江苏省社区老年人群糖尿病流行特点的研究

目的探讨江苏省老年人群糖尿病（ＤＭ）的流行特征及影响因素。方法按分层整群抽样原则，共抽取江苏省城乡八层样本计１６３６人，按照ＷＨＯ的诊断标准进行调查。结果该省６０岁以上社区老年人群ＤＭ、糖耐量减低（ＩＧＴ）的粗患病率分别为１４４９％和１０２１％，已达到一个比较高的水平；ＤＭ和ＩＧＴ患病率随体质量指数（ＢＭＩ）的增大而增高、职业性体力活动强度的增加而降低；ＤＭ家族史阳性者患病率显著高于阴性者，城镇高于乡村，女性高于男性。结论该省老年人群ＤＭ的患病率已达到较高水平，加强老年人群ＤＭ的预防和控制，已成为该省卫生工作的一项紧迫任务。     

北京军队老年人糖尿病患病率、发病率调查

目的 了解老年人群2型糖尿病(DM)的患病率和发病率，探讨其流行特征和相关危险因素。方法 自1996年5月至2000年6月间，对在我院进行健康查体的老年人群进行空腹血糖(FPG)、馒头餐后2h血糖(PPG)和血脂测定，如PPG≥7．2mmol/L，加作75g口服葡萄糖耐量试验(OGTT)，测其服糖后2h血糖。采用Logistic回归分析对4年中新发现的DM和糖耐量低减(IGT)的危险因素进行分析。结果 基线人群2239例，平均随访了3．7年，2型DM标化后的患病率由1996年的15．7％上升到2000年的23．9％，DM的患病率随着年龄增长，呈逐步上升趋势(P＜0．001)；同期IGT标化后的患病率由12．8％上升为13．9％。标化后的DM发病率为33．75／1000人年；标化后的IGT的发病率为42．25／1000人年。经Logistic逐步回归分析表明FPG、PPG、体质指数(BMl)和平均动脉压(MBP)与2型DM发生明显相关。结论 老年人DM患病率和发病率较以往我国一般人群调查为高，在本组人群呈逐年上升趋势，应重视老年人群DM的防治工作。     

Components of the metabolic syndrome and incidence of diabetes in elderly Italians: the Italian Longitudinal Study on Aging

The aim of this study was to explore the relationship among components of the metabolic syndrome and their role in the development of diabetes. We included 2295 subjects, aged 65-84 years, participating in the Italian Longitudinal Study on Aging, a population-based study conducted in 1992 and with a follow-up in 1996. Factor analysis was conducted, separately for diabetic and non-diabetic men and women, using the principle components method and varimax rotations. Factor scores for the baseline were used as independent variables in logistic regressions models to determine risk factors predicting the development of diabetes. Factor analysis among non-diabetic elderly showed two factors for men (body size/insulin resistance, blood pressure/lipids) and three for women (body size, lipids, blood pressure). Among diabetic subjects, three factors emerged for men (body size/lipids/insulin resistance, body size/blood pressure, glucose) and four for women (body size/lipids/insulin resistance, lipids, body size/glucose/insulin resistance, lipids/blood pressure). For non-diabetic men and women, the body size factor (body size/insulin resistance factor for men) was strongly associated with diabetes incidence (OR=2.30, 95% CI 1.41-3.74 and OR=2.06, 95% CI 1.33-3.17, respectively). This study confirms that the metabolic syndrome (MetS) does not recognize one single underlying factor in an elderly cohort and that the obesity factor is a strong predictor of development of new onset diabetes.     

The prevalence of diabetes mellitus (DM) type II among Iranian elderly population and its association with other age-related diseases, 2012

DM type II is one of the most common chronic diseases. The objective of this study is to investigate the prevalence of DM and its association with other age-related diseases in Iran, 2012. In this cross-sectional study, people aged 60 years and over were selected using multistage sampling method. Mini-Nutritional Assessment (MNA), Activity of Daily Living (ADL), and Geriatric Depression Scale (GDS-15 items) questionnaires were used. History of common disorders was taken through self-report, medical records and the results of clinical examinations. A total of 1350 old people were studied. DM type II was found in 297 (22.0%) subjects and 371 (27.5%) of subjects were not aware of their DM status. Hypertension (55.6%), high serum cholesterol (51.8%), malnutrition (40.1%), Alzheimer's disease (16.9%), weight loss within past year (16.1%), weight gain within past year (11.7%), frailty (64.6%), insomnia (50.1%), and vision problems (62.6%) were significantly more common in diabetics. Those who were not aware of their status of DM either were between diabetics and non-diabetics or more similar to non-diabetics. Considering high prevalence of age-related diseases among Iranian elderly people, in particular women and those with DM type II, preventive measures are recommended so as to decrease and control DM type II and its consequent complications.     

