 768 elderly (> 60 years) T2DM in-patients (356 men and 412 women) were recruited from the Department of Endocrinology at Tianjin Nankai University affiliated hospital. Bioelectrical Impedance Analysis (BIA) was used to assess body composition, and Montreal Cognitive Assessment (MoCA) was used to evaluate cognitive performance. T2DM patients were categorized into normal cognitive function (NC) and cognitive impairment (CI) groups based on MoCA scores and stratified by sex. Binary logistic regression was employed to examine the association between FMR and CI.ResultsAmong the participants, 42.7% of men and 56.3% of women experienced cognitive deterioration. Women with CI exhibited lower body mass index (BMI) and skeletal muscle mass index (SMI), while men with cognitive disorders showed lower SMI, FMR, and higher fat mass index (FMI). FMR was consistently unrelated to cognition in females, irrespective of adjustment made. However, in males, FMR was significantly associated with an increasing risk of cognitive dysfunction after adjusting for demographic and clinical variables (OR: 1.175, 95% CI: 1.045–1.320, p = 0.007). Furthermore, for each 0.1 increase in FMR, the incidence of CI rose by 31.1% after additional adjustment for BMI. In males, the prevalence of CI increased sequentially across FMR quartiles (p < 0.05).ConclusionElderly T2DM men with high FMR had unfavorable cognitive function. FMR is independently associated with an increased risk of CI in male T2DM patients regardless of BMI.

Prediction model for mild cognitive impairment in patients with type 2 diabetes using the autonomic function test.

Type 2 diabetes mellitus (T2DM) is a risk factor for cognitive impairment, and reduced heart rate variability (HRV) has been correlated with cognitive impairment in elderly individuals. This study investigated risk factors and validated a predictive model for mild cognitive impairment (MCI) in patients with T2DM using an autonomic function test. Patients with T2DM, 50-85years of age, who attended the diabetes clinic at Gyeongsang National University Hospital between March 2018 and December 2019, were included. A total of 201 patients had been screened; we enrolled 124 patients according to the inclusion and exclusion criteria in this study. Cognitive function was assessed using the Montreal Cognitive Assessment-Korean version (MOCA-K); MCI was defined as a total MOCA-K score ≤ 23. Risk factors for MCI in patients with T2DM, including demographic- and diabetes-related factors, and autonomic function test results, were analyzed. Based on multivariate logistic regression, a nomogram was developed as a prediction model for MCI. Thirty-nine of 124 patients were diagnosed with MCI. Age, education, and decreased cardiovagal function were associated with a high risk for MCI, with cardiovagal function exerting the greatest influence. However, diabetes-related factors, such as glycemic control, duration of diabetes, or medications, were not associated with the risk for MCI. The nomogram demonstrated excellent discrimination (area under the curve, 0.832) and was well calibrated. Approximately one-third of patients had MCI; as such, carefully evaluating cognitive function in elderly T2DM patients with reduced HRV is important to prevent progression to dementia.

Correlation between long-term glycemic variability and cognitive function in middle-aged and elderly patients with type 2 diabetes mellitus: a retrospective study.

