Association between the Vicious Cycle of Diabetes-Associated Complications and Glycemic Control among the Elderly: A Systematic Review

A comprehensive review of current status of infection prevention and control program in low- and middle-income countries

OBJECTIVE

This systematic review aims to underscore the adoption and implementation of infection prevention and control (IPC) practices based on the World Health Organization's Infection Prevention and Control Assessment Framework (IPCAF) in low- and middle-income countries (LMICs).

METHODS AND DESIGN

Systematic review.

GUIDING METHODOLOGY

Cochrane Handbook for systematic reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

DATA SOURCES

PubMed, Google Scholar, Web of Science, Scopus, Cochrane, grey literature and reference lists of studies published between January 2018 and September 2024.

ELIGIBILITY CRITERIA TO RECRUIT STUDIES

Peer reviewed full length, cross-sectional, mixed method and quasi-experimental studies written in English, conducted in LMICs and used IPCAF as assessment tool.

DATA EXTRACTION AND SYNTHESIS

Data were extracted on a data extraction form and quality of studies was evaluated by using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields. Evidence was generated as a group of themes.

FINDINGS

In total, 24 studies were selected based on eligibility criteria. IPC program was implemented to a varying degree in healthcare facilities (HCFs) of LMICs. Key barriers reported were; no allocation of budget for IPC, insufficient staffing of full-time IPC professionals, absence of clear IPC goals, challenges in staff training, lack of resources, no periodic monitoring and inconsistent availability of IPC supplies.

CONCLUSIONS

There was an evidence on implementation of IPC program in the HCFs of LMICs, however, LMICs faced substantial challenges in achieving consistent and effective IPC.

In Vitro Alpha-Glucosidase Inhibitory Effect of Etlingera Elatior Ethanol Extract Growing in Gayo Highland, Aceh Province, Indonesia

Background

The prevalence of diabetes mellitus (DM) is increasing overtime, potentially leading to various severe health complications and mortality. Despite therapeutic agents have currently been developed, unexpected adverse effects are inevitable. Hence, safe and effective medications such as those of plant origin are critical to prevent unexpected complication in DM sufferers. Etlingera elatior has been widely used as spice and traditional medicine to treat diabetes in Aceh Province, Indonesia. However, study regarding α-glucosidase inhibitory effect of E. elatior growing in Gayo highlands, Aceh, Indonesia, is completely lacking. The aim of this study was to evaluate in vitro α-glucosidase inhibitory effect of E. elatior ethanol extracts (EEEE) growing in Gayo highlands, Aceh Province, Indonesia.

Methods

Antioxidant activity was determined using DPPH procedure, whereas α-glucosidase inhibition assay was carried out using spectrophotometric method. Data analysis was performed using One-Way Analysis of Variance (ANOVA), followed by Duncan's multiple range test at α=0.05.

Results

Phytochemical analysis revealed the presence of total phenolic (TPC), total flavonoid (TFC), and total tannin (TTC) content in all E. elatior plant parts, in which the highest TPC was found in the stem (158.38 GAE/g), whereas the highest TFC and TTC was obtained in the rhizome extracts. The extract of fruit showed the strongest antioxidant activities, followed by the stem and leaf, with IC 50 of 2.381 μg/mL, 6.966 μg/mL, and 19.365 μg/mL, respectively. All E. elatior extracts revealed a significant inhibitory activity against α-glucosidase at the concentration of 500 μg/mL, in which the stem extract showed the most effective α-glucosidase inhibitory effect with IC 50 value of 5.15 μg/mL, suggesting its promising potential as antidiabetic agent.

Conclusions

This study highlights E. elatior potency as a novel source of antioxidant and natural antidiabetic compounds that are useful for the prevention and treatment of diabetes.

The effects of diabetes self-management programs on clinical and patient reported outcomes in older adults: a systematic review and meta-analysis

Objectives

With diabetes self-management continuing to become more complex for older adults, self-management programs have been shown to support this population in meeting their multifaceted medical needs. Building on our previous systematic review and meta-analysis, we aimed to update the literature on the effectiveness of diabetes self-management programs and investigate the impact of specific self-management interventions on clinical and patient-reported outcomes.

