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Diabetes In Elderly Adults

Diabetes in Elderly Adults

Diabetes in Elderly Adults

Abstract
Diabetes is common in the elderly population. By the age of 75, approximately 20% of the population are afflicted with this illness. Diabetes in elderly adults is metabolically distinct from diabetes in younger patient populations, and the approach to therapy needs to be different in this age group. Diabetes is associated with substantial morbidity from macro- and microvascular complications. Several lines of evidence suggest that optimal glycemic control and risk factor modification can substantially reduce the risk of complications in elderly patients. In the past, treatment options were limited. However, recent studies have delineated several new and exciting therapeutic opportunities for elderly patients with diabetes.
Decision Editor: John E. Morley, MB, BCh
Epidemiology
Numerous studies have evaluated the incidence and prevalence of type 2 diabetes in the elderly population. The most recent Health and Nutrition Survey, HANES III, suggests that approximately 20% of the population develop diabetes by the age of 75 (Fig. 1) (1). At least half of these patients are unaware they have the disease (2). The prevalence of diabetes is much higher in some ethnic groups, especially Native Americans, Hispanics, blacks, and Micronesians. Because elderly patients with diabetes are living longer and are likely to use increasing amounts of scarce health care resources in the next several decades, diabetes in aged adults may ultimately prove to be the most important epidemic of the 21st century.
There are several lines of evidence to suggest that type 2 diabetes in elderly adu Continue reading

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Incidence of type 1 diabetes in China, 2010-13: population based study

Incidence of type 1 diabetes in China, 2010-13: population based study

Abstract
Objective To estimate the incidence of type 1 diabetes in all age groups in China during 2010-13.
Design Population based, registry study using data from multiple independent sources.
Setting National registration system in all 505 hospitals providing diabetes care, and communities of patients with diabetes in 13 areas across China, covering more than 133 million person years at risk, approximately 10% of the whole population.
Participants 5018 people of all ages with newly diagnosed type 1 diabetes and resident in the study areas from 1 January 2010 to 31 December 2013.
Main outcome measures Incidence of type 1 diabetes per 100 000 person years by age, sex, and study area. Type 1 diabetes was doctor diagnosed and further validated by onsite follow-up. Completeness of case ascertainment was assessed using the capture mark recapture method.
Results 5018 cases of newly diagnosed type 1 diabetes were ascertained: 1239 participants were aged <15 years, 1799 were aged 15-29 years, and 1980 were aged ≥30 years. The proportion of new onset cases in participants aged ≥20 years was 65.3%. The estimated incidence of type 1 diabetes per 100 000 persons years for all ages in China was 1.01 (95% confidence interval 0.18 to 1.84). Incidence per 100 000 persons years by age group was 1.93 (0.83 to 3.03) for 0-14 years, 1.28 (0.45 to 2.11) for 15-29 years, and 0.69 (0.00 to 1.51) for ≥30 years, with a peak in age group 10-14 years. The incidence in under 15s was positively correlated with latitude (r=0.88, P<0.001), although this association was not observed in age groups 15 Continue reading

Type 2 Diabetes: Mastering Injectable Combination Therapies to Individualize & Optimize Outcomes

Type 2 Diabetes: Mastering Injectable Combination Therapies to Individualize & Optimize Outcomes

For clinicians, the treatment of diabetes can be challenging. Because type 2 diabetes is progressive, a key to successful therapy is the need for additional agents over time. It is critical to have the clinical ability to individualize therapy by patient and medication characteristics. With the availability of injectable combination therapies, there are more opportunities than ever to accommodate patient preferences while improving glycemic control while harnessing the extraglycemic benefits of additional agents to open the door for successful management.
As a value added-resource, a specialized toolkit will also be included as a supplement to the webcast. The toolkit will provide for clinicians the latest treatment guidelines and updated reference guide. In addition, the toolkit will provide helpful information and resources for families and caregivers.
Delineate the factors that should be considered when selecting agents to individualize therapy in type 2 diabetes;
Understand current evidence regarding the efficacy, safety, and limitations of the most recently approved classes of agents for patients who require treatment intensification;
Apply evidence- and guideline-based recommendations to individualize combination therapy when treatment intensification is indicated;
Incorporate effective communication techniques and educational tools to improve the patient’s knowledge of type 2 diabetes and treatment.
Faculty:
John (Jack) L. Leahy, MD
Professor of Medicine
Chief of Endocrinology, Diabetes and Metabolism
University of Vermont
Colchester, Vermont
Moderator:
John J. Rus Continue reading

Diabetes in the Elderly

Diabetes in the Elderly

Chapter Headings
Key Messages
Diabetes in the elderly is metabolically distinct from diabetes in younger people and the approach to therapy should be different.
Sulphonylureas should be used with caution because the risk of hypoglycemia increases exponentially with age.
Long-acting basal analogues are associated with a lower frequency of hypoglycemia than conventional insulins in this age group.
In elderly people, if mixture of insulin is required, the use of premixed insulins as an alternative to mixing insulins minimizes dose errors.
Introduction
The definition of “elderly” varies, with some studies defining the elderly population as ≥60 years of age. Administrative guidelines frequently classify people >65 years of age as elderly. Although there is no uniformly agreed-upon definition of elderly, it is generally accepted that this is a concept that reflects an age continuum starting sometime after age 65 and is characterized by a slow, progressive impairment in function that continues until the end of life (1).
Diagnosis
As noted in the Definition, Classification and Diagnosis of Diabetes, Prediabetes and Metabolic Syndrome chapter (p. S8), glycated hemoglobin (A1C) can be used as 1 of the diagnostic tests for type 2 diabetes in adults. Unfortunately, normal aging is associated with a progressive increase in A1C, and there is a significant discordance between fasting plasma glucose–based and A1C-based diagnosis of diabetes in this age group, a difference that is accentuated by race and gender (2). Pending further studies to define the role of A1C in the diagnosis Continue reading

The Link Between Diabetes and Depression

The Link Between Diabetes and Depression

Depression and diabetes are two conditions that can sometimes go hand-in-hand. First, diabetes can increase the risk of depression, according to a growing body of research. In fact, having diabetes doubles the risk of depression, compared to people who don't have the disease. Conversely, depression also can increase the risk of Type 2 diabetes, research shows.
It's often a vicious cycle. Depression can get worse as the complications of diabetes get worse, and be depressed can stop people from managing their diabetes as effectively as they need to, which can lead to increased incidence of long-term complications such as retinopathy, neuropathy or nephropathy.​
Depression can color everything in a person's life. The ability to do everyday activities can become overwhelming, and this includes taking care of diabetes, such as taking medications, eating right and exercising. Fatigue and lack of enthusiasm can cause people to withdraw from the things they used to like to do. Emotions become flat and thoughts can turn to sadness, anxiety or even suicide.
Unfortunately, a large proportion of people suffering from depression and diabetes never receive help for the depression. Sometimes it's not recognized by healthcare professionals, and sometimes people who are depressed don't communicate to their doctors about their thoughts and feelings or don't realize that they are depressed.
Symptoms of Depression
Recognizing the symptoms of depression is important for getting the help that's needed.
Feeling sad for a prolonged period of time.
Feeling restless or anxious for no apparent reas Continue reading

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