Aging and comorbidities influence the risk of hospitalization and mortality in diabetic patients experiencing severe hypoglycemia

Background and aimsTo assess the risk of hospitalization and mortality within 1 year of severe hypoglycaemia and theirs clinical predictors.Methods and resultsWe retrospectively examined 399 admissions for severe hypoglycemia in adults with DM at the Emergency Department (ED) of the University Hospital of Novara (Italy) between 2012–2017, and we compared the clinical differences between older (aged ≥65 years) and younger individuals (aged 18–64 years). A logistic regression model was used to explore predictors of hospitalization following ED access and 1-year later, according to cardiovascular (CV) or not (no-CV) reasons; 1-year all-cause mortality was also detected.The study cohort comprised 302 patients (median [IQR] age 75 [17] years, 50.3% females, 93.4% white, HbA_1c level 7.6% [1.0%]). Hospitalization following ED access occurred in 16.2% of patients and kidney failure (OR 0.50 [95% CI 1.29–5.03]) was the only predictor of no-CV specific hospitalization; 1-year hospitalization occurred in 24.5% of patients and obesity (OR 3.17 [95% CI 1.20–8.12]) and pre-existing heart disease (OR 3.20 [95% 1.20–9.39]) were associated with CV specific hospitalization; 1-year all-cause mortality occurred in 14.9% of patients and was associated with older age (OR 1.12 [95% CI 1.07–1.18]) and pre-existing heart disease (OR 2.63 [95% CI 1.19–6.14])ConclusionsSevere hypoglycemia is associated with risk of hospitalization and mortality mainly in elderly patients and it may be predictive of future cardiovascular events in diabetic patients with pre-existing heart disease and obesity.     

圣·约翰草提取物对伴有抑郁症的2型糖尿病合并高血压老年患者的疗效

目的 探讨抗抑郁植物药圣·约翰草提取物对伴有抑郁症的2型糖尿病合并高血压老年患者的临床疗效.方法 将106例伴有抑郁症的2型糖尿病合并高血压的老年患者随机分为药物治疗组(30例),心理治疗组(24例),物理治疗组(28例)和安慰剂组(26例),均治疗12周.以汉密尔顿抑郁量表(HAMD)减分率评定疗效,监测患者血压水平及糖化血红蛋白值(Hb)A1c.结果 (1)各组HAMD减分率分别为80%、54.2%、50%和37%,差异有统计学意义(P<0.05).药物治疗组疗效均优于其他3组(P<0.05).(2)治疗12周后,各治疗组收缩压及舒张压均较治疗前下降(P均<0.05),有效率差异有统计学意义(P均<0.05).(3)治疗12周后,各冶疗组HbA1c值均较治疗前有所下降(P<0.05).结论 圣·约翰草提取物能显著改善2型糖尿病合并高血压老年患者伴发的抑郁症,且有利于患者的血压和血精控制.     

圣·约翰草提取物对老年2型糖尿病患者并存抑郁症的疗效观察

目的 探讨抗抑郁植物药圣·约翰草提取物对并存抑郁症的老年2型糖尿病患者的临床疗效及对血糖的影响. 方法 将并存抑郁症的老年2型糖尿病患者118例随机分为5组,圣·约翰草提取物组(26例)、劳拉西泮组(22例)、心理组(24例)、物理组(24例)和对照组(22例),均治疗12周.以汉密尔顿抑郁量表(HAMD)减分率评定疗效,采用糖化血红蛋白(HbAlc)水平监测血糖控制情况. 结果 (1)治疗12周后,4个治疗组HAMD减分率分别为80.8%、63.6%、62.5%、58.3%,与对照组(18.2%)比较,差异有统计学意义(P<0.01),圣·约翰草提取物组疗效优于其他3组(P<0.05);(2)治疗12周后,圣·约翰草提取物组HbAIt(6.5±0.6)%,比治疗前明显下降(P<0.01),且优于其他3组[分别为(7.5±0.8)%、(7.4±0.8)%和(7.4±1.0)%]. 结论 圣·约翰草提取物能显著改善老年2型糖尿病患者伴发的抑郁症状,且有利于患者的血糖控制.     