To investigate the correlation between long-term glycemic variability and cognitive function in middle-aged and elderly patients with type 2 diabetes mellitus (T2DM). This retrospective analysis includes 222 patients hospitalized at Second Affiliated Hospital of Anhui Medical University from June 2021 to June 2023. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE). All patients were categorized into the MCI group and the non-MCI group based on their MoCA score. Long-term blood glucose fluctuations were measured using glycated hemoglobin A1c standard deviation (HbA1c-SD) and fasting plasma glucose standard deviation (FPG-SD). The study compared general clinical data, blood biochemical indicators, and glycemic variability indicators between the two groups. The differences between the groups were compared using t-test, Chi-Square Test, or Mann-Whitney U test. Kendall's correlation analysis, multivariate logistic regression analysis and ROC curve correlation analysis were further used to analyze the correlation and diagnostic power. The differences in age, MoCA scores, MMSE scores, HOMA-β, HbA1c-M, HbA1c-SD, FPG-M, FPG-SD, eGFR, Smoking, GLP-1RA and SGLT-2i usage were statistically significant between the two groups (P<0.05). Kendall's correlation analysis showed that age, HbA1c-M, HbA1c-SD, FPG-M, and FPG-SD was negatively correlated with MoCA scores; meanwhile, the HOMA-β, and eGFR was positively correlated with MoCA scores. Multiple logistic regression analysis revealed that HbA1c-SD, FPG-SD and Smoking were risk factors for cognitive dysfunction, while eGFR, GLP-1RA and SGLT-2i usage was a protective effect. The area under the curve (AUC) values for predicting MCI prevalence were 0.830 (95% CI [0.774-0.877], P<0.001) for HbA1c-SD, 0.791 (95% CI [0.655-0.808], P<0.001) for FPG-SD, and 0.698 (95% CI [0.633-0.757], P<0.001) for eGFR. The optimal diagnostic values were 0.91, 1.32, and 74.81 ml/min/1.73 m2 for HbA1c-SD, FPG-SD, and eGFR, respectively. Cognitive function in middle-aged and elderly T2DM patients is influenced by long-term blood glucose variability, with poorer cognitive function observed in individuals with higher blood glucose variability. The impact of HbA1c-SD on MCI exhibited a greater magnitude compared to that of PFG-SD and smoking. Additionally, renal function, GLP-1RA and SGLT-2i usage exert positive effects on cognitive function.

The impact of physical disability on the risk of gastric cancer incidence in elderly patients with diabetes: a focus on regional disparity.

Elderly patients with type 2 diabetes mellitus (T2DM) may have a higher risk of physical disability. This study investigated the incidence of gastric cancer according to physical disability status in elderly patients with T2DM. The National Health Insurance Service claims data were used. A total of 76,162 participants aged 60 years or above, diagnosed with T2DM, were included. The association between physical disability status and gastric cancer incidence was evaluated using the Cox regression analysis. Additionally, subgroup analysis was performed according to region. A total of 9,154 (12.0%) individuals had physical disability. Gastric cancer incidence was more common in participants with physical disability (3.3%) than those without (2.4%). A higher risk of gastric cancer incidence was found in elderly T2DM patients with physical disability (Hazard Ratio (HR) 1.18, 95% Confidence Interval (95% CI) 1.04-1.34). Such tendencies were maintained regardless of region, although the effect of physical disability status on gastric cancer incidence was particularly significant in individuals residing in non-metropolitan areas (HR: 1.19, 95% CI: 1.01-1.40). Elderly patients with T2DM who had physical disability showed a higher risk of gastric cancer incidence. The findings suggest a need to monitor elderly T2DM patients with disability as they may be susceptible to difficulties in accessing cancer-related healthcare.

Cognitive decline in elderly patients with type 2 diabetes is associated with glycated albumin, ratio of Glycated Albumin to glycated hemoglobin, and concentrations of inflammatory and oxidative stress markers

ObjectiveTo investigate the correlations of cognitive function with glycated albumin (GA), the ratio of GA to glycated hemoglobin (GA/HbA1c), and the concentrations of interleukin-6 (IL-6) and superoxide dismutase (SOD) in elderly patients with type 2 diabetes mellitus (T2DM). MethodsA total of 44 elderly T2DM patients were evaluated for cognitive function using the mini-mental state examination (MMSE) and the Montreal cognitive assessment (MoCA). Patients were then divided into two groups based on the MMSE and MoCA scores: a cognitive dysfunction group and a normal cognitive function group. The correlations of the MMSE and MoCA scores with GA/HbA1c, GA, IL-6, and SOD were analyzed. Logistic regression analysis was used to identify independent influential factors for cognitive dysfunction. The predictive value of GA and GA/HbA1c for cognitive dysfunction in elderly T2DM patients was evaluated by receiver operating characteristic (ROC) curve analysis. ResultsAmong these patients, 28 had cognitive impairment. They had significantly higher GA/HbA1c, increased GA and IL-6 levels, and lower SOD concentrations than the normal cognitive function group (all P < 0.05). GA/HbA1c was negatively correlated with the MMSE (r = −0.430, P = 0.007) and MoCA (r = −0.432, P = 0.007) scores. SOD was positively correlated with the MMSE (r = 0.585, P=0.014) and MoCA (r = 0.635, P=0.006) scores. IL-6 was negatively correlated with the MoCA score (r = −0.421, P=0.015). Age and GA/HbA1c were independent factors contributing to cognitive dysfunction. The areas under the ROC curves of GA and GA/HbA1c for the diagnosis of cognitive dysfunction were 0.712 and 0.720, respectively. ConclusionsGA and GA/HbA1c are related to cognitive dysfunction in elderly patients with T2DM.