Methods

We updated our literature search in the following databases: Medline, EMBASE, PsychINFO, CINAHL and Cochrane Database of Randomized Controlled Trials from November 2013 to July 2023 for studies that may fit our inclusion criteria. Two independent reviewers screened and extracted data from the included group of studies.

Results

A total of 17 studies with 21 comparison arms met the inclusion criteria, totalling 5976 older adults (3510 individuals randomized to self-management programming and 2466 to usual care). The pooled effectiveness of diabetes self-management programs in older adults on glycemic control (hemoglobin A1C) was a reduction of -0.32 (95% CI -0.44, -0.19). Specifically, the most effective approach on glycemic control (A1C) was the use of feedback (-0.52%; 95% CI -0.68, -0.36). Overall, self-management programs improved behaviour change outcomes, with feedback interventions being most effective (standardized mean difference [SMD] 0.91; 95% CI 0.39, 1.43). The effect of self-management programs on body mass index, weight and lipids were statistically and clinically significant.

Conclusions

The evidence for diabetes self-management programs for older adults demonstrates a small but clinically meaningful reduction in A1C, improvement in patient-reported outcomes (behaviour, self-efficacy, knowledge), and other clinical outcomes (BMI, weight and lipids). The specific strategy used in diabetes self-management programs for older adults should be considered to achieve optimal results on outcomes.

Association of acute glycemic parameters at admission with cardiovascular mortality in the oldest old with acute myocardial infarction

OBJECTIVES

Stress-related glycemic indicators, including admission blood glucose (ABG), stress-hyperglycemia ratio (SHR), and glycemic gap (GG), have been associated with worse outcomes after acute myocardial infarction (AMI). However, data regarding their prognostic value in the oldest old with AMI are unavailable. Therefore, this study aimed to investigate the association of stress-related glycemic indicators with short- and long-term cardiovascular mortality (CVM) in the oldest old (≥ 80 years) with AMI.

METHODS

In this prospective study, a total of 933 consecutive old patients with AMI admitted to FuWai hospital (Beijing, China) were enrolled. On admission, ABG, SHR, and GG were assessed and all participants were classified according to their quartiles. Kaplan-Meier, restricted cubic splines (RCS), and multivariate Cox regression analyses were performed to evaluate the association between these glycemic indicators and CVM within 30 days and long-term follow-up.

RESULTS

During an average of 1954 patient-years of follow-up, a total of 250 cardiovascular deaths were recorded. Kaplan-Meier analyses showed the lowest CVM in quartile 1 of ABG and in quartile 2 of SHR and GG. After adjusting for potential covariates, patients in quartile 4 of ABG, SHR, and GG had a respective 1.67-fold (95% CI: 1.03-2.69; P = 0.036), 1.80-fold (95% CI: 1.16-2.79; P = 0.009), and 1.78-fold (95% CI: 1.14-2.79; P = 0.011) higher risk of long-term CVM risk compared to those in the reference groups (quartile 1 of ABG and quartile 2 of SHR and GG). Furthermore, RCS suggested a J-shaped relationship of ABG and a U-shaped association of SHR and GG with long-term CVM. Additionally, we observed similar associations of these acute glycemic parameters with 30-day CVM.

CONCLUSIONS

Our data first indicated that SHR and GG consistently had a U-shaped association with both 30-day and long-term CVM among the oldest old with AMI, suggesting that they may be useful for risk stratification in this special population.

Roxadustat, a HIF-PHD inhibitor with exploitable potential on diabetes-related complications

Diabetes mellitus (DM) is a group of metabolic diseases caused by absolute or relative deficiency of insulin secretion and characterized by chronic hyperglycemia. Its complications affect almost every tissue of the body, usually leading to blindness, renal failure, amputation, etc. and in the final stage, it mostly develops into cardiac failure, which is the main reason why diabetes mellitus manifests itself as a high clinical lethality. The pathogenesis of diabetes mellitus and its complications involves various pathological processes including excessive production of mitochondrial reactive oxygen species (ROS) and metabolic imbalance. Hypoxia-inducible Factor (HIF) signaling pathway plays an important role in both of the above processes. Roxadustat is an activator of Hypoxia-inducible Factor-1α, which increases the transcriptional activity of Hypoxia-inducible Factor-1α by inhibiting hypoxia-inducible factor prolyl hydroxylase (HIF-PHD). Roxadustat showed regulatory effects on maintaining metabolic stability in the hypoxic state of the body by activating many downstream signaling pathways such as vascular endothelial growth factor (VEGF), glucose transporter protein-1 (GLUT1), lactate dehydrogenase (LDHA), etc. This review summarizes the current research findings of roxadustat on the diseases of cardiomyopathy, nephropathy, retinal damage and impaired wound healing, which also occur at different stages of diabetes and greatly contribute to the damage caused by diabetes to the organism. We attempts to uncover a more comprehensive picture of the therapeutic effects of roxadustat, and inform its expanding research about diabetic complications treatment.

