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Diabetes in elderly

J Slieker, P Frauche, J Jurt, V Addor, C Blanc, Nicolas Demartines, M Hübner
BACKGROUND: Enhanced recovery after surgery (ERAS) pathway includes recovery goals requiring active participation of the patients; this may be perceived as "aggressive" care in older patients. The aim of the present study was to assess whether ERAS was feasible and beneficial in older patients. METHODS: Since June 2011, all consecutive colorectal patients were included in an ERAS pathway and documented in a dedicated prospective database. This retrospective analysis included 513 patients, 311 younger patients (<70 years) and 202 older patients (≥70 years)...
October 21, 2016: International Journal of Colorectal Disease
Taulant Muka, Lauren C Blekkenhorst, Joshua R Lewis, Richar L Prince, Nicole S Erler, Albert Hofman, Oscar H Franco, Fernando Rivadeneira, Jessica C Kiefte-de Jong
OBJECTIVE: We aimed to study whether dietary fat composition (n-3 and n-6 polyunsaturated fatty acids ratio (PUFAs) and PUFAs and saturated fatty acids (SFAs) ratio) is associated with total body fat (TF) and body fat distribution and whether this association was modified by the presence of chronic disease in middle-aged and elderly women in two population-based cohorts in the Netherlands and Australia. METHODS: The study was performed in the Rotterdam Study (RS), a prospective cohort study among subjects aged 55 years and older (N = 1182 women) and the Calcium Intake Fracture Outcome Study (CAIFOS), a 5-year randomized controlled trial among women age 70+ (N = 891)...
September 28, 2016: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
Christoph Nowak, Samira Salihovic, Andrea Ganna, Stefan Brandmaier, Taru Tukiainen, Corey D Broeckling, Patrik K Magnusson, Jessica E Prenni, Rui Wang-Sattler, Annette Peters, Konstantin Strauch, Thomas Meitinger, Vilmantas Giedraitis, Johan Ärnlöv, Christian Berne, Christian Gieger, Samuli Ripatti, Lars Lind, Nancy L Pedersen, Johan Sundström, Erik Ingelsson, Tove Fall
Insulin resistance (IR) and impaired insulin secretion contribute to type 2 diabetes and cardiovascular disease. Both are associated with changes in the circulating metabolome, but causal directions have been difficult to disentangle. We combined untargeted plasma metabolomics by liquid chromatography/mass spectrometry in three non-diabetic cohorts with Mendelian Randomization (MR) analysis to obtain new insights into early metabolic alterations in IR and impaired insulin secretion. In up to 910 elderly men we found associations of 52 metabolites with hyperinsulinemic-euglycemic clamp-measured IR and/or β-cell responsiveness (disposition index) during an oral glucose tolerance test...
October 2016: PLoS Genetics
John I Shin, Kevin Phan, Parth Kothari, Jun S Kim, Javier Z Guzman, Samuel K Cho
STUDY DESIGN: This is a retrospective analysis of administrative database. OBJECTIVE: To elucidate the effect of glycemic control on surgical outcomes of middle-aged and elderly idiopathic scoliosis patients undergoing spinal fusion surgery. SUMMARY OF BACKGROUND DATA: Diabetes mellitus (DM) is a condition thought to adversely affect outcomes of spine surgery. However, no study has stratified glycemic control levels and their impact on outcome for idiopathic scoliosis patients receiving a spinal fusion surgery...
October 19, 2016: Clinical Spine Surgery
K Rygiel
Alzheimer's disease (AD) is a neurodegenerative disease, in which an accumulation of toxic amyloid beta in the brain precedes the emergence of clinical symptoms. AD spectrum consists of presymptomatic, early symptomatic, and symptomatic phase of dementia. At present, no pharmacotherapy exists to modify or reverse a course of AD, and only symptomatic treatments are available. Many elderly patients, diagnosed with multiple medical conditions (such as cardiovascular diseases, Type 2 diabetes mellitus, and cerebrovascular diseases) are at increased risk of the development of mild cognitive impairment (MCI), AD, and vascular dementia...
October 2016: Journal of Postgraduate Medicine
M Satheesh Kumar, Ayush Lohiya, Viviktha Ramesh, Priyamadhaba Behera, Sarika Palepu, S A Rizwan
OBJECTIVES: To compare pulse oximetry and Ankle-Brachial Index (ABI) with duplex ultrasonography as reference standard to determine the diagnostic accuracy for screening asymptomatic PVD in type 2 diabetes mellitus. METHODS: This cross-sectional study was conducted in 2012 at tertiary hospital in Madurai among diabetic patients attending the medicine outpatient department (OPD). Type 2 Diabetes Mellitus patients, asymptomatic with regards to symptoms and signs of PVD, aged above 40 years were included...
