老年糖尿病与心脏

随增龄老年糖尿病发病率升高,而老年糖尿病并发心血管疾病者亦增多。本文介绍了老年糖尿病并发心血管疾病的病理改变和临床特点,并重点对冠心病和心脏、小血管病变及心血管植物神经病变作了详细讨论。     

老年糖尿病与糖尿病足

老年糖尿病足,是由于糖尿病患者血管病变而使肢端缺血和因周围神经病变而失去感觉,合并感染的足,称为糖尿病足。但由于此病多发生在四肢手足末端,因此,又称为肢端坏疽。它是糖尿病足发展的一个严重阶段,也是老年糖尿病患者致残、致死的重要原因之一。严重威胁着糖尿...     

浅谈老年糖尿病

糖尿病是常见病、多发病,患病率随着人们生活水平的提高、人口老化、生活方式的改变而迅速增加。老年人是糖尿病的高危人群,预防和治疗糖尿病已成为不容忽视的世界性公共卫生问题。了解老年糖尿病的特点,对提高老年患者生活质量、减少病死率均有很大的帮助。本文对老年糖尿病的特点进行如下综述。     

老年糖尿病与X综合征

由国内外调查可见:老年糖尿病患病率高于非老年人,有家族史者高于没有者;体重超重者高于非超重者;脑力劳动者高于体力劳动者;台湾高于大陆;海外华人高于海内同胞。总之,纵向看,我国几千年来已知此病为“富贵病”;横向看,各国都已认识此病为“西方世界病”或“西方生活方式病”。     

老年糖尿病流行病学

糖尿病不仅见于青少年和中年,更常见于老年人。在美国,６５～７４岁的老年人约４０％患有糖尿病或糖耐量低减（ＩＧＴ）,８０岁以上的老年人约５０％。１９９６年的一项调查表明,江苏省６０岁以上社区老年人群ＤＭ的粗患病率为１４４９％,是同年龄组１９８０年全国...     

老年糖尿病治疗体会

现将近年来我们治疗 60岁以上老年糖尿病患者的体会介绍如下。老年糖尿病大多为非胰岛素依赖性型 ,其症状多不典型 ,且年龄越大 ,三多症状越不明显 ,而并发症表现突出 ,因此不能仅以三多症状的轻重来判断病情及治疗效果。对老年糖尿病须注意其血糖和尿糖的不一致性 ,因老年人肾小球滤过率下降 ,肾糖阈增高 ,所以其血糖高时尿糖也可阴性或明显偏低 ,易致对病情和疗效判断失误。老年人肝肾功能减退 ,对降糖药的耐受性差。一般认为 ,应用短效甲苯磺丁脲及达美康较妥 ,不主张用易引起乳酸酸中毒的双胍…     

老年糖尿病

本文从病因、临床特征、诊断、治疗四方面综述了有关老年糖尿病的最新研究进展。     

糖尿病脑病与老年性痴呆

糖尿病（DM）脑病的概念形成于60年代,以后在临床和实验性糖尿病鼠都有研究,病人主要表现轻、中度认知功能障碍。由于这些表现度不十分严重或缺乏对这方面的了解而常被忽视。我佃心理学界的研究表明,注射胰岛素和口服降糖药的病人存在认知功能障碍,而饮食控制组的病人认知功能在正常范围,提示病人认知功能障碍与病情严重程度有关。1型糖尿病人认知功能损害主要在联想记忆和学习热能注意力方面,2型糖尿病人认知功能损害主要在学习和记忆方面,可能存在记忆提取过程的缺陷。     