Distribution of lean mass and mortality risk in patients with type 2 diabetes

AimsThe aim of the study is to evaluate the association of distribution of lean mass with the risk of all-cause mortality among patients with type 2 diabetes.MethodsThe present cohort study included 2 335 patients with type 2 diabetes. Lean mass was assessed by dual energy X-ray absorptiometry. Cox proportional hazards regressions were used to estimate the association of lean mass distribution on the risk of mortality.ResultsThe average age of the patients was 58 years at baseline and 51.4% of patients were women. During a median follow-up of 4.31 years, 128 patients died. The multivariable-adjusted hazards ratios for all-cause mortality were 1.00, 1.63 (0.89–2.99), and 2.68(1.51–4.76) across the tertiles of android-to-gynoid lean mass ratio (P for trend < 0.001), respectively. The positive association of android-to-gynoid lean mass ratio with the risk of all-cause mortality was present among patients of different ages, body mass index ≥ 24 kg/m², hemoglobin A1c ≥ 7.0%, nonsmokers, men, patients using insulin, and patients with diabetes durations of more than 10 years.ConclusionsHigher android-to-gynoid lean mass ratio, assessed by dual energy X-ray absorptiometry, was significantly associated with increased risk of all-cause mortality among patients with type 2 diabetes.     

Prevalence and determinants of diabetes distress in patients of diabetes mellitus in a tertiary care centre

Background

Patients of diabetes mellitus experience psychological difficulties associated with their disease which remains unrecognized involving several states related to coping with diabetes. Diabetes distress is a distinct condition which is often mistaken for depression and is related to adverse disease outcomes.

Impact of diabetes mellitus on mortality rates and outcomes in myocardial infarction

BackgroundDiabetes mellitus (DM) represents a major cardiovascular risk factor for increased risk of coronary artery disease and myocardial infarction (MI). DM is also associated with a poorer clinical outcome in MI.Materials and methodsThe nationwide German inpatient population treated between 2005 and 2016 was used for statistical analyses. Hospitalized MI patients were stratified by the presence of DM and investigated for the impact of DM on in-hospital events.ResultsIn total, 3,307,703 hospitalizations for acute MI (37.6% female patients, 56.8% aged ≥ 70 years) treated in Germany during 2005–2016 were included in this analysis. Of these patients, 410,737 (12.4%) died while in hospital. Overall, 1,007,326 (30.5%) MI cases were coded for DM. While the rate of MI patients with DM increased slightly over time, from 29.8% in 2005 to 30.7% in 2016 (β = 7.04, 95% CI: 4.13–9.94; P < 0.001), their in-hospital mortality decreased from 15.2% to 11.5% (β = -0.36, 95% CI: -0.38 to -0.34; P < 0.001). Rates of in-hospital death (13.2% vs 12.1%; P < 0.001) and recurrent MI (0.8% vs 0.6%; P < 0.001) were higher in MI patients with vs without DM. Also, in MI patients with DM, significantly lower use of coronary artery angiography (51.5% vs 56.8%; P < 0.001) and interventional revascularization (37.6% vs 43.9%; P < 0.001) was noted.ConclusionAlthough in-hospital mortality of patients with MI decreased in both diabetes and non-diabetes patients, in-hospital deaths were still higher in diabetes patients, thereby revealing the impact of this metabolic disorder on cardiovascular outcomes.     

Lens opacity and mortality in diabetes

A population-based cohort of 294 diabetic patients were examined for the presence of lens opacities and followed up for a median of 6 years. Only two patients were lost to follow-up but there were 73 deaths, 49 in the 108 patients with opacities and 24 in the 184 patients without (odds ratio 2.4, 95% Cl 1.5-3.9). Lens opacities were a powerful predictor of death and the effect was independent of other prognostic factors. The presence of cataract identifies a high risk sub-group of elderly diabetic patients.     

Prediction of mortality risk in the elderly

Purpose

Ways to predict the risk of cardiovascular (CV) events or all-cause mortality have largely been derived from populations in which old and very old subjects were underrepresented. We set out to estimate the incremental prognostic utility of inflammation and atherosclerosis markers in the prediction of all-cause and CV mortality in elderly men.

Methods

In a prospective population-based cohort study, conventional CV risk factors were documented in 403 independently living elderly men. C-reactive protein (CRP) and interleukin (IL)-6 levels were measured. Carotid plaques were assessed by ultrasound. Analyses were performed with proportional hazards analyses, and bootstrapping was used for internal validation. Main outcome was CV and all-cause mortality occurring during 4 years of follow-up.