August 2016: Journal of the Association of Physicians of India
M Henze, H Alfonso, L Flicker, J George, S A Paul Chubb, G J Hankey, O P Almeida, J Golledge, P E Norman, B B Yeap
AIMS: To investigate behavioural, physical and biochemical characteristics associated with diabetes in the oldest age group of elderly men. METHODS: We conducted a cross-sectional analysis of community-dwelling men aged 79-97 years from Perth, Western Australia. Lifestyle behaviours, self-rated health, physical function, and fasting glucose and HbA1c levels were assessed. RESULTS: Of 1426 men, 315 had diabetes (22%). Men with diabetes were of similar age to men without (84...
October 20, 2016: Diabetic Medicine: a Journal of the British Diabetic Association
Usha Sambamoorthi, Arijita Deb, Steve Zhou, Rahul Garg, Tao Fan, Anders Boss
We examined the real-world utilization and persistence of rapid acting insulin (RAI) in elderly patients with type 2 diabetes who added RAI to their drug (OAD) regimen. Insulin-naïve patients aged ≥65 years, with ≥1 OAD prescription during the baseline period, who were continuously enrolled in the US Humana Medicare Advantage insurance plan for 18 months and initiated RAI were included. Among patients with ≥2 RAI prescriptions (RAIp), persistence during the 12-month follow-up was assessed. Multivariate logistic regression analyses identified factors affecting RAI use and persistence...
2016: Journal of Diabetes Research
D L Liang, X Y Li, L Wang, H Xu, X P Tuo, Z J Jian
Objective: To investigate the current status and influence factors of ACEI/ARB application in elderly coronary heart disease outpatients complicated with diabetes mellitus in 21 provinces of China. Methods: In this multicenter, non-intervention and cross-sectional survey, the elderly coronary heart disease patients aged 60 years or over were recruited from 165 hospitals in 21 provinces across China from April to July 2011. Current status and influence factors of ACEI/ARB application among 1 789 cases with diabetes mellitus were investigated in the survey...
September 27, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Matthew L Maciejewski, Bradley G Hammill, Elizabeth A Bayliss, Laura Ding, Corrine I Voils, Lesley H Curtis, Virginia Wang
BACKGROUND: Medicare beneficiaries with multiple chronic conditions are typically seen by multiple providers, particularly specialists. Clinically appropriate referrals to multiple specialists may compromise the continuity of care for multiple chronic condition beneficiaries and create care plans that patients may find challenging to reconcile, which may impact patient outcomes. OBJECTIVE: The objective was to examine whether glycemic control or lipid control was associated with the number of prescribers of cardiometabolic medications...
October 14, 2016: Medical Care
Clive Rosendorff
Many guidelines for the management of hypertension have recommended that the goal of antihypertensive treatment in the elderly (usually specified as 80 years or above) should be less than 150/90 mmHg. SPRINT included subjects 50 years or above, and a substantial proportion of subjects 75 years and older. These are individuals at high risk for adverse cardiovascular events because of high prevalence of hypertension and atherosclerotic disease. The less stringent BP goals have been based on a percieved danger of lowering BP to levels that threaten vital organ pefusion (myocardium, brain, kidney)...
September 2016: Journal of Hypertension
Shokei Kim-Mitsuyama
There is accumulating evidence that RAS inhibitors not only reduce blood pressure, but also exert pleiotropic effects, including a renoprotective effect, amelioration of insulin resistance, reduction in onset of diabetes, and suppression of cardiovascular remodelling,. However, the definite benefit of RAS inhibition in treatment of hypertension with CKD or DM is not conclusive. We previously performed the OlmeSartan and Calcium Antagonists Randomized (OSCAR) study comparing the preventive effect of high-dose ARB therapy versus ARB plus CCB combination therapy on cardiovascular morbidity and mortality in 1164 Japanese elderly hypertensive patients with baseline type 2 diabetes and/or CVD (Am J Med (2012))...
September 2016: Journal of Hypertension
Suzanne Oparil
Heart disease, stroke, and kidney failure are leading causes of death worldwide, and hypertension is a significant risk factor for each. Hypertension is less common in women, compared to men, in those younger than 45 years of age. This trend is reversed in those 65 years and older. In the US between 2011-2014, the prevalence of hypertension in women and men by age group was 6% vs 8% (18-39 years), 30% vs 35% (40-59 years), and 67% vs 63% (60 years and over). Awareness, treatment, and control rates differ between genders with women being more aware of their diagnosis (85% vs 80%), more likely to take their medications (81% vs 71%) and more frequently having controlled hypertension (55% vs 49%)...
