[Diabetic complications and their features in the elderly]

According to great increase in the number of patients with diabetes mellitus, especially in the elderly, it is important to know clinical features of diabetic complications in the elderly. In this review, we described elderly-specific clinical characteristics of diabetic complications. First, duration of diabetes in the elderly has a broad range, and as a consequence, elderly patients exhibit a remarkable heterogeneity in their complication status. Second, as acute complications, hyperglycemic coma and hypoglycemia are especially at high risk in the elderly. Third, as for chronic complications, such as retinopathy, nephropathy, neuropathy, diabetic foot, stroke as well as ischemic heart disease, several features in the elderly patients are different from those in the non-elderly. Since these complications affect both quality of life and prognosis of the elderly, understanding these elderly-specific characteristics of diabetic complications would be necessary in the management of diabetes in the elderly.

Nonketotic hypertonicity in diabetes mellitus

Nonketotic hypertonicity (NKH) is one of the most common endocrine emergencies. It is more common in the elderly patient with noninsulin-dependent diabetes mellitus but may occur in insulin-dependent diabetes as well. Although there are many possible precipitating causes, the final common pathway is usually decreased access to water. Treatment consists of vigorous hydration, electrolyte replacement, and small amounts of insulin. Most deaths from NKH occur in the first 2 days of hospitalization; therefore, a significant decrease in morbidity and mortality can be expected by education of patients and their caregivers in the prevention of NKH.

[Hypoglycemic complications of oral drug therapy of diabetes mellitus. 21 cases]

The authors present 21 cases of severe hypoglycaemic side effects in diabetics treated with oral sulphonylurea drugs, including two deaths. The medications involved the most frequently were glibenclamide followed by glybutamide and glicalzide. Such side effects often occur early and are unrelated to dose. The classical predisposing factors were noted : old age, renal insufficiency, hepato-cellular insufficiency, drug associations -- in particular oral anticoagulants and salicylates. The indications for such drugs in the treatment of diabetes are discussed. Their use seems doubly illogical in the case of late onset obesity diabetes since the latter is accompanied by cardiovascular complications. It is dangerous in the elderly, particularly sensitive to the risks of hypoglycaemia and in who the diagnosis of "diabetes" is too often made on inadequate grounds.

Effects of diabetes mellitus on bone mass in juvenile and adult-onset diabetes

To assess the influence of diabetes mellitus on bone metabolism, we measured skeletal mass in the forearms of 35 patients with juvenile diabetes on insulin and 101 stable patients with adult-onset diabetes, on diet alone, insulin, or oral hypoglycemic agents. There was a significant loss of bone mass in both juvenile and adult-onset diabetes (P less than 0.01) as compared to controls matched for age and sex. The decrease was already present in patients with diabetes of less than five years' duration. Bone loss and duration of the diabetes did not correlate; the greatest decrease in bone mass was observed in the patients receiving oral agents. These data are consistent with the hypothesis that the loss of skeletal tissue in diabetes reflects the underlying disease since it occurs early and is not related to severity as evidenced by the need for insulin, to duration, or to treatment with insulin or diet alone.