Correlation of HbA1c Level with Lipid Profile in Type 2 Diabetes Mellitus Patients Visiting a Primary Healthcare Center in Jeddah City, Saudi Arabia: A Retrospective Cross-Sectional Study.

Type 2 diabetes mellitus (T2DM) patients are at high risk of dyslipidemia, which in turn is associated with macrovascular diseases, such as heart diseases and stroke, and microvascular diseases, such as neuropathy and nephropathy. There are contradictory findings in the literature regarding the relationship between glycated hemoglobin (HbA1c) and the lipid profile among T2DM patients. This study was performed to investigate the association between HbA1c level and the lipid profile in elderly T2DM patients at a primary care hospital in Jeddah City, Saudi Arabia. This study is a retrospective cross-sectional study conducted at the Prince Abdul Majeed Healthcare Center (PAMHC) in Jeddah, Saudi Arabia. The sociodemographic and clinical data of the T2DM patients who had visited the PAMHC from 1 January 2020 to 31 December 2021, were collected from the data registry of the PAMHC and analyzed for publication. The study included a total of 988 T2DM patients (53.3% male). Of the participants, 42.9% were aged between 55 and 64 years. Dyslipidemia parameters were presented as high LDL-c (in 60.3% cases), low HDL-c (in 39.8% cases), high triglycerides (in 34.9% cases), and high total cholesterol (in 34.8% cases). The correlation of HbA1c with total cholesterol (TC) and triglycerides (TGs) was positively significant, thereby highlighting the important link between glycemic control and dyslipidemia. A mean increase of 4.88 mg/dL and 3.33 mmHg in TG level and diastolic blood pressure, respectively, was associated with the male gender, in comparison to the female gender. However, the male gender was significantly associated with the reduction in the mean cholesterol level, BMI, HbA1c, HDL-c, and LDL-c by 11.49 mg/dL, 1.39 kg/m2, 0.31%, 7.47 mg/dL, and 5.6 mg/dL, respectively, in comparison to the female gender. The results of this study show that HbA1c was significantly associated with cholesterol and triglyceride levels in the T2DM patients included in the study. Our findings highlight the important relationship between glycemic control and dyslipidemia.

Lipidomics analysis of impaired glucose tolerance and type 2 diabetes mellitus in overweight or obese elderly adults.

Aging, obesity, and type 2 diabetes mellitus (T2DM) form a metabolic disease continuum that has a continuously increasing prevalence. Lipidomics explains the complex interactions between lipid metabolism and metabolic diseases. We aimed to systematically investigate the plasma lipidome changes induced by newly diagnosed impaired glucose tolerance (IGT) and T2DM in overweight/obese elderly individuals and to identify potential biomarkers to differentiate between the IGT, T2DM, and control groups. Plasma samples from 148 overweight/obese elderly individuals, including 52 patients with IGT, 47 patients with T2DM, and 49 euglycemic controls, were analyzed using a high-coverage nontargeted absolute quantitative lipidomics approach. We quantified 1840 lipids from thirty-eight classes and seven lipid categories. Among overweight/obese elderly individuals, the lipidomic profiles of IGT and T2DM patients were significantly different from those of controls, while they were similar in the IGT and T2DM groups. The concentrations of diglycerides, triglycerides, phosphatidylcholines, and ceramides were obviously altered in the IGT and T2DM groups. Particularly, IGT and T2DM induced the accumulation of triglycerides with longer carbon atom numbers (C44-50) and saturated or lower double bond numbers (n (C=C) = 0-2). Furthermore, a total of 17 potential lipidic biomarkers were identified to successfully differentiate between the IGT, T2DM, and control groups. In overweight/obese elderly patients, IGT and T2DM induced apparent lipidome-wide changes. This study's results may contribute to explaining the complex dysfunctional lipid metabolism in aging, obesity, and diabetes.