Does computerized cognitive training improve diabetes self-management and cognition? A randomized control trial of middle-aged and older veterans with type 2 diabetes

AIMS

This randomized control trial compared an adaptive computerized cognitive training intervention with a non-adaptive version. The primary hypothesis predicted better diabetes self-management in type 2 diabetes patients at 6 months post-intervention than baseline in the adaptive arm, with seven secondary outcomes.

METHODS

Intent-to-treat analysis of veterans without dementia aged 55+ from the Bronx, NY and Ann Arbor, MI (N = 90/per arm) used linear mixed model analyses.

RESULTS

Contrary to the hypothesis, only memory showed more improvement in the adaptive arm (p < 0.01). Post-hoc analyses combined the two arms; self-management improved at six-months post-intervention (p < 0.001). Memory, executive functions/attention, prospective memory, diastolic blood pressure, and systolic blood pressure improved (p < 0.05); hemoglobin A1c and medication adherence did not improve significantly.

CONCLUSIONS

The adaptive computerized cognitive training was not substantially better than non-adaptive, but may improve memory. Post-hoc results for the combined arms suggest computer-related activities may improve diabetes self-management and other outcomes for middle-aged and older patients with type 2 diabetes. Practice effects or awareness of being studied cannot be ruled out.

Family support-based intervention using a mobile application provided by pharmacists for older adults with diabetes to improve glycaemic control: a randomised controlled trial

Background Family support is crucial in the care of older patients with diabetes. However, more information is needed to evaluate the potential benefits of family-based intervention through a mobile application by pharmacists in the older diabetes patients. Aim To evaluate the effectiveness of family support-based intervention via a mobile application by pharmacists on clinical outcomes, family behaviour, diabetes knowledge, self-management practices and medication adherence in older adults with type 2 diabetes. Method A randomised controlled trial was conducted in a hospital in the south of Thailand with 9 months of follow-up. Family members in the intervention group (n = 78) received diabetes educational courses and encouragement via a mobile application from pharmacists to help their older relatives with diabetes in self-management tasks. The control group received usual care (n = 79). Results As compared to baseline, significant improvements were observed in the intervention patients for glycosylated haemoglobin (HbA_1c), blood pressure, family behaviour in diabetes care, diabetes knowledge, self-management practices and medication adherence (P < 0.001). The intervention group showed greater decline in HbA_1c levels relative to the control group (- 0.97% vs. - 0.12%; P = 0.001). Significant differences between groups for changes in blood pressure levels including scores of family behaviour, diabetes knowledge, self-management and medication adherence were found (P ≤ 0.001), with the intervention group showing greater improvement. Conclusion Family support intervention via a mobile application by pharmacists is beneficial to diabetes care for older adults.Trial registration number: TCTR20200615001 (date 13 June 2020, retrospectively registered).

IMPACT OF NON-SURGICAL PERIODONTAL TREATMENT ON SERUM TNF-α LEVELS IN INDIVIDUALS WITH TYPE 2 DIABETES: A SYSTEMATIC REVIEW AND META-ANALYSIS

OBJECTIVE

The objective of this systematic review and meta-analysis was to search for scientific evidence on the impact of non-surgical periodontal therapy on tumor necrosis factor alpha (TNF-α) in type 2 diabetics.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement has been followed. The study was registered (CRD42020192790) in the International prospective register of systematic reviews. Searches were conducted in five databases. Restrictions on publication date were not imposed in anyway. The studies reporting the serum TNF-α levels of individuals with type 2 diabetes mellitus (DM) before and after non-surgical periodontal therapy were included. Studies' selection, extraction of data and risk of bias assessment were performed in duplicate. Consensus was achieved. Meta-analysis was carried out. The 95% confidence interval and odds ratio were provided.

