Non-insulin-dependent diabetes in older patients

Nathan, David M.; Singer, Daniel E.; Godine, John E.; Perlmuter, Lawrence C.

doi:10.1016/0002-9343(86)90355-4

Cited by 82 publications

(43 citation statements)

References 22 publications

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“…Previous studies have found either no effect of duration (10,13,21,40) or a doseresponse relationship (14,16,23,30) after controlling for age. With a larger sample size and broader age distribution than earlier studies, we observed an increased risk of severe ED with increased diabetes duration.…”

Section: Research Design and Methods -mentioning

confidence: 86%

Association of Type and Duration of Diabetes With Erectile Dysfunction in a Large Cohort of Men

Bacon¹,

Hu²,

et al. 2002

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OBJECTIVE -Differences in risk of erectile dysfunction (ED) by characteristics of diabetes among older men are not well understood. We examined the association of type and duration of diabetes with erectile function in men Ͼ50 years of age in a large prospective cohort study. RESULTS -Men with diabetes had an age-adjusted relative risk (RR) of 1.32 (95% CI 1.3-1.4) for having ED compared with men without diabetes. In multivariable regression analyses, men with type 1 and type 2 diabetes were at a significantly higher risk for ED (type 1 diabetes RR ϭ 3.0, 95% CI 1.5-5.9; type 2 diabetes RR ϭ 1.3, 1.1-1.5) than nondiabetic men. Men with type 2 diabetes had an increasingly greater risk of ED with increased duration since diagnosis (trend test P value Ͻ0.0001) (RR ϭ 1.7, 95% CI 1.1-2.7, for men diagnosed Ͼ20 years previously). CONCLUSIONS -For men over age 50 years, increasing duration of diabetes was positively associated with increased risk of ED relative to nondiabetic subjects. This association persisted despite the higher prevalence of other comorbid conditions. ED prevention and diabetes management efforts are likely to go hand-in-hand. RESEARCH DESIGN AND METHODS

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Section: Research Design and Methods -mentioning

confidence: 86%

Association of Type and Duration of Diabetes With Erectile Dysfunction in a Large Cohort of Men

Bacon¹,

Hu²,

et al. 2002

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“…1 Anywhere from 25 to 75% of diabetic men will develop ED. 1,[7][8][9] It has been observed that 15% of healthy men have an altered glucose tolerance curve. 10 The pathophysiologic mechanisms involved in the development of ED in diabetics are vascular, neuropathic, or due to gonadal dysfunction.…”

Section: Risk Factors and Causative Diseasesmentioning

confidence: 99%

Core document on erectile dysfunction: key aspects in the care of a patient with erectile dysfunction

Brotons¹,

Campos²,

González-Correales³

et al. 2004

Int J Impot Res

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The aim of this Core Document of the Spanish Consensus on Erectile dysfunction (ED) is to offer guidance to the nonspecialist physician in the management of patients with ED. ED is one of the most frequent chronic health problems in men older than 40 y of age and may also act as a sentinel symptom for other important underlying diseases. Its etiology can be classified into organic, psychogenic, or mixed. In most cases, the underlying cause of ED is usually a chronic health problem (such as diabetes, hypertension, atherosclerosis, and so on) or an adverse drug effect. The initial step in the management is to assess erectile function in patients with risk factors for ED. Once ED has been established, a detailed sexual, medical, and social history, including a review of medications used, is the most important aspect of a patient's assessment. Generally, examination should be limited to the cardiovascular, neurological, and urogenital systems. Fasting glucose and blood lipid profile should be performed in every man with ED, and free testosterone levels in men older than 50 y or if hypogonadism is suspected; other diagnostic tests are optional and should be requested on an individualized basis. In many cases, the most likely cause of ED can be identified based on the above information. Therapeutic intervention should be patient-oriented and based on the expectations and wishes of the patient and his partner, who should be included in discussions whenever possible. Basic interventions common to any type of ED include sexual counseling, lifestyle modifications, treatment of associated medical conditions, and switching to alternative drugs with lower risk of ED. In certain cases, an etiologic treatment may be performed (sex therapy, revascularization surgery, and hormonal therapy). Most patients with ED will benefit from symptomatic treatments; first-line therapy may be prescribed by physicians who are not specialists in ED, and includes oral agents such as inhibitors of phosphodiesterase type 5, currently considered the drugs of choice for initial treatment of ED. Intracavernous drugs are the second-line therapy, and surgical treatments, such as implantation of penile prostheses, are reserved for urologists/ andrologists who specialize in ED. Referral may be appropriate where indicated by age, clinical findings, or the patient's request.

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“…Visual impairment can develop from vascular complications that involve retinal lesions and become more prevalent with the progression of aging (Carter 1994;Lee et al 2003). Importantly, some of the vascular complications associated with diabetes include microvascular dysfunction in the retina (Nathan et al 1986). Furthermore, diabetic retinopathy is the leading cause of blindness in the working age population (Morello 2007;Madsen-Bouterse and Kowluru 2008;Shah 2008;Yamagishi et al 2008;Ali and El-Remessy 2009;Crawford et al 2009;Curtis et al 2009;Ng 2009;Nsiah-Kumi et al 2009;Paulus and Gariano 2009).…”

Section: Introductionmentioning

confidence: 99%

Aging increases retinal vascular lesions characteristic of early diabetic retinopathy

2010

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The goal of this study was to determine whether aging induces retinal vascular lesions that are similar to those seen in diabetic retinopathy. Female rats were randomly divided into four groups; each group represented a time point and consisted of four non-diabetic rats and four diabetic rats. At time points of 3, 12, 18, or 22 months of age, retinas were isolated and subjected to retinal trypsin digestion (RTD) for isolation of retinal capillary networks. Blood glucose, body weight, and hemoglobin A1c (HbA1c) levels were monitored throughout the study. One RTD from each animal was stained with Hematoxylin and Periodic Acid Schiff's (PAS) reagent to analyze acellular capillaries and pericyte loss, while the contralateral RTD from each animal was subjected to TUNEL assay to assess apoptosis in the retinal vascular cells. The numbers of acellular capillaries and pericyte loss were significantly increased between the 12 vs. 18 month groups, and the 18 vs. 22 month groups. Similarly, acellular capillaries and pericyte loss increased with aging in the diabetic rat retinas; however, the appearance of acellular capillaries and pericyte loss occurred at 3 months of diabetes. TUNEL assay showed increased apoptosis associated with acellular capillaries and pericyte loss in both normal, aged rats and diabetic rats. In conclusion, retinal vascular lesions that develop in aged rat retinas have striking similarities to those of diabetic rat retinas. The breakdown of normal vascular architecture with aging appears to have resemblance with the anatomical and histological lesions associated with diabetic retinopathy.

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Non-insulin-dependent diabetes in older patients

Cited by 82 publications

References 22 publications

Association of Type and Duration of Diabetes With Erectile Dysfunction in a Large Cohort of Men

Association of Type and Duration of Diabetes With Erectile Dysfunction in a Large Cohort of Men

Core document on erectile dysfunction: key aspects in the care of a patient with erectile dysfunction

Aging increases retinal vascular lesions characteristic of early diabetic retinopathy

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