Type 2 diabetes mellitus in older adults: clinical considerations and management

Bellary, Srikanth; Kyrou, Ioannis; Brown, James E.; Bailey, Clifford J.

doi:10.1038/s41574-021-00512-2

Cited by 314 publications

(252 citation statements)

References 182 publications

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“…First, the results of this study have to be interpreted within the limit of its design. The fact that participants of the S.AGES cohort were included according to three specific diseases (T2DM, AF and chronic pain) might induce an inclusion bias, even though these diseases are highly prevalent in the older population [ 27 , 49 , 50 ]. Besides, Tramadol prescription in this study was probably higher than in the whole French population because one third of the participants were recruited in the chronic pain sub-cohort.…”

Section: Discussionmentioning

confidence: 99%

Use of potentially driver-impairing drugs among older drivers

et al. 2022

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Background Road safety is a major issue among seniors. Potentially Driver-Impairing (PDI) drugs are known to increase the risk of car accident. The aim of this cross-sectional study was to describe PDI-drug consumption among older drivers and determine associated factors. Methods The S.AGES cohort is a French non-interventional real-life prospective study of 3700 community-dwelling participants aged ≥65 years old, suffering from type 2 diabetes (T2DM), chronic pain or atrial fibrillation (AF). Baseline data of drivers with known treatment (n = 1783) were used for the analyses. PDI drugs were defined according to the French classification. Results One thousand seven hundred eighty-three drivers were included (66% males; mean age 76 (Standard deviation = 5.78) years old). 21% (n = 373) took PDI drugs, 64% of which took only one (n = 239). The most frequent PDI drugs were: Zolpidem (11%; n = 60); Zopiclone (8%; n = 45); Bromazepam (8%; n = 44); Tramadol (7%; n = 39); Pregabalin (6%; n = 31). Drivers taking PDI drugs had more often chronic pain (OR [95% CI] = 2.30 [1.54–3.46]), history of depressive disorder (4.28 [3.00–6.14]) and polypharmacy (taking at least 5 different medications; 4.32 [2.97–6.41]), and less often T2DM (0.54 [0.37–0.79]), and AF (0.48 [0.32–0.71]). Conversely, they had a lower Activities of Daily Living score (0.34 [0.17–0.68]). Conclusions The rate of aged drivers in the S.AGES cohort taking PDI drugs is concerning and highlights the need to carefully assess and reassess PDI-drug prescriptions in this population, particularly hypnotics, anxiolytics and opioids. Trial registration ClinicalTrials.gov NCT01065909 (First posted: February 9th, 2010).

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Section: Discussionmentioning

confidence: 99%

Use of potentially driver-impairing drugs among older drivers

et al. 2022

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“…Body composition changes with ageing especially increase in visceral fat and ectopic fat distribution is pro-inflammatory and obesity is associated among others with high baseline C-reactive protein and interleukin-6 (45). Intramuscular fat infiltration together with sedentary lifestyle, poor dietary habits and effects of medications further aggravates insulin resistance in older adults (46). Obesity is associated with mitochondrial dysfunction, which in is also thought to be responsible for insulin resistance, frailty, and sarcopenia (47)(48)(49).…”

Section: Discussionmentioning

confidence: 99%

Gender Differences in Body Composition in Pre-Frail Older Adults With Diabetes Mellitus