The Effect of Combined Exercises and Consumption of Mulberry Leaf Extract on Serum Inflammatory Markers Level in Elderly Type 2 Diabetes Mellitus Men

Objective: This study aimed to investigate the effect of 8 weeks combined exercise and consumption of Mulberry leaf extract on the serum levels of inflammatory and atherosclerosis indicators in elderly men with type 2 diabetes mellitus (T2DM).&#x0D; Materials and Methods: 40 elderly men T2DM aged between 65 to 70 years old were purposefully selected and randomly divided into five equal groups (training, supplement, training+ supplement, placebo, and control). A daily dose of 1000 mg Mulberry leaf extract, 3 times a day, was used for 2 months by the supplement group. Training groups performed combined exercises for eight weeks, each week three sessions of 90 minutes.&#x0D; Results: The results showed that the amount of salusin-β and interleukin-6 in the training, training + supplement and supplement groups decreased significantly at the end of the study; Meanwhile, the level of salusin-α increased significantly in the training (P= 0.001), training + supplement (P= 0.001) and supplement (P= 0.01) groups. Also, the results of the covariance analysis showed that the amount of salusin-β and interleukin 6 were lower (P= 0.001), and the level of salusin-α was higher significantly in the training (P= 0.001), training +supplement (P= 0.001), and supplement (P= 0.001) groups compared to the control groups.&#x0D; Conclusion: It seems that the consumption of Mulberry leaf extract, and combined exercises, is effective in controlling the inflammatory indicators and atherosclerosis related to diabetes in the T2DM elderly.

Effect of statin treatment on mortality in elderly patients with type 2 diabetes mellitus patients: a retrospective cohort study

BackgroundThe effects of statins on the reduction of mortality in individuals aged 75 years or older remain controversial. We conducted this study to investigate whether there is an association between statin therapy and mortality in patients with type 2 diabetes mellitus (T2DM) who are over the age of 75 years.MethodsThe present study used data from the Staged Diabetes Targeting Management Study, which began in 2005. A total of 518 T2DM patients older than 75 years were included. Cox regression analyses were used to evaluate the association between statins and specific causes of death in patients with T2DM.ResultsAfter a follow-up period of 6.09 years (interquartile range 3.94–8.81 years), 111 out of 518 patients died. The results of Cox regression analyses showed that there was no significant association between statin use and all-cause mortality (HR 0.75; 95% CI 0.47, 1.19) after adjustment for all potential confounders. Subgroup analysis indicated that statins had no association with the risk of all-cause mortality or deaths caused by ischemic cardiovascular diseases in T2DM patients with or without coronary heart disease.ConclusionsOur study found no significant association between all-cause mortality and statin use in T2DM patients over the age of 75 years. More evidence is needed to support the use of statins in the elderly T2DM patients.

Sarcopenia in Type 2 Diabetes Mellitus: Study of the Modifiable Risk Factors Involved.

(1) Background: Sarcopenia has gained much interest in recent years due to an increase in morbidity. Sarcopenia is associated with type 2 diabetes mellitus (T2DM) and vice versa. There is a paucity of information regarding the prevalence and predictors of sarcopenia among T2DM individuals. The aim of the present study was to determine the prevalence and predictors of sarcopenia among T2DM individuals. (2) Methods: This study included 159 diabetics (cases) and 79 non-diabetics (controls) aged >50 years. The subjects were assessed for demographic and anthropometric parameters. Sarcopenia (according to the Asian Working Group for Sarcopenia 2019 criteria) was assessed using Jammer's hydraulic dynamometer for handgrip strength, dual-energy X-ray absorptiometry for muscle mass, and 6m gait speed. The biochemical investigations included glycated hemoglobin; fasting and prandial glucose; fasting insulin; lipid, renal, liver, and thyroid profiles; serum calcium; phosphorous; vitamin D; and parathyroid hormone (PTH). Appropriate statistical methods were used to determine the significance of each parameter, and a multivariate regression analysis was applied to determine the predictors. (3) Results: The prevalence of sarcopenia was significantly higher among the cases than the controls (22.5% vs. 8.86%, p-0.012). Body mass index (BMI) (OR-0.019, CI-0.001-0.248), physical activity (OR-0.45, CI-0.004-0.475), serum calcium levels (OR-0.155, CI-0.035-0.687), hypertension (OR-8.739, CI-1.913-39.922), and neuropathy (OR-5.57, CI-1.258-24.661) were significantly associated with sarcopenia following multivariate regression analysis. (4) Conclusions: T2DM individuals are prone to sarcopenia, especially those with a low BMI, low physical activity, hypertension, neuropathy, and low serum calcium levels. Hence, by modifying these risk factors among the elderly T2DM, sarcopenia can be prevented.