September 2016: Journal of Hypertension
Seung Won Lee, Hyeon Chang Kim, Yong-Ho Lee, Hansol Choi, Ji Hye Park, Yumie Rhee, Chang Oh Kim
OBJECTIVE: We examined whether HbA1c is associated with carotid atherosclerosis in a community-dwelling elderly Korean population with normal fasting glucose. DESIGN AND METHOD: Using data from the Korean Urban Rural Elderly study, we conducted a cross-sectional analysis in 1,133 participants (335 men and 798 women) with mean age 71.8 years. All participants had fasting blood glucose less than 100   mg/dL (5.6mmol/L) and a level of HbA1c below 6.5% (48 mmol/mol)...
September 2016: Journal of Hypertension
Jiadela Teliewubai, Yu-Yan Lv, Shi-Kai Yu, Bin Bai, Chen Chi, Kai Wang, Yi-Wu Zhou, Jing Xiong, Yi Zhang, Ya-Wei Xu
OBJECTIVE: The Eighth Joint National Committee Panel recommended novel blood pressure (BP) goals for individuals with hypertension, which is still under debate. We therefore assessed patients' target organ damages in controlled hypertensives defined by the Seventh or Eighth Joint National Committee thresholds (JNC7 and JNC8) in a community-based elderly Chinese population, in order to find the optimal BP goal for the elderly Chinese. DESIGN AND METHOD: 1599 community-based elderly participants (age > 65 years old) were recruited in the northern Shanghai...
September 2016: Journal of Hypertension
Yuki Imaizumi, Kazuo Eguchi, Toshiki Kaihara, Kumiko Urano, Rieko Shinagawa, Minoru Araki, Koji Inoue, Koichiro Hokao, Yuka Tsujita, Takuya Furusawa, Ryuichiro Kaku, Kazuomi Kario
OBJECTIVE: We tested the hypothesis that sarcopenia, an age-related loss of skeletal muscle mass and function, is associated with arterial stiffness in patients with diabetes (DM). DESIGN AND METHOD: We studied 65 hypertensives in the Real BP study, an observational study of home BP telemonitoring system. As parameters of sarcopenia, we used locomotive syndrome scale, circumference of the wrist, lower leg, and thigh (10 cm above the patella), grip strength, and 6 minute-walk test...
September 2016: Journal of Hypertension
Unna Triam-Anuruck, Prin Vathesatogkit, Teerapat Yingchoncharoen, Wisuit Katekao, Oraporn See, Sukit Yamwong, Piyamitr Sritara
OBJECTIVE: Hypertension (HTN) inarguably causes remodeling of left ventricle (LV). However, the effect of awareness, treatment and control of hypertension on LV geometry has not been established. We sought to identify the relationship between the classification of LV geometry and awareness, treatment and control of hypertension in a large Thai elderly population. DESIGN AND METHOD: Participants with complete echocardiographic data were enrolled in 2012. Detailed hypertension data was retrieved from the survey in 1997, 2002, 2007 and 2012...
September 2016: Journal of Hypertension
Jürgen Bohlender, Jürg Nussberger, Beate Bohlender
OBJECTIVE: In elderly hypertensive patients, systolic blood pressure (sBP) goals recommended by US and European guidelines (ESH) for the initiation of treatment are more liberal than in younger patients because of an increased risk of treatment-associated side-effects and hypotension. Carotid stenosis increases with age and poses a risk of brain ischemia if hypotension occurs. Its relevance for the routine care of elderly hypertensives, however, remains unclear. We analyzed data on precerebral artery morphology and BP evolution from a survey of aged hospitalized patients...
September 2016: Journal of Hypertension
Ernesto Schiffrin
Hypertension has been defined by the levels of BP above which lowering BP will reduce the cardiovascular risk associated with elevated BP. This level has been classically 140/90 mmHg on the basis of actuarial data from the insurance industry. However, we now know that cardiovascular risk rises progressively from levels as low as 115/75 mmHg upward with a doubling of the incidence of both coronary heart disease and stroke for every 20/10-mmHg increment of BP. In uncomplicated hypertension without cardiovascular risk factors or target organ damage, there is little randomized clinical trial evidence that lowering SBP of <160 mmHg reduces cardiovascular risk...
September 2016: Journal of Hypertension
Lawrence Appel
The identification of explicit blood pressure targets for clinical management remains controversial, particularly in older individuals with co-morbidities. Recommendations from the panel appointed to the Eighth Joint National Committee (JNC 8) and results of the SPRINT trial have rekindled interest in this issue. JNC8 recommended a higher (more relaxed) BP goal of < 150/90, instead of the traditional BP goal of <140/90, in persons aged 60+. In contrast, the recently completed SPRINT trial, which enrolled high risk patients without diabetes, documented that a lower (more stringent) SBP goal of <120 mmHg reduced total mortality and cardiovascular disease events compared to <140 mmHg...
September 2016: Journal of Hypertension
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