2022

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Background & AimsAgeing is a risk factor for diabetes mellitus (DM) and frailty. It is associated with body composition changes including increase in fat mass (FM), central fat distribution, decrease in fat free mass (FFM) and skeletal muscle which are risk factors for DM. This study aims to evaluate gender differences in body composition in pre-frail diabetics and association with physical performance, cognitive function and perceived health. In addition, we aim to explore the association of obesity, sarcopenia, sarcopenic obesity, and body composition in pre-frail older adults to DM status.MethodsCross-sectional study of 192 pre-frail community dwelling older adults (≥ 65 years). Data was collected on demographics, physical function, cognition, frailty, sarcopenia, perceived health and body composition using the InBody S10. Univariate and multivariate logistic regression were undertaken to explore the association of sarcopenic obesity, obesity, sarcopenia and body composition measures to DM status.ResultsThere were insignificant within-gender differences for physical function, cognition and body composition, except for a higher prevalence of obesity defined by body mass index (BMI) and body fat percentage (BF%), increased fat mass index(FMI) and fat free mass index(FFMI) in females with DM. There were significant between-gender differences for those with DM where females overall had lower education levels, lower perceived health, higher prevalence of depression and low mental vitality, lower overall physical function (low short physical performance battery scores, low gait speed and hand grip strength), lower cognitive scores, lower muscle mass and muscle quality with higher FMI, FM/FFM and visceral fat area(VFA). BMI, VFA>100 cm2, FMI and FFMI were found to be independently associated with DM status after multivariable adjustment.ConclusionWithin pre-frail DM vs non-DM, there were insignificant differences in body composition, physical function, cognition and perceived health within gender except for FMI, BF% and FFMI in females. There were significant differences between gender in pre-frail DM in muscle mass, quality, functional, cognitive and mental status. Further longitudinal studies are required to understand the pathogenesis, trajectory of DM and protective role of oral hypoglycemics in pre-frail older adults.

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“…Currently, there is no consensus as to which markers of inflammation best represent chronic inflammation or can distinguish among the various phases of inflammatory responses [ 38 ]. The fact that DM2 is mostly an age-related disease accentuates heterogeneity of DM2-related phenotypes by increasing the potential in DM2 patients for the development of multiple comorbidities, malnutrition, sarcopenia, and frailty [ 39 , 40 ]. In addition to the well-known fact that the risk of vascular complications and mortality increases with the duration of DM2 and is dependent on how glycemia is regulated, new evidence has also emphasized, in this regard, the importance of patient age and the age of DM2 onset [ 9 , 41 ].…”

Section: Aimmentioning

confidence: 99%

Clustering Inflammatory Markers with Sociodemographic and Clinical Characteristics of Patients with Diabetes Type 2 Can Support Family Physicians’ Clinical Reasoning by Reducing Patients’ Complexity

et al. 2021

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Diabetes mellitus type 2 (DM2) is a complex disease associated with chronic inflammation, end-organ damage, and multiple comorbidities. Initiatives are emerging for a more personalized approach in managing DM2 patients. We hypothesized that by clustering inflammatory markers with variables indicating the sociodemographic and clinical contexts of patients with DM2, we could gain insights into the hidden phenotypes and the underlying pathophysiological backgrounds thereof. We applied the k-means algorithm and a total of 30 variables in a group of 174 primary care (PC) patients with DM2 aged 50 years and above and of both genders. We included some emerging markers of inflammation, specifically, neutrophil-to-lymphocyte ratio (NLR) and the cytokines IL-17A and IL-37. Multiple regression models were used to assess associations of inflammatory markers with other variables. Overall, we observed that the cytokines were more variable than the marker NLR. The set of inflammatory markers was needed to indicate the capacity of patients in the clusters for inflammatory cell recruitment from the circulation to the tissues, and subsequently for the progression of end-organ damage and vascular complications. The hypothalamus–pituitary–thyroid hormonal axis, in addition to the cytokine IL-37, may have a suppressive, inflammation-regulatory role. These results can help PC physicians with their clinical reasoning by reducing the complexity of diabetic patients.

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Type 2 diabetes mellitus in older adults: clinical considerations and management

Cited by 314 publications

References 182 publications

Use of potentially driver-impairing drugs among older drivers

Use of potentially driver-impairing drugs among older drivers

Gender Differences in Body Composition in Pre-Frail Older Adults With Diabetes Mellitus

Clustering Inflammatory Markers with Sociodemographic and Clinical Characteristics of Patients with Diabetes Type 2 Can Support Family Physicians’ Clinical Reasoning by Reducing Patients’ Complexity

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