Development of elderly diabetes burden scale for elderly patients with diabetes mellitus

Background:   The purpose of the present paper was to validate an elderly diabetes burden scale (EDBS) and to assess its correlates in elderly patients with diabetes mellitus.
Methods:   Comprehensive questionnaires about both diabetes-specific and non-specific quality of life (QOL) were given by an interviewer to 455 elderly diabetic patients aged > 65 years. To assess diabetes-specific QOL, the EDBS was developed. The internal consistency and test–retest reliability of the EDBS were assessed. The validity of the EDBS was assessed with the correlation with the Philadelphia Geriatric Center morale scale, the mini-mental state examination (MMSE) and diabetic complications, treatment of diabetes, hemoglobin (Hb) A1c, frequency of hypoglycemia, and socioeconomic factors.
Results:   Factor analysis of the 23 items on EDBS produced six reliable components (Cronbach's α): symptom burden (0.55), dietary restrictions (0.89), social burden (0.89), worry about diabetes (0.85), treatment dissatisfaction (0.85), and burden by tablets or insulin (0.77). It was found that the EDBS and its six subscales had good test–retest reliability ( r  = 0.94–0.99). However, the EDBS correlated significantly with the morale scale but not with MMSE, suggesting convergent and discriminant validity. The high scores of some subscales and total EDBS were significantly associated with high HbA1c level, frequency of hypoglycemia, and insulin therapy, showing construct validity. Multivariate analyses revealed that hyperglycemia, frequency of hypoglycemia, insulin treatment, the presence of microangiopathy, and low positive social support were independently associated with increased elderly diabetes burden scores.
Conclusion:   The EDBS is a simple but reliable and valid measure of diabetic-specific QOL in elderly people with diabetes mellitus.     

The burden of diabetes mellitus in elderly patients from an Asian tertiary hospital

Summary

Diabetes mellitus (DM) has been declared as a global public health threat to society. However, the burden of the disease in elderly Asian patients has not been described. The aim of the study is to assess the disease burden of DM and its associated adverse outcomes in elderly patients from an Asian hospital using the hospital inpatient database.

Methods

Retrospective study of hospital discharge database from 2004 to 2008 to identify patients aged 65 years and above with DM and its associated ‘adverse outcomes’ using International Statistical Classification of Diseases and Related Health Problems, 9th Revision, Australian Modification (ICD-9-AM) codes.

Results

Of 89,875 hospitalized patients aged 65 years and above over the 5 years, 31,124 (34.6%) patients had DM, and the percentage of DM cases increased steadily from 34.3% to 35.6%. Prevalence of DM-associated adverse outcomes was higher in DM patients than in non-DM patients (53.8% vs. 31.5%, p < 0.001). For trends over time, the adverse outcomes decreased in both DM patients (58.1% to 53.6%) and non-DM patients (34.3% to 31.4%, all p < 0.001). All disease-specific adverse outcomes except renal disease decreased over time both in DM and non-DM patients (all p < 0.05). There were increased trends over time for renal disease in both DM patients (16.1% to 23.2%, p < 0.001) and non-DM patients (6.7% to 10.4%, p < 0.001).

Conclusion

The burden of DM in this group of elderly patients is high. Elderly patients with DM experienced much higher rates of the adverse outcomes.     

The growing burden of infective endocarditis in the elderly.

See doi:10.1016/S1095-668X(03)00309-9for the article to whichthis editorial refers Infective endocarditis is a rare disease which still carriesa severe prognosis partly because of changes in epidemiologydue to the growing number of patients with a high risk profile.In this respect there is an growing proportion of elderly patientswith infective endocarditis related to the increase in lifeexpectancy in industrialised countries. As an illustration thepatients over 70 represent 26% of the cases with infective endocarditisin the Euro Heart Survey     

The burden of diabetes mellitus and impaired fasting glucose in an urban population of Sri Lanka

Aims

To describe the burden of diabetes mellitus and impaired fasting glucose in middle‐aged residents (35–64 years) in an urban area of Sri Lanka.

Methods

A cross‐sectional survey was conducted in the Ragama Medical Officer of Health area, from which 2986 participants (1349 men and 1637 women) were randomly selected from the electoral registry between January and December 2007. The participants underwent a physical examination and had their height, weight, waist and hip circumferences and blood pressure measured by trained personnel. Fasting blood samples were taken for measurement of glucose, HbA_1c and lipids. The prevalence of diabetes (fasting plasma glucose > 7 mmol/l) and impaired fasting glycaemia (fasting plasma glucose 5.6–6.9 mmol/l) and major predictors of diabetes in Sri Lanka were estimated from the population‐based data.

Results

Age‐adjusted prevalence of diabetes mellitus in this urban population was 20.3% in men and 19.8% in women. Through the present screening, 263 patients with diabetes and 1262 with impaired fasting glucose levels were identified. The prevalence of newly detected diabetes was 35.7% of all patients with diabetes. Among patients with diabetes, only 23.8% were optimally controlled. In the regression models, high BMI, high waist circumference, high blood pressure and hypercholesterolaemia increased the fasting plasma glucose concentration, independent of age, sex and a family history of diabetes.

