Population-based cross-sectional study of 11 645 Spanish nonagenarians with type 2 diabetes mellitus: cardiovascular profile, cardiovascular preventive therapies, achievement goals and sex differences

Abstract

ObjectivesTo evaluate the risk profile, achievement of cardiometabolic goals, and frequency and optimal use of cardiovascular preventive therapies among nonagenarians with type 2 diabetes mellitus (T2DM). To investigate possible sex differences.Design and settingA cross-sectional population study of 11 645 persons aged ≥90 years with T2DM living in Madrid (Spain). Sociodemographic, clinical and therapy profiles were collected through electronic records in primary care. We considered antihypertensive therapy and lipid-lowering therapy to be optimal when known patients with hypertension with albuminuria received renin–angiotensin system blockers and statins had been prescribed for overt cardiovascular disease.ResultsThe prevalence of coronary artery disease was higher in males than in females (21.5% vs 12.6%, p<0.01), as was that of peripheral artery disease (8.5% vs 2.3%, p<0.01). However, the prevalence of cerebrovascular disease was similar in both sexes (16.5% vs 16%; p=0.44). Haemoglobin A1c was lower than 7% in 64.4% of cases, with female predominance in patients with known dementia (67.1% female vs 59.9% male; p<0.01). Antiplatelet therapy was significantly more frequent in males than in females (48.1% vs 44.3%; p<0.01), as were statins (43.2% vs 40.2%; p<0.01). Both in primary and in secondary prevention, rates for simultaneous achievement of the HbA1c, blood pressure, LDL-C goals were significantly lower among females (p<0.01). For each criterion of optimal use of cardiovascular preventive therapies, adherence was significantly better in males than in females.ConclusionOur study showed that the risk of cerebrovascular disease was similar in both male and female Spanish nonagenarians. Adherence was poorer in females for all criteria of optimal use of cardiovascular preventive therapies. Our findings indicate that the known sex differences in younger patients with T2DM persist in patients aged ≥90 years. There is considerable room for improvement in standards of preventive care in nonagenarians with T2DM, especially in females.

Clinical features and sulfonylurea usage among outpatients with diabetes aged ≥90 years in an urban diabetes clinic in Tokyo

“…Our results showed there was no difference in HbA1c between male and female patients with diabetes aged ≥90 years. This is consistent with a previous population‐based cross‐sectional study of 11,645 Spanish type 2 diabetes patients aged ≥90 years, which also showed a similar glycemic control between male and female patients 7 …”

Epidemiology and Economic Burden of Cardiovascular Disease in Patients with Type 2 Diabetes Mellitus in Spain: A Systematic Review

“…The literature review identified several studies that reported the prevalence of CVD or a type of CVD in patients with T2DM in special populations, such as those of a predetermined age range or with additional comorbidities (Table 2 ). These studies focused on elderly patients [ 29 , 31 , 35 , 61 ], patients with HF [ 30 , 31 , 33 , 35 ] and patients with kidney disease [ 59 , 60 ]. Several studies reported age as one of the main risks for CVD in patients with T2DM.…”

“…Also, a large regional study in Catalonia showed that the prevalence of CVD was 32.3% in patients aged ≥ 75 years and about 10 points lower in the overall population [ 42 ]. Two studies analysed the prevalence of CVD specifically in patients aged 85 and ≥ 90 years, respectively [ 29 , 61 ]: in one study, the prevalence of stroke was slightly higher among patients with T2DM aged 85 years (14.0%) than in studies of the general population [ 29 ]; in the other study, the prevalence of CHD and PAD among nonagenarians with diabetes in the community of Madrid was higher in males than in females (21.5 vs. 12.6% and 8.5 vs. 2.3%, respectively; both p < 0.01) [ 61 ]. However, the prevalence of stroke in the latter study was similar in both sexes (16.5 vs. 16.0%; p = 0.44) [ 61 ].…”

Diabetes, Albuminuria and the Kidney—Brain Axis

“…Over the past few years, despite a wide variability in the methodologies and outcome assessments, several studies have shown associations between albuminuria and the risk of developing cognitive impairment and dementia, as well as a correlation with imaging markers for cognitive decline. Moreover, a recent meta-analysis provided the same conclusions [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ] based on the results of population-based studies. Less is known about T2D specifically; however, because T2D patients suffer from both an increased risk of cognitive impairment and kidney disease [ 22 , 23 , 24 , 25 , 26 , 27 , 28 ], elucidating the mechanisms of disease and exploring the interplay between the brain and kidney might potentially help to prevent cognitive impairment both in general and T2D populations.…”