Association of diabetes mellitus and dementia: The Rotterdam Study

Summary Dementia and non-insulin-dependent diabetes mellitus (NIDDM) are highly prevalent disorders in the elderly. Diabetes has repeatedly been reported to affect cognition, but its relation with dementia is uncertain. We therefore studied the association between diabetes and dementia in the Rotterdam Study, a large population-based study in the elderly. Of 6330 participants, aged 55 to 99 years old, complete information on diabetes and presence of dementia was available. Diabetes was diagnosed as use of anti-diabetes medication or random or post-load serum glucose over 11 mmol/l. Dementia was diagnosed through a stepped approach, including a sensitive screening of all participants and a comprehensive diagnostic work-up. Diabetes was present in 724 (11.4 %) subjects. Of the 265 dementia patients 59 (22.3 %) had diabetes. Multiple logistic regression analyses, adjusting for age and sex differences, revealed a positive association between diabetes and dementia (odds ratio: 1.3, 95 % confidence interval: 1.0–1.9). In particular, strong associations were found between dementia and diabetes treated with insulin (odds ratio: 3.2, 95 % confidence interval: 1.4–7.5). The relation was strongest with vascular dementia, but was also observed with Alzheimer's disease. These associations were independent of educational attainment, smoking, body mass index, atherosclerosis, blood pressure and antihypertensive drug treatment, and could not be explained by clinical cerebral infarctions. The results suggest that NIDDM is associated with dementia. Alzheimer's disease may be more frequent in elderly diabetic patients treated with insulin. [Diabetologia (1996) 39: 1392–1397] Received: 20 May 1996 and in revised form: 22 July 1996     

Diabetes treatment deintensification in Australians with dementia compared to the general population: A national cohort study

Background

Diagnosis of dementia may change peoples' goals of care. In people with diabetes, this may lead to relaxing treatment targets and reducing the use of diabetes medications. The aim of this study was to examine changes in diabetes medication use before and after initiating medication for dementia.

Methods

A national cohort of people aged 65–97 years, living with dementia and diabetes, and a general population cohort with diabetes matched for age, sex, and index date were extracted from the Australian national medication claims database. Trajectories of diabetes medication use, expressed as mean defined daily dose (DDD) each month for each individual from 24 months before to 24 months after the index date, were estimated using group-based trajectory modeling (GBTM). Cohorts were analyzed separately.

Results

People with dementia (N = 1884) and the matched general population (N = 7067) had a median age of 80 years (interquartile range 76–84) and 55% were female. In both models, people exhibited one of five diabetes medication trajectories, with 16.5% of people with dementia and 24.0% of the general population assigned to trajectories that represented deintensification. In the general population model, those on deintensifying trajectories were older than those on stable trajectories (median 83 vs. 79 years). In the dementia cohort model, those on high or low deintensifying trajectories were slightly older (median age 81 or 82, respectively, vs. 80 years) and had at least 1 more comorbidity (median 8 or 7, respectively, vs. 6) than those on stable trajectories.

Conclusions

Initiating medication for dementia does not appear to be a trigger for deintensification of diabetes treatment regimens. Deintensification was more common in the general population; people living with dementia are potentially overtreated for diabetes.     

Prevalence of dementia in older latinos: the influence of type 2 diabetes mellitus,stroke and genetic factors