Effect of Dapagliflozin on Clinical Outcome after Drug-Eluting Stent Implantation in Elderly T2DM Patients: A Real-World Study.

To investigate the effect of dapagliflozin therapy on the clinical outcome of drug-eluting stent (DES) implantation in elderly patients with type 2 diabetes mellitus (T2DM). We retrospectively studied the real-world data of patients with coronary heart disease who received DES implantation in our hospital from May 2019 to May 2021. Baseline general data and laboratory results of patients were collected. All patients were followed up for two years after PCI, and the follow-up endpoints included in-stent restenosis, major adverse cardiovascular events (MACE), revascularization, rehospitalization, and all-cause mortality. Compared with those before treatment, body mass index, systolic blood pressure, diastolic blood pressure, TG, TC, LDL-C, FBG, and HbA1c were decreased in both groups after treatment, while HDL-C was increased after treatment (P < 0.05). There were significant differences in BMI, systolic blood pressure, diastolic blood pressure, FBG, and HbA1c between the two groups before and after treatment. At the end of follow-up, the incidence of in-stent restenosis and MACE in the dapagliflozin group was lower than that in the nondapagliflozin group. K-M curve analysis showed a significant difference in in-stent restenosis and MACE after DES implantation between the dapagliflozin group and the nondapagliflozin group (logrankχ2 = 5.093, 4.524; P = 0.024, 0.033). In accurate clinical data, dapagliflozin could significantly improve the postoperative BMI, blood pressure, and blood glucose outcome of patients with T2DM complicated with coronary heart disease and positively impact in-stent restenosis and MACE.

Non-invasive diagnostic potential of salivary miR-25-3p for periodontal disease and osteoporosis among a cohort of elderly patients with type 2 diabetes mellitus

ObjectiveOsteoporosis (OP) and periodontal disease (PD) are two common health issues that threaten the older population and potentially connected each other in the context of type 2 diabetes mellitus (T2DM). Dysregulated expression of microRNAs (miRNAs) may contribute to the development and progression of both OP and PD among elderly T2DM patients. The present study aimed to evaluate the accuracy of miR-25-3p expression for the detection of OP and PD when compared to a mixed group of patients with T2DM.MethodsThe study recruited 45 T2DM patients with normal bone mineral density (BMD) and healthy periodontium, 40 type 2 diabetic osteoporosis patients coexistent with PD, 50 type 2 diabetic osteoporosis patients with healthy periodontium, and 52 periodontally healthy individuals. miRNA expression measurements in the saliva were determined by real-time PCR.ResultsThe salivary expression of miR-25-3p was higher in type 2 diabetic osteoporosis patients than patients with T2DM only and healthy individuals (P < 0.05). Among type 2 diabetic osteoporosis patients, those with PD exhibited a higher salivary expression of miR-25-3p than those with healthy periodontium (P < 0.05). Among type 2 diabetic patients with healthy periodontium, a higher salivary expression of miR-25-3p was noted in those with OP than those without (P < 0.05). We also found a higher salivary expression of miR-25-3p in T2DM patients than healthy individuals (P < 0.05). It was revealed that the salivary expression of miR-25-3p was increased as the T scores of BMD of patients were lowered, the PPD and CAL values of patients were enhanced. The salivary expression of miR-25-3p used as a test to predict a diagnosis of PD among type 2 diabetic osteoporosis patients, a diagnosis of OP among type 2 diabetic patients, and a diagnosis of T2DM among healthy individuals produced AUC of 0.859. 0.824, and 0.886, respectively.ConclusionThe findings obtained from the study support salivary miR-25-3p confers non-invasive diagnostic potential for PD and OP among a cohort of elderly T2DM patients.