Conclusions

Our data demonstrate the heavy burden of diabetes in this urban population. Short‐ and long‐term control strategies are required, not only for optimal therapy among those affected, but also for nationwide primary prevention of diabetes.     

Evaluation of the burden of type 2 diabetes mellitus in population of Puducherry,South India

AimsTo find out the prevalence of undiagnosed diabetes mellitus and the correlates among the adult population of Puducherry, South India.MethodsIn this population based cross-sectional study in the rural and urban field practice area of Mahatma Gandhi Medical College and Research Institute, Puducherry, by simple random sampling 1013 adults of 30 years and above, not on anti-diabetics drugs were included. Main outcome measures were the prevalence and correlates of undiagnosed diabetes mellitus among the adult population. Pre-designed and pre-tested questionnaire was used to elicit the information on family and individual socio-demographic variables. Height, weight, waist and hip circumference, blood pressure were measured and venous blood was collected to measure fasting blood glucose and blood cholesterol.ResultsOverall, 10.3% study subjects were diagnosed as diabetic. In univariate analysis age, dilatory habit, tobacco addiction, body mass index, waist hip ratio, hypertension, and total blood cholesterol were found statistically significant. In multivariate logistic regression (LR method) analysis age, residence, education, dietary habit, tobacco addiction, body mass index, waist hip ratio and total blood cholesterol were statistically significant.ConclusionsIn our study adults having increased age, urban residence, illiterate, non-vegetarian diet, tobacco addiction, obese and high total blood cholesterol were important correlates.     

The burden of chronic obstructive pulmonary disease in the elderly population

BackgroundChronic obstructive pulmonary disease (COPD) is a common disease and an important health care problem in older adults. The impact of age and specific geriatric issues on COPD in elderly patients has not been well established.MethodsA cross-sectional study of elderly COPD patients was conducted in Japan by using a regional COPD registry database. We compared indices of disease severity (pulmonary function, exercise tolerance, quality of life, and frequency of exacerbations), presence of comorbidities, geriatric conditions (cognitive function, mental status, and activities of daily living [ADL]), and adherence to prescribed drug regimens between elderly and younger patients with COPD.ResultsIn total, 279 patients with stable COPD (median age, 74 years) were identified; 86% of these patients were elderly (65 years of age or older). Elderly COPD patients, especially those who were 75 years of age or older, had significantly more cases of dyspnea, lower exercise tolerance, and poorer ADL and a higher incidence of severe exacerbations than younger patients (all P<0.05). In addition, the prevalence of comorbidities, including cardiovascular disease and cancer, was significantly higher in elderly COPD patients. Elderly COPD patients had specific geriatric conditions, including cognitive impairment. Adherence to inhaled drug regimens in elderly patients was as favorable as that in younger patients.ConclusionsAge and specific geriatric conditions have a great negative impact on COPD in elderly patients. Geriatric conditions should be addressed in the management of elderly COPD patients.     

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。     

The status of South Asia's growing elderly population

Populations in South Asia, although less aged than other populations of Asia and the West, are aging rapidly. This paper presents demographic, social, and economic characteristics of the elderly in Bangladesh, India, Nepal, Pakistan, and Sri Lanka, and reviews evidence on whether or not the family situation and status of the elderly have changed in recent decades. There is not strong evidence that the status of the elderly has declined nor that it was uniformly high in the past, but there is indication that economic power has long been an important determinant of status. The paper concludes with a discussion of how future elderly may be different from today's, the limits on developing programs for the elderly in countries at relatively low levels of economic development, and the need for additional research on the elderly of South Asia.An earlier version of this paper was presented at the South Asia Conference on Population Trends and Family Planning, New Delhi, March 14–20, 1989, sponsored by the Registrar General of India and the East-West Population Institute. The author is grateful to the East-West Center, the University of Hawaii, and the U.S. Agency for International Development for supporting this work and to Phyllis Tabusa for her expert bibliographic assistance. The views expressed here are those of the author alone and are not those of the National Academy of Sciences.     

Prevalence of diabetes mellitus in a sample of the elderly population of the city of Catania

The prevalence of diabetes mellitus is increasing world-wide, even if it varies markedly in the geographical areas and populations investigated. This study is part of the Progetto Finalizzato Invecchiamento (Aging Project) of the Italian NCR (National Research Council) and is aimed at investigating the prevalence of diabetes and selected clinical characteristics in a study sample aged between 65 and 84 years of age resident in Catania (Italy). The prevalence rate for type II diabetes was 22.8% and it is certainly among the highest values recorded to date in other areas of Italy and abroad. We distinguished between two forms of diabetes in subjects >70 years of age: aged diabetes with onset in middle age (AD); and diabetes of senescence with onset after 70 years of age (DS). Prevalence rate was 18% for AD and 4.8% for DS, respectively. The age-specific rates of AD and DS show the progressive lower prevalence rates of the former and the higher rates of the latter. We assume that DS is mainly caused by atherosclerotic processes and represents the typical form of diabetes in the elderly.     