OBJECTIVES: To estimate dementia prevalence in older Mexican Americans, determine the distribution of dementia by etiology, and evaluate the contribution of type 2 diabetes mellitus, stroke, and apolipoprotein E (ApoE) genotype to dementia. DESIGN: Analysis of baseline data from an epidemiological cohort study. SETTING: Sacramento Valley, California. PARTICIPANTS: One thousand seven hundred eighty-nine Latinos aged 60 and older residing in targeted census tracts during 1998-99. MEASUREMENTS: Each subject was interviewed and screened for dementia and cardiovascular risk factors and diseases. Fasting blood samples were drawn for glucose, insulin, and lipids. Buccal cells were obtained for genetic analysis of ApoE. A three-stage process of screening was used to diagnose dementia, including cognitive testing, a clinical examination, and imaging to determine etiology. Presence of dementia was established according to National Institute of Neurological Disorders and Stroke/Alzheimers and Related Disorders Association criteria and California Alzheimer's Disease Diagnostic and Treatment Criteria. RESULTS: Overall dementia prevalence was 4.8%. Prevalence in those aged 85 and older was 31%. Education and Anglo cultural orientation was negatively associated with dementia risk. Risk of dementia was nearly eight times higher in those with both type 2 diabetes mellitus and stroke. Forty-three percent of dementia was attributable to type 2 diabetes mellitus, stroke, or a combination of the two. ApoE allele frequency was E2 5.9%, E3 90.1%, and E4 4%. Those with any E4 and 4-4 combinations had a higher risk for dementia than those with the E3-3 combination. CONCLUSIONS: Dementia prevalence in this ethnic group is similar to that reported in Canadian and European studies but lower than in Caribbean-Hispanics residing in the United States. The etiological fraction of dementia attributable to type 2 diabetes mellitus and stroke is substantial and points toward the need for intervention research and treatment with the goal of reducing neurological sequelae in groups with high prevalence of type 2 diabetes mellitus. The allele frequency of ApoE was similar to that in other published studies on Mexican Americans. The low frequency of the E4 allele may contribute to the difference in etiology of dementia in older Mexican Americans and older people of European background. Dementia in this ethnic group may be related to preventable causes, with a smaller genetic component than in Europeans.     

Diabetes mellitus and alcohol

Alcohol influences glucose metabolism in several ways in diabetic patients as well as in non-diabetic patients. Since alcohol inhibits both gluconeogenesis and glycogenolysis, its acute intake without food may provoke hypoglycaemia, especially in cases of depleted glycogen stores and in combination with sulphonylurea. Consumed with a meal including carbohydrates, it is the preferred fuel, which may initially lead to somewhat higher blood glucose levels and hence an insulin response in type 2 diabetic patients. Depending on the nature of the carbohydrates in the meal, this may be followed by reactive hypoglycaemia.Moderate consumption of alcohol is associated with a reduced risk of atherosclerotic disorders. Diabetic patients benefit from this favourable effect as much as non-diabetic patients. Apart from effects on lipid metabolism, haemostatic balance and blood pressure, alcohol improves insulin sensitivity. This improvement of insulin sensitivity may also be responsible for the lower incidence of type 2 diabetes mellitus reported to be associated with light-to-moderate drinking. In case of moderate and sensible use, risks of disturbances in glycaemic control, weight and blood pressure are limited.Excessive intake of alcohol, however, may not only cause loss of metabolic control, but also annihilate the favourable effects on the cardiovascular system.     

Diabetes mellitus in centenarians

Objectives

To describe the prevalence of diabetes mellitus (DM) in centenarians.

Design

Cross‐sectional, population‐based.

Setting

Forty‐four counties in northern Georgia.

Participants

Two hundred forty‐four centenarians (aged 98–108, 15.8% male, 20.5% African American, 38.0% community dwelling) from the Georgia Centenarian Study (2001–2009).

Measurements

Nonfasting blood samples assessed glycosylated hemoglobin (HbA_1c) and relevant clinical parameters. Demographic, diagnosis, and DM complication covariates were assessed.

Results

12.5% of centenarians were known to have DM. DM was more prevalent in African Americans (27.7%) than whites (8.6%, P < .001). There were no differences between men (16.7%) and women (11.7%, P = .41) or between centenarians living in the community (10.2%) and in facilities (13.9%, P = .54). DM was more prevalent in overweight and obese (23.1%) than nonoverweight (7.1%, P = .002) centenarians. Anemia (78.6% vs 48.3%, P = .004) and hypertension (79.3% vs 58.6%, P = .04) were more prevalent in centenarians with DM than in those without, and centenarians with DM took more nonhypoglycemic medications (8.6 vs 7.0, P = .02). No centenarians with HbA_1c of less than 6.5% had random serum glucose levels greater than 200 mg/dL. DM was not associated with 12‐month all‐cause mortality, visual impairment, amputations, cardiovascular disease, or neuropathy. Thirty‐seven percent of centenarians reported onset before age 80 (survivors), 47% between age 80 and 97 (delayers), and 15% aged 98 and older (escapers).