RESULTS

Six hundred and twenty-three references were retrieved and eighteen studies were included. Meta-analysis demonstrated that the serum levels of TNF-α in individuals with type 2 DM decreased six months after non-surgical periodontal therapy (mean difference = -1.90, confidence interval = -3.05--0.74). Included studies presented low risk of bias.

CONCLUSION

Non-surgical periodontal therapy has an impact on serum TNF-α levels at six months in type 2 DM patients.

Association Between Stress Hyperglycemia Ratio and In-hospital Outcomes in Elderly Patients With Acute Myocardial Infarction

Backgrounds: Emerging evidence suggests that stress hyperglycemia ratio (SHR), an index of relative stress hyperglycemia, is of great prognostic value in acute myocardial infarction (AMI), but current evidence is limited in elderly patients. In this study, we aimed to assess whether SHR is associated with in-hospital outcomes in elderly patients with AMI.

Methods: In this retrospective study, patients who were aged over 75 years and diagnosed with AMI were consecutively enrolled from 2015, January 1st to 2019, December 31th. Admission blood glucose and glycosylated hemoglobin (HbA1C) during the index hospitalization were used to calculate SHR. Restricted quadratic splines, receiver-operating curves, and logistic regression were performed to evaluate the association between SHR and in-hospital outcomes, including in-hospital all-cause death and in-hospital major adverse cardiac and cerebrovascular events (MACCEs) defined as a composite of all-cause death, cardiogenic shock, reinfarction, mechanical complications of MI, stroke, and major bleeding.

Results: A total of 341 subjects were included in this study. Higher SHR levels were observed in patients who had MACCEs (n = 69) or death (n = 44) during hospitalization. Compared with a SHR value below 1.25, a high SHR was independently associated with in-hospital MACCEs (odds ratio [OR]: 2.945, 95% confidence interval [CI]: 1.626–5.334, P < 0.001) and all-cause death (OR: 2.871 95% CI: 1.428–5.772, P = 0.003) in univariate and multivariate logisitic analysis. This relationship increased with SHR levels based on a non-linear dose-response curve. In contrast, admission glucose was only associated with clinical outcomes in univariate analysis. In subgroup analysis, high SHR was significantly predictive of worse in-hospital clinical outcomes in non-diabetic patients (MACCEs: 2.716 [1.281–5.762], P = 0.009; all-cause death: 2.394 [1.040–5.507], P = 0.040), but the association was not significant in diabetic patients.

Conclusion: SHR might serve as a simple and independent indicator of adverse in-hospital outcomes in elderly patients with AMI, especially in non-diabetic population.

Prevalence of polypharmacy and associated factors in older adults living in Rio Branco, Acre, Brazil: a cross-sectional population-based study, 2014

OBJECTIVE

To analyze polypharmacy prevalence and associated factors in older adults living in Rio Branco, Acre, Brazil, in 2014.

METHODS

This was a cross-sectional population-based study using complex sampling with older adults. Polypharmacy was defined as concomitant use of five or more medications.

RESULTS

Polypharmacy prevalence was 14.9% (95%CI 11.8;18.6), positively associated with females (OR=2.29 - 95%CI 1.41;3.74), white race/skin color (OR=1.61 - 95%CI 1.10;2.38), dependence (OR=1.65 - 95%CI 1.05;2.60), change in eating habits/dieting (OR=1.66 - 95%CI 1.16;2.36), hospitalization in the last 12 months (OR=1.61 - 95%CI 1.02;2.53) and presence of the following self-reported morbidities: systemic arterial hypertension (OR=2.40 - 95%CI 1.33;4.34), diabetes mellitus (OR=2.17 - 95%CI 1.23;3.84), osteoporosis (OR=2.92 - 95%CI 1.84;4.64) and heart problems (OR=2.94 - 95%CI 1.90;4.56).

CONCLUSION

This study found that polypharmacy in the older adults was associated with demographic and health conditions.