Unique aspects of diabetes mellitus in the elderly

Diabetes mellitus is a common condition in the geriatric population. In older subjects it may present in unusual ways and may be associated with unusual conditions. Hyperglycemia produces a variety of effects, including osmotic diuresis and cognitive dysfunction, which seriously impair the quality of life of the older individual. Older diabetics need to have their diabetes well controlled. The approach to diabetic control in older individuals is similar to that in younger individuals, with some notable exceptions.     

Economic impact of diabetes mellitus in the elderly

Diabetes mellitus is a prevalent disease in Americans aged 65 years and older. It leads to significant morbidity, mortality, and utilization of health care services. Using extant data, we estimated that health care services provided to elderly persons with diabetes cost $5.16 billion annually, nearly 80% of which were attributed to hospital costs. Treatment for cardiovascular disease as a complication of diabetes accounted for the largest proportion of these costs. In addition to admissions for uncomplicated diabetes, substantial portions of inpatient costs were attributed to renal and neurologic diseases. Expenditures per capita for medical care were 50% higher in the elderly diabetic population than in an elderly nondiabetic population. The average yearly expenditure per diabetic patient was estimated to be $4265, $900 of which were out-of-pocket expenses. We conclude that increased vigilance to prevent or delay the incidence of morbidity leading to hospital admissions must take priority in caring for patients with DM. Intensifying outpatient care may offer the opportunity to accomplish this goal.     

Atypical presentation of diabetes mellitus in the elderly

Diabetes mellitus is a common problem affecting the elderly. Unfortunately, many people learn they have a problem only after late sequelae of the disease are present. Classic symptoms of hyperglycemia may be lacking or confused with other age-prevalent problems or the aging process itself. Any change in condition, whether medical or psychological, deserves a glucose control assessment. Because of problems in diagnosis, glucose screening has been advocated. Only by diagnosing diabetes mellitus early can late complications be prevented and a high quality of life assured.     

Screening for non-insulin-dependent diabetes mellitus in the elderly

There are three major obstacles to a recommendation for screening the elderly for NIDDM. The first is the conflicting evidence as to whether early detection and treatment reduce complications. The second is that treatment of hyperglycemia with attainment of euglycemia is difficult to achieve in the elderly. Nondrug therapy often fails because of lifelong eating habits, denture problems, fixed income, and physical handicaps. Drug therapy is fraught with the dangers of hypoglycemia and drug interactions. Compliance with therapy often is poor and leads to conflicts between physician and patient that may be detrimental in the treatment of other diseases in which intervention has proven worthwhile. The third obstacle is the lack of data regarding the adverse effects of labeling and noncompliance issues in the face of a positive screening test. Because obesity is a risk factor for NIDDM and hypertension in conjunction with NIDDM leads to atherosclerosis, screening and treatment for these two conditions are warranted whether or not NIDDM is present concurrently. Medicine is in a dynamic state of flux and, undoubtedly, conflicts over the benefits of early treatment and patient compliance will be resolved. Until then, there is no justification for screening for NIDDM in the elderly.     

Drug interactions in the elderly with diabetes mellitus

The elderly with diabetes mellitus are usually treated with many types of drugs. This, together with pharmacokinetic and pharmacodynamic changes connected with aging, can lead to an occurrence of drug interactions. They are often manifested as hypoglycaemia, decompensation of diabetes or an increase of frequency of adverse effects of drugs used together. It is important to pay an attention especially to hypoglycaemia, which brings many risks in the elderly. An article is focused on probable drug interactions when combination of various antidiabetics, antidiabetics with antihypertensives or hypolipidemics is used. Despite ACE-inhibitors and beta-blockers can influence the compensation of diabetics, their use is not contraindicated in these patients, because of their huge benefit in the prevention of cardiovascular events. An article brings an overview of antidiabetics metabolised by means of the system of cytochrome P 450 and resulting drug interactions with inhibitors and inductors of these enzymes. These drug interactions are not usually important in clinical practice and it is possible to prevent them with careful monitoring of glycaemia, instruction of patients and alternatively modification of the doses of hypoglycaemic medication after a termination of the treatment of responsible inductor or inhibitor.     

拉萨市区藏族中老年人群糖尿病患病率粗筛

目的 了解拉萨市区藏族中老年人群糖尿病患病情况及分布特点。方法 采用在居民集中区普查的方法对4851例藏族中老年人群进行饮食结构、体力活动问卷调查及空腹、餐后2h血糖和(或)口服葡萄糖耐量检查。结果 拉萨市区藏族中老年人群糖尿病患病率为6．8％，糖耐量低减为11．6％，他们的体重指数超标、体力活动少和血压高者其糖尿病、糖耐量异常的患病率明显高于正常人群。结论 肥胖、高血压、过多脂肪和蛋白的摄入、运动量减少和低文化程度是拉萨市区藏族中老年人群糖尿病的危险因素。