Health literacy, self-efficacy, self-care behaviors, and glycemic control among older adults with type 2 diabetes mellitus: a cross-sectional study in Thai communities

BackgroundProperly understanding the health information of people with type 2 diabetes mellitus (T2DM) is the basis for better risk factor management, which also positively affects their quality of life. The aim of this study was to investigate diabetes health literacy (HL), self-efficacy, and self-care behaviors associated with glycemic control among older adults with T2DM in northern Thai communities.MethodsA cross-sectional study was conducted among 414 older adults over the age of 60 diagnosed with T2DM. The study was conducted in Phayao Province from January to May 2022. Simple random sampling of the patient list for the Java Health Center Information System program was used. Questionnaires were used to collect data on diabetes HL, self-efficacy, and self-care behaviors. Blood samples were tested for estimated glomerular filtration rate (eGFR) and glycemic controls, such as fasting blood sugar (FBS) and glycated hemoglobin (HbA1c).ResultsThe mean age of participants was 67.1 years. FBS (mean ± SD = 108.5 ± 29.5 mg/dL) and HbA1c (mean ± SD = 6.6 ± 1.2%) levels were found to be abnormal in 50.5% (≥ 126 mg/dL) and 17.4% (≥ 6.5%) of the subjects, respectively. There was a strong correlation between HL and self-efficacy (r = 0.78), HL and self-care behaviors (r = 0.76), and self-efficacy and self-care behaviors (r = 0.84). The eGFR was significantly correlated with diabetes HL (r = 0.23), self-efficacy (r = 0.14), self-care behaviors (r = 0.16), and HbA1c (r = -0.16) scores. Linear regression after adjusting for sex, age, education, DM duration, smoking, and drinking alcohol showed that FBS level was inversely associated with diabetes HL (Beta = -0.21, R2 = 11.0%), self-efficacy (Beta = -0.43, R2 = 22.2%), and self-care behavior (Beta = -0.35, R2 = 17.8%), whereas HbA1C level was negatively associated with diabetes HL (Beta = -0.52, R2 = 23.8%), self-efficacy (Beta = -0.39, R2 = 19.1%), and self-care behavior (Beta = -0.42, R2 = 20.7%).ConclusionDiabetes HL was related to self-efficacy and self-care behaviors in elderly T2DM patients and was shown to influence their health, including glycemic control. These findings suggest that implementing HL programs to build competence in self-efficacy expectations is important for contributing to improvements in diabetes preventive care behaviors and HbA1c control.

Assessment of Elderly Type 2 Diabetic Patients who Self-adjust Their Insulin Regimen in Al-Qassim Region

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a multifactorial chronic disease. To avoid long-term and short-term complications, good glycemic control must be achieved. The majority of T2DM patients who require insulin therapy have their doses modified by their physicians; this procedure takes time and may not result in the optimal glycemic control. AIM: This study aims to ascertain whether elderly T2DM patients in Al-Qassim region modify their own insulin regimen and its effect on their glycemic control. METHODS: This cross-sectional study was conducted in Al-Qassim University Medical City and Diabetic Centers in Buraydah, Saudi Arabia. Data were collected using a questionnaire. RESULTS: A total of 384 participants were enrolled with a mean age of 70.2 ± 6.0 (61–94) years, majority (53.6%) of whom were females. About half (50.8%) were not educated and two-third (66.1%) giving insulin injections by themselves. Less than half (40.6%) of the participants changed their insulin dose, out of which 8.3% changed the dose by themselves. The mean hemoglobin A1C (HbA1c) level was 8.8 ± 1.9 with a range of 5.2–17. About 30.5% had recent hypoglycemic attacks, majority (47.9%) of whom had only one episode. Diabetic complications were seen among 127 participants with retinopathy as the most common (43.3%) complication. Hypoglycemic attacks and insulin dose adjusting were not found to be significantly associated (p = 0.476). The last HbA1c level was found to be significantly associated with adjusting insulin dose. CONCLUSION: Self-adjusting insulin dose was found to be rare. Moreover, HbA1c in patients who self-adjust their insulin dose was found to be significantly lower.