The modifying role of physical activity in the cross-sectional and longitudinal association of health-related quality of life with physiological functioning-based latent classes and metabolic syndrome

BACKGROUND

Single cardio-metabolic risk factors are each known modifiable risk factors for adverse health and quality of life outcomes. Yet, evidence on the clustered effect of these parameters and the metabolic syndrome (MetS) on health-related quality of life (HRQoL) is still limited and mostly cross-sectional. The objectives of this study were to identify clusters of cardio-metabolic physiological functioning, to assess their associations with HRQoL in comparison with the MetS, to elucidate the modifying role of physical activity, and to assess differences in health service utilization.

METHODS

This study is based on longitudinal data from two time points (2010/11 & 2017/18) of the Swiss Study on Air Pollution and Lung and Heart Diseases (SAPALDIA). Latent class analysis (LCA) grouped participants based on a priori selected cardio-metabolic and MetS related physiological functioning variables (Body mass index, body fat, glycated hemoglobin, blood triglycerides, blood pressure). The 36-item Short-Form Health Survey (SF-36) was used to assess HRQoL. Quantile regressions were performed with and without adjustment for physical activity, to detect independent associations of the latent classes, MetS and physical activity with HRQoL. To assess the modifying role of physical activity, we additionally grouped participants based on the combination of physical activity and latent classes or MetS, respectively. Logistic regressions were used to investigate health service utilization as outcome.

RESULTS

The LCA resulted in three classes labeled "Healthy" (30% of participants in 2017/18), "At risk" and "Unhealthy" (29%). The Unhealthy class scored lowest in all physical component scores of HRQoL. Compared to healthy and active participants, inactive participants in the "Unhealthy" class showed lower scores in the physical functioning domain both cross-sectionally (- 9.10 (- 12.02; - 6.18)) and longitudinally. This group had an odds ratio of 2.69 (1.52; 4.74) for being hospitalized in the previous 12 months.

CONCLUSIONS

These results point to subjects with adverse cardio-metabolic physiological functioning and low activity levels as an important target group for health promotion and maintenance of well-being. The promotion of physical activity at the early stages of aging seems pivotal to mitigate the impact of the MetS on HRQoL at higher age.

Thirteen-year trends in the prevalence of diabetes according to socioeconomic condition and cardiovascular risk factors in a Swiss population

INTRODUCTION

To estimate the prevalence of and trends in diabetes according to sociodemographic indicators and cardiovascular risk factors in a Swiss population.

RESEARCH DESIGN AND METHODS

Annual cross-sectional study of adults residing in the state of Geneva. We included 9886 participants (51% women; mean age (SD) of 48.9 (13.4) years). Diagnosed diabetes was self-reported; undiagnosed diabetes was defined as having fasting plasma glucose level of ≥7 mmol/L and no previous diagnosis; total diabetes as the sum of diagnosed and undiagnosed diabetes. To assess trends, we grouped survey years into three time periods: 2005-2010, 2011-2014, and 2015-2017. To assess inequalities, we constructed the relative index of inequality (RII) and the slope index of inequality (SII) for education, income, and health insurance subsidy (state program based on socioeconomic disadvantage).

RESULTS

In total, 683 diabetes cases were identified. In 2015-2017, total diabetes prevalence was 11.8% (8.6%-14.9%) among lowest income participants, and 4.7% (3.4%-5.9%) among highest income participants (p<0.01). Similar findings were observed for education. Among participants with full health insurance subsidy, diabetes prevalence was 19.4% (12.1%-26.8%), and 6.1% (5.3%-7.0%) among those without (p<0.01). High diabetes prevalence was observed among participants who were men, older, overweight or obese, hypertensive, and hypercholesterolemic. Among participants with diabetes, 74.0% (63.5%-84.4%) in the lowest income group were diagnosed, compared with 90.2% (81.9%-98.4%) in the highest income group (p=0.04). Over the 13-year period, widening relative and absolute inequalities in total diabetes prevalence were observed for education and income. The education-RII (95% CI) increased from 1.51 (95% CI 1.01 to 2.32) in 2005-2010 to 2.54 (95% CI 1.58 to 4.07) in 2015-2017 (p=0.01), and the education-SII (95% CI) from 0.04 (95% CI 0.01 to 0.08) to 0.08 (95% CI 0.04 to 0.10; p<0.01). The income-RII increased from 2.35 (95% CI 1.44 to 3.84) to 3.91 (95% CI 2.24 to 6.85; p<0.01), and the income-SII from 0.08 (95% CI 0.04 to 0.12) to 0.011 (95% CI 0.07 to 0.14; p=0.01). Inequalities by health insurance subsidy were large (RII 3.56 (95% CI 1.90 to 6.66) and SII 0.10 (95% CI 0.05 to 0.15)) but stable across the study period.