Results

Increasing tertiles of CRP, IL-6, and number of plaques were independently associated with all-cause and CV mortality. With information on age, carotid plaques, IL-6, and CRP yielded good discriminatory power for all-cause and CV mortality: area under the receiver operating characteristic curve (95% confidence interval), 0.76 (0.70-0.82) and 0.74 (0.68-0.80), respectively. Combined use of only IL-6 and plaque burden allowed identification of subjects with low and high mortality risk. The Framingham PROCAM and a Dutch Risk Function poorly predicted mortality risk, similar or worse than a model using age alone.

Conclusion

In the old and very old, IL-6 and number of carotid plaques are powerful predictors of mortality risk in the years to come. Conventional risk scores seem to perform unsatisfactorily.     

新疆汉族和维吾尔族人群糖尿病流行现状调查及影响因素分析

目的 了解新疆地区汉族和哈萨克族人群糖尿病流行现状及影响因素分析. 方法 整群随机抽取新疆石河子市周边及喀什地区18岁以上汉族和维吾尔族常驻居民8000名,行问卷调查、体格检查及生化检测. 结果 汉族和维吾尔族男性、女性及总糖尿病患病率分别为8.14％、7.77％、7.93％和2.36％、2.55％、2.45％,标化率分别为6.40％、7.06％、6.66％和2.15％、2.55％、2.38％.汉族超重、肥胖人群糖尿病患病率高于维吾尔族(8.58％vs3.04％,11.47％vs3.38％,P＜0.05).年龄、肥胖、高血压为汉族和维吾尔族人群糖尿病患病共同的危险因素. 结论 汉族糖尿病患病率高于维吾尔族,可针对不同民族生活方式、膳食结构和糖尿病患病危险因素差异,有针对性地预防糖尿病发生.     

Prevalence of diabetes mellitus in Croatia

The aim of this study was to obtain an accurate estimate of diabetes prevalence in Croatia and additional estimates of impaired fasting glucose (IFG), undiagnosed diabetes, and insulin resistance.The study was part of the First Croatian Health Project. Field work included a questionnaire, anthropological measurements, and blood sampling. A nationally representative sample of 1653 subjects aged 18–65 years was analyzed.A total of 100 participants with diabetes were detected, among them 42 with previously unknown diabetes. The prevalence was 6.1% (95% CI: 4.59–7.64), with a significant difference by age. IFG prevalence (WHO-criteria) was 11.3%. The ratio of undiagnosed/diagnosed diabetes was 72/100, unevenly distributed by the regions. HOMA-IR was >1 in 40.4% of the subjects.This survey revealed a higher prevalence of diabetes than previously estimated, whereas that of IFG was as expected. A significant difference in the proportion of undiagnosed diabetes among the regions warrants attention.     

江苏地区糖尿病、代谢综合征患病率现况调查

目的调查2008年江苏地区糖尿病、代谢综合征（MS）及其相关疾病的患病情况。方法采用多阶段分层整群随机抽样方法,对该人群进行问卷调查,并行空腹血糖、口服葡萄糖耐量试验、血脂、身高、体质量、腰臀围、体质指数、血压检测。糖尿病采用1999年WHO的诊断标准,MS采用中华医学会糖尿病学分会2004年建议的诊断标准,分析患病率。应用卡方检验进行率的比较,并对MS的危险因素做多因素logstic回归分析。结果江苏地区3436名20岁以上人群糖尿病、MS、高血糖、高血压、超重或肥胖、高甘油三酯血症和低高密度脂蛋白胆固醇血症的粗患病率分别为10．9％、18．7％、23．0％、35．4％、39．8％、28．5％和13．3％,标化后患病率分别为8．56％、15．9％、18．9％、27．8％、35．8％、27．1％和13．2％,上述疾病的患病率随年龄的增长而增加。女性MS患病率：农村（19．9％）〉城镇（15．8％）〉城市（14．6％）,男性城镇（23．7％）〉农村（21．7％）〉城市（19．9％）。经logistic回归分析显示性别、年龄、文化程度为MS的危险因素。结论江苏地区20岁以上人群糖尿病、MS患病率分别为8．56％和15．9％,已成为影响城乡居民健康的重大公共卫生问题,应加强防治工作力度。     

The prevalence of diabetes in elderly people.

The prevalence of diabetes mellitus was investigated in a sample of people aged 65 to 85 years, using a modified oral glucose tolerance test and 1985 WHO criteria. Of the sample of 861, 52 had previously been diagnosed diabetic; 583 consented to be tested and 19 were diabetic. The prevalence of previously diagnosed diabetes was 6.0 (95% CI 4.3 to 8.1) %, and the prevalence of previously undiagnosed diabetes was 3.3 (95% CI 2.0 to 5.0) %. The high prevalence of previously diagnosed diabetes might be due to the longstanding community diabetes care in the area studied.     