Mediating Role of Depression Between Diabetes Management Self-Efficacy and Diabetes Self-Care Behavior Among Elderly Type 2 Diabetes Mellitus Patients in China.

To investigate the current status of diabetes self-care behavior and the association between depression, self-efficacy and self-care in a sample of Chinese elderly type 2 diabetes mellitus (T2DM) patients. A cross-sectional study with a convenient sample including 240 elderly T2DM patients collected the data of demographic characteristics, diabetes self-care behavior, self-efficacy and depression status. The difference of self-care behavior in different sample characteristics was compared by independent t-test. The Personal correlation analysis was employed to examine the correlation of study variables. The method of bootstrap was used to analyze mediating role of depression. Only 22.5% of patients reported better diabetes self-care behavior and depression partly mediated the association between self-efficacy and self-care behavior. The significant coefficient of path a (B = -0.052, p < 0.001) and path b (B = -0.423, p < 0.05) indicated negative associations of self-efficacy on depression, and depression on self-care behavior. The indirect effect (Path a × b) between self-efficacy and self-care behavior through depression was significant (B = 0.022, p < 0.05), the 95% bias-corrected bootstrap confidence interval was 0.004 to 0.006. Meanwhile, the mediating role of depression was not found significant among the participants reported 60-74 years old (B = 0.104, p < 0.001). But depression completely mediated this association among the participants reported 75-89 years old (B = 0.034, p > 0.05). The level of diabetes self-care behavior among the elderly T2DM patients in Dahu community of Anqing city was hardly optimistic. The self-efficacy focused intervention could be encouraged for community and clinicians to improve diabetes self-care behavior. Moreover, the prevalence of depression and T2DM is increasing in younger population. More work is needed to confirm these findings, especially conducting cohort studies on different populations.

The association between glucose fluctuation with sarcopenia in elderly patients with type 2 diabetes mellitus.

Growing evidence shows that sarcopenia is more prevalent in patients with type 2 diabetes mellitus (T2DM) than in the normal population. However, currently, data on the relationship between blood glucose fluctuation and sarcopenia in elderly patients with T2DM are still limited. In this study, 280 patients ≥ 60 years with T2DM were divided into sarcopenic group and non-sarcopenic group, according to the diagnostic criteria of the 2019 Asian Working Group for Sarcopenia. They wore MeiQi to acquire the indexes including time in range (TIR), time above range (TAR), time below range (TBR), mean amplitude of glycemic excursion (MAGE), coefficient of Variation (CV), blood glucose standard deviation (SD), largest amplitude of glycemic excursions (LAGE) and mean glucose (MG). The prevalence rate of sarcopenia was statistically analyzed and the different indicators of glucose fluctuation between the two groups were compared. We analyzed the indexes of glucose fluctuation and appendicular skeletal muscle mass index (ASMI), handgrip strength, the time of five times sit to stand test (FTSST) with Spearman's correlation analysis. Logistic regression was used to analyze the influence factors for sarcopenia. The prevalence of sarcopenia was 15.36%. TIR, MG and TAR were correlated with ASMI, handgrip strength, the time of FTSST. MG and TAR were risk factors for sarcopenia, while TIR was the protective factor of sarcopenia. After adjusting mixing factors, logistic regression analysis showed that TIR was an independent protective factor. The result of the Chi-square test showed that the incidence of sarcopenia in different TIR ranges was different: the proportion of patients with sarcopenia was 40.48% (TIR ≤50%), 20.41% (50%<TIR≤70%) and 8.47% (TIR >70%). TIR is associated with sarcopenia in elderly T2DM patients. Furtherly, the incidence rate of sarcopenia decreases with the increase of TIR.

Statin Prescription Patterns Among Elderly Patients with Type 2 Diabetes: A Cross-Sectional Study in Lebanon.