CONCLUSION

Among adults living in Geneva, Switzerland, substantial differences were observed in diabetes prevalence across socioeconomic and cardiovascular risk groups over a 13-year period, and relative and absolute socioeconomic inequalities appeared to have increased.

Association of Dyslipidemia and Comorbidities with Risk Factors Among Diabetic Patients: A Retrospective Analysis

PURPOSE

To find out the association of dyslipidemia and comorbidities with risk factors among type-2 diabetes mellitus (T2DM) patients attending King Abdulaziz University Hospital (KAUH) Jeddah, Saudi Arabia (SA).

PATIENTS AND METHODS

Three hundred and twenty-five T2DM patients were enrolled from the electronic record of the KAUH. The patients' existing comorbidities and dyslipidemia correlation with demographic, clinical, and available laboratory data were sought. Statistical analysis was performed on SPSS-23.

RESULTS

Of the total 325 T2DM patients with a mean age of 60.13±10.5 years [males 95 (29.23%) and females 230 (70.77%)] were included from the electronic record. Poor glycemic control was observed in 222 (68.31%) subjects (HbA1c > 7%), and 154 (47.39%) subjects had DM for more than ten years. Among our study subjects, 103 (31.69%) were hypertensive (HTN), 112 (34.46%) had ischemic heart disease (IHD), 45 (13.85%) were obese, 8(2.46%) had a stroke and 269 (82.77%) had dyslipidemia. Of the total 269 dyslipidemic patients,168 (62.45%) were on hypolipidemic treatment. On comparison of study variables according to dyslipidemia versus normal lipid levels, the lipid profile, including HDLc, LDLc, TC, and TG, revealed a highly significant difference (p-value <0.001) whereas many variables were not significantly different. HBA1c, FBG, and RBG were significantly higher in dyslipidemic subjects. Logistic regression analysis of risk factors and comorbidities in our patients revealed that age 60-69 years and 70-79 years had a significant association with comorbidities. Similarly, logistic regression analysis of risk factors and dyslipidemia in our patients revealed no statistically significant association.

CONCLUSION

Our results observed that the comorbidities were associated with increasing age and common comorbidities were HTN, IHD, dyslipidemia. Our study has highlighted the current trends in T2DM symptomatology and comorbidities. Efficient management and control by early screening and developing healthy lifestyles in our patients can be very helpful in the prevention of all these highly morbid complications of this preventable disease.

Vortioxetine versus sertraline in metabolic control, distress and depression in Mexican patients with type 2 diabetes

Background

Depression in patients with type 2 diabetes (T2D) is often undiagnosed and remains untreated, leading to poor therapy adherence and ill health-related outcomes. We evaluated the effect of vortioxetine versus sertraline in the treatment of depression, distress and metabolic control in subjects with T2D and depression.

Methods

Participants were selected from the Clinic for Diabetes, diagnosed with depression when the score was ≥14 in the Hamilton Depression Rating Scale, and verified by a psychiatrist in agreement with the DSM-5 instrument (Diagnostic and Statistical Manual of Mental Disorders, fifth edition). The criteria for recruitment also included glycosylated hemoglobin ≥7.5%, 18 to 60 years of age, and written informed consent. Pharmacological treatment for depression was assigned randomly: vortioxetine (10 mg/day) or sertraline (75 mg/day) for 8 weeks. Biochemical parameters, anthropometric measures and depression symptoms were evaluated after antidepressant treatment. This was a randomized singled-blind study.

Results

Subjects that met the inclusion criteria were 50, of which only 21 patients with T2D and depression finished the treatment. Vortioxetine and sertraline showed partial remission of depression. Vortioxetine showed a major effect size in glycosylated hemoglobin and a moderate effect size on weight loss, fasting plasma glucose (FPG), cholesterol and triacylglycerol levels. On the other hand, patients treated with sertraline presented a slight increase in body weight, body mass index (BMI), and in all biochemical markers.