Conclusion

Diabetes mellitus is a risk factor for cardiovascular disease and mortality but is seen in persons who live into very old age. Aside from higher rates of anemia and use of more medications, few clinical correlates of DM were observed in centenarians.     

Blood Glucose and Diabetes Mellitus in Subjects Aged 85 Years or More

ABSTRACT. Blood and urine glucose values and the prevalence of diabetes mellitus were determined in the course of a health survey covering inhabitants of Tampere, Finland, aged 85 or over. Out of the total cohort, 561 (83%) subjects, of whom 82% were women, were examined. A high blood glucose level (≥7.0 mmol/l) was recorded in 10% of the males and 7% of the females. The prevalence of diabetes mellitus in the series was 17%. Five per cent of the total series were on drug treatment for their diabetes; 5 % of the diabetics were on insulin therapy and 25% took oral antidiabetic drugs, while 70% were either on diet or had no treatment. Diabetes seems to be common among the very aged, but it is generally mild and easy to treat.     

Diabetes mellitus and geriatric syndromes

Diabetes mellitus is associated with an increased prevalence and incidence of geriatric syndrome: functional disabilities, depression, fall, urinary incontinence, malnutrition and cognitive impairment. Geriatric syndrome not only leads to frailty, loss of independence and low quality of life, but also becomes a major obstacle in the treatment and care of diabetic people. The risk factors or contributing factors of geriatric symptoms are micro- and macrovascular complications, age-rated comorbid disease and aging per se. Comprehensive geriatric assessment of geriatric syndrome, including basic activities of daily living, instrumental activities of daily living, gait and balance, visual acuity, the Mini-Mental State Examination, depression scores, history and risk of fall, urination and nutrition, should be performed as part of the care of elderly diabetic patients, in particular old-old patients. Because geriatric syndromes are multifactorial and share risk factors, diabetic people with any geriatric symptoms should be treated with a common concentric strategy, such as supervised exercise therapy including muscle-strengthening training, psychological support, social support for adherence, and good glycemic control with avoidance of hypoglycemia.     

Type 2 diabetes mellitus,cognitive impairment and dementia

Aims We set out to examine the evidence for an association between cognitive impairment or dementia and the presence of Type 2 diabetes mellitus (DM). We also sought evidence of potential mechanisms for such an association. Methods A literature search of three databases was performed and the reference lists of the papers so identified were examined, using English language papers only. Results We found evidence of cross-sectional and prospective associations between Type 2 DM and cognitive impairment, probably both for memory and executive function. There is also evidence for an elevated risk of both vascular dementia and Alzheimer’s disease in Type 2 DM albeit with strong interaction of other factors such as hypertension, dyslipidaemia and apolipoprotein E phenotype. Both vascular and non-vascular factors are likely to play a role in dementia in diabetes. Conclusions Current classification structures for dementia may not be adequate in diabetes, where mixed pathogenesis is likely. Further research into the mechanisms of cognitive impairment in Type 2 DM may allow us to challenge the concept of dementia, at least in these patients, as an irremediable disease. Diabet. Med. 16, 93–112 (1999)     

Sarcopenia and frailty in older patients with diabetes mellitus

Sarcopenia is defined as age‐associated loss of muscle mass and function, and is frequently accompanied by diabetes mellitus (DM) in older adults. Some of the mechanisms of the development of sarcopenia including insulin resistance, chronic inflammation and mitochondrial dysfunction are also associated with the pathogenesis of DM. Sarcopenia provides the basis for frailty, which is a state that is highly vulnerable to stressors, and can lead to disability, dependency and mortality, and older DM patients are often in a state of frailty. Given the background of an increasing number of older DM patients, the screening and early detection of sarcopenia/frailty and appropriate intervention would be expected to improve the prognosis and quality of life in older patients. Geriatr Gerontol Int 2016; 16: 293–299.