Even though statins have been proven to be effective in both primary and secondary prevention of cardiovascular disease among diabetic patients, a suboptimal use of the latter has been detected in real clinical practice, especially among older adults. This study aimed to evaluate the patterns and predictors of statin use among elderly patients with type 2 diabetes mellitus (T2DM) in Lebanon. This is a cross-sectional study that extended between April 2021 and February 2022. Our study involved elderly T2DM outpatients, aged 65-80years, who presented to 40 community pharmacies for prescription filling. Diabetes status was ascertained via dispensed medication information, and patients were classified based on the American Diabetes Association preset risk scores for cardiovascular diseases in diabetics: low, moderate, or high risk. The questionnaire included patients' demographics, clinical information, and status of statin use. A total of 420 diabetic geriatric patients were observed in this study; their mean age was 70years (± 7), and there was a predominance of males, 270 (64.3%). Almost all patients were classified as being at high risk, 396 (94.3%), while the rest were at moderate risk; thus, all were recommended to receive statins; however, statin prescription was only reported among 197 (46.9%), with atorvastatin and rosuvastatin being the most used: 102 (51.8%) and 62 (31.5%), respectively. Of patients prescribed statins, 60 (14.3%) were taking them for primary prevention and 137 (32.6%) for secondary prevention. Patients having a higher Charlson Comorbidity Index score had lesser odds of being prescribed statins (odds ratio [OR] 0.15, 95% confidence interval [CI] 0.02-0.8, p = 0.028); however, those presenting with a history of dyslipidemia and coronary artery disease had higher odds of statin prescription (OR 10.5, 95% CI 4.2-26.1, p < 0.001, and OR 5.0, 95% CI 2.4-10.5, p < 0.001, respectively). Despite patients' eligibility to receive statins, statin undertreatment was evident among elderly outpatients with T2DM in Lebanon, which was modulated by several predictors.

Association of skin autofluorescence with low bone density/osteoporosis and osteoporotic fractures in type 2 diabetes mellitus.

BackgroundAdvanced glycation end products (AGEs) that abnormally accumulate in diabetic patients have been reported to damage bone health. We aimed to investigate the association between skin autofluorescence (SAF)‐AGEage (SAF − AGEs × age/100) and low bone density (LBD)/osteoporosis or major osteoporotic fractures (MOFs) in patients with type 2 diabetes mellitus (T2DM).MethodsThis study was nested in the prospective REACTION (Risk Evaluation of Cancers in Chinese Diabetic Individuals) study and included 1214 eligible participants. SAF was used to measure skin AGEs (SAF‐AGEs). Fracture events were determined by an in‐person clinical follow‐up. Binary logistic regression analysis, linear regression analysis, and a restricted cubic spline nested in logistic models were used to test outcomes.ResultsThe overall prevalence of LBD/osteoporosis in middle‐aged or elderly T2DM patients was 35.7% (n = 434), and the overall incidence of MOFs was 10.5% (n = 116). Logistic analysis showed a significantly positive relationship between quartiles of SAF‐AGEage and the risk of LBD/osteoporosis (odds ratio [OR] 2.02, 95% CI 1.34–3.03; OR 3.63, CI 2.44–5.39; and OR 6.51, CI 4.34–9.78) for the multivariate‐adjusted models, respectively. SAF‐AGEage was associated with MOFs with a multivariate‐adjusted OR of 1.02 (CI 0.52–2.02), 2.42 (CI 1.32–4.46), and 2.70 (CI 1.48–4.91), respectively. Stratified analyses showed that SAF‐AGEage was significantly associated with MOFs only in females, nonsmokers, nondrinkers, individuals with lower body mass index, and those without LBD/osteoporosis. Linear regression analyses showed that higher SAF‐AGEs were associated with a higher level of serum N‐terminal propeptide of type I procollagen (s‐PINP) and serum carboxy‐terminal cross‐linking peptide of type I collagen (s‐CTX), with a multivariate‐adjusted OR of 1.02 (CI 0.24–1.80) and 6.30 (CI 1.77–10.83), respectively.ConclusionsIn conclusion, SAF‐AGEage was positively associated with the prevalence of LBD/osteoporosis or MOFs in patients with T2DM. A positive association between SAF‐AGEs and the level of s‐PINP and s‐CTX was found.