Conclusions

Vortioxetine may ameliorate depressive symptoms and metabolic control in patients with T2D and depression. Trial registration number: NCT03978286.

From Iceberg of Pre-diabetes to Poor Glycemic Control in Diabetics: An Elderly Based Study in Shiraz, South of Iran

BACKGROUND

Delay in diagnosis of diabetes mellitus (DM) in older adults is more catastrophic than other age groups. This study investigated the prevalence of pre-diabetes, DM, and glycemic control in the elderly.

METHODS

In this cross-sectional study, a sample of 412 older adults >60 years from Shiraz, Iran, were recruited through a multistage cluster random sampling. Demographic, clinical, and laboratory information were collected by interview, physical examination, and reviewing the medical records. Data were analyzed using SPSS 20.

RESULTS

Mean age was 68.1 ± 6.2 years and female-to-male ratio was 1.1. Out of all, 137 (33.2%) were diagnosed as diabetic including 128 (31%) as known cases and 9 (2.2%) as new cases of DM, whereas 275 (66.7%) were diagnosed as new cases of pre-diabetes. Multivariable analysis showed that low level of education (OR = 5.2, 95% CI: 1.5-16.6), hyperlipidemia (OR = 3.5, 95% CI: 2.1-5.8), liver disease (OR = 3.1, 95% CI: 1.4-6.9), and hypertension (HTN) (OR = 1.9, 95% CI: 1.1-3.2) were the most common predictors of DM in the elderly, respectively. Out of all diabetics, 33.6% had FBS >130 mg/dL and 25.5% had HbA1c >8%, whereas these figures were ≥100 mg/dL and ≥5.7% in 36.7% and 21.4% of pre-diabetics, respectively.

CONCLUSIONS

The pre-diabetic elderly were mostly undiagnosed, while one-third to one-fourth of DMs had poor glycemic indices. These figures show the need for pre-diabetes and diabetes screening in the elderly, especially in those with low level of education, hyperlipidemia, liver disease, or HTN. Furthermore, regular monitoring of glycemic indices in the diabetic and pre-diabetic elderly is recommended.

Polypharmacy in Type 2 Diabetes Mellitus: Insights from an Internal Medicine Department

BACKGROUND AND OBJECTIVES

Polypharmacy heavily impacts the quality of life of patients worldwide. It is a necessary evil in many disorders, and especially in type 2 diabetes mellitus, as patients require treatment both for this condition and its related or unrelated comorbidities. Thus, we aimed to evaluate the use of polypharmacy in type 2 diabetes mellitus vs. non-diabetes patients.

MATERIALS AND METHODS

A cross-sectional retrospective observational study was conducted. We collected the medical records of patients hospitalized in the Internal Medicine Clinic of the Clinical Emergency Hospital of Bucharest, Romania, for a period of two months (01/01/2018-28/02/2018). Patients diagnosed with type 2 diabetes mellitus were included in the study group, whereas patients who were not diabetic were used as controls.

RESULTS

The study group consisted of 63 patients with type 2 diabetes mellitus (mean age 69.19 ± 9.67 years, range 46-89 years; 52.38% males). The control group included 63 non-diabetes patients (mean age 67.05 ± 14.40 years, range 42-93 years, 39.68% males). Diabetic patients had more comorbidities (10.35 ± 3.09 vs. 7.48 ± 3.59, p = 0.0001) and received more drugs (7.81 ± 2.23 vs. 5.33 ± 2.63, p = 0.0001) vs. non-diabetic counterparts. The mean number of drug-drug and food-drug interactions was higher in type 2 diabetes mellitus patients vs. controls: 8.86 ± 5.76 vs. 4.98 ± 5.04, p = 0.0003 (minor: 1.22 ± 1.42 vs. 1.27 ± 1.89; moderate: 7.08 ± 4.08 vs. 3.54 ± 3.77; major: 0.56 ± 0.74 vs. 0.37 ± 0.77) and 2.63 ± 1.08 vs. 2.19 ± 1.42 (p = 0.0457), respectively.

CONCLUSIONS

Polypharmacy should be an area of serious concern also in type 2 diabetes mellitus, especially in the elderly. In our study, type 2 diabetes mellitus patients received more drugs than their non-diabetes counterparts and were exposed to more drug-drug and food-drug interactions.