Prevalence,risk factors,and management of uncontrolled hypertension among patients with diabetes: A hospital-based cross-sectional study

AimsThis research examines the prevalence of uncontrolled hypertension and associated risk factors among patients with diabetes in Saudi Arabia.MethodsA hospital-based, cross-sectional study was used in patients with diabetes and hypertension attending outpatient diabetes clinics in King Khaled Hospital and Prince Sultan Center for Health Care in Al-Kharj, Riyadh. Patients’ information, data on hypertension, type of treatment, and comorbidities were captured through electronic medical records. Uncontrolled hypertension was defined as blood pressure (BP) measurements greater than or equal to 140/90 mmHg. Antihypertensive medication use among these patients was analyzed. Multivariate analysis was performed to detect the associated factors of uncontrolled hypertension.ResultsOf 1178 outpatients‬ with diabetes who were included in the study sample, uncontrolled hypertension presented in 846 (71.8%). Most patients were on two antihypertensive medications, and the most frequently used was calcium channel blockers, followed by angiotensin-converting enzyme inhibitors. Individuals most likely to have uncontrolled hypertension were those older than 65 years (OR 1.99, 95%CI: 1.059, 3.77), male (OR = 1.51, 95%CI: 1.031, 2.22), and obese (OR = 2.39, 95%CI: 1.63, 3.504), with two (OR = 3.894, 95% CI: 2.481, 6.114) or three or more comorbidities (OR = 4.020, 95% CI: 2.510, 6.439), and with polypharmacy (OR = 1.814, 95% CI: 1.238, 2.656).ConclusionThe extent of uncontrolled hypertension among patients with diabetes in the study sample was found to be high. Age, sex, obesity, number of comorbidities, and polypharmacy are the most important correlates with increased risk of uncontrolled hypertension.     

Trends in the effects of pre-transplant diabetes on mortality and cardiovascular events after kidney transplantation

Aims/IntroductionIt is not clear whether survival in kidney transplant recipients with pre‐transplant diabetes has improved over the past decades. We compared the rates of mortality and major adverse cardiovascular events (MACE) after renal transplantation in patients with and without pre‐transplant diabetes. Furthermore, we investigated whether transplant era and recipient age affected the association between diabetes status and adverse events.Materials and MethodsThis retrospective cohort study included 691 patients who underwent renal transplantation between 1994 and 2016 at a single tertiary center. We compared the incidences of post‐transplant mortality and four‐point MACE in patients with and without pre‐transplant diabetes using Kaplan–Meier analysis and the Cox proportional hazard model, and assessed the interactions between diabetes status and transplant era and recipient age.ResultsOf 691 kidney recipients, 143 (20.7%) had pre‐transplant diabetes. The mean follow‐up duration was 94.5 months. Kaplan–Meier analysis showed that patients with pre‐transplant diabetes had higher incidences of post‐transplant mortality and four‐point MACE compared with those without pre‐transplant diabetes (log–rank test, P < 0.001 for both). After adjusting for potential confounding factors, pre‐transplant diabetes was associated with an increased risk of post‐transplant mortality and four‐point MACE (hazard ratio 1.90, 95% confidence interval 1.05–3.44, P = 0.034; and hazard ratio 1.75; 95% confidence interval 1.02–3.00, P = 0.043, respectively). The associations between pre‐transplant diabetes status and all‐cause mortality and four‐point MACE were not affected by transplant era or recipient age.ConclusionsPre‐transplant diabetes remains a significant risk factor for mortality and four‐point MACE in kidney transplant recipients.     

四川巴中地区老年人糖尿病及糖调节受损患病率的调查

目的了解四川巴中地区老年人糖尿病（DM）及糖调节受损的发病现状。方法采用多级抽样的方法,抽取2414名巴中地区60岁及以上人群进行问卷调查、体检、血糖检查和糖耐量试验。结果2414名对象中,有252例患DM,患病率为10．4％;女性DM患病率高于男性,城镇高于农村,大专及以上文化程度的发病率最低,从事脑力劳动的高于体力劳动的,随经济收入的增高,DM患病率增高。单纯IFG患病率为6．6％,单纯的IGT患病率为22．8％,IFG合并IGT的患病率为1．9％。结论巴中地区老年人糖尿病及糖调节受损的患病形势严峻,应重视和加强防治工作。