Search

Background Type 2 diabetes mellitus (T2DM) and frailty are associated with functional decline in older population. Objective To explore the individual response to a multimodal intervention on functional performance. Design A cluster-randomised multicentre clinical trial. Setting Outpatients in hospital or primary care. Subjects 843 (77.83 years, 50.65% men) prefrail and frail individuals ≥70 years with T2DM. Methods Participants were allocated to usual care group (UCG) or a multicomponent intervention group (IG): 16-week progressive resistance training, seven nutritional and diabetological educational sessions and achievement of glycated haemoglobin (7–8%) and blood pressure (<150 mmHg) targets. Functional performance was assessed with the Short Physical Performance Battery (SPPB) at 1 year. We used multivariate binomial and multinomial logistic regression models to explore the effect of the IG, and adherence on the outcomes studied, in several adjusted models. Results 53.7% in the IG versus 38.0% in the UCG improved by at least 1 point in their SPPB score [OR (95% CI): 2.07 (1.43, 2.98), P value <0.001]. Age, SPPB score and number of frailty criteria met decreased the probability of improving the SPPB score. Factors associated with worsening were pertaining to IG (decreased), age, SPPB score and the number of frailty criteria (increased). An adherence ≥84% was needed to achieve benefits, reaching the peak in the probability of improving SPPB when this was ≥85% [OR(95%CI): 2.38 (1.29, 4.79), P value 0.014]. Conclusions Factors predicting the likelihood of improvement in a multimodal programme in pre-frail and frail older adults with diabetes are age, basal SPPB score, the number of frailty criteria and adherence. [ABSTRACT FROM AUTHOR]

Aims Prediabetes is used to identify people at increased risk for diabetes. However, the importance of prediabetes in older populations is still poorly explored. Therefore, we aimed to investigate the prevalence of prediabetes, based on either glycated haemoglobin (HbA1c) levels or fasting glucose (FG) levels, or both and the progression of prediabetes to diabetes or to mortality in older participants of the English Longitudinal Study on Ageing. Materials and methods Prediabetes was categorized based on HbA1c levels (5.7%–6.4%) and/or FG levels (5.6–7.0 mmol/L). Information regarding mortality and incident diabetes were recorded during follow-up period of 10 years. Results In 2027 participants (mean age: 70.6 years, 55.2% females), the prevalence of prediabetes ranged between 5.9% and 31.1%. Over 8 years of follow-up, 189 participants (5.4% of the initial population) developed diabetes and 606 (17.4%) died. Among 1,403 people with HbA1c at the baseline <5.7%, 33 developed diabetes and 138 died; in contrast, among 479 participants with a diagnosis of prediabetes using a value of HbA1c between 5.7% and 6.4%, 62 developed diabetes and 56 died. Similarly, among 1,657 people with normal values of FG at baseline 60 had a diagnosis of diabetes during follow-up and 163 died, compared to 225 with FG between 5.6 mmol/L and 7.0 mmol/L in which 35 developed diabetes and 31 died. Conclusion The prevalence of prediabetes in older adults is high, but the progression from prediabetes to diabetes is uncommon, whereas the regression to normoglycemia or the progression to death was more frequent. [ABSTRACT FROM AUTHOR]

The author stresses the need for more education and training of trial personnel in conducting studies in older people with diabetes. Topics include his opinion on the absence of clinical trial evidence or first class real world observational data, the strong reliance by general practitioners and hospital specialists in Great Britain on the recommendations from the National Institute for Health and Care Excellence, and key step in the creation of the 2019 American Endocrine Society guideline.

The author discusses the concept of metabolic syndrome in older persons. The condition is driven to high degree by environmental factors, such as poor physical activity and excess calorie intake. A number of factors associated with ageing predispose to increasing elements of the metabolic syndrome, including the increase in adiposity and visceral obesity that occurs with ageing.

Background: hospital and exercise-based cardiac rehabilitation programmes do not suit many older patients and home-based rehabilitation may be more effective. Objective: to evaluate a home-based intervention for patients aged 65 years or over discharged home from hospital after emergency admission for suspected myocardial infarction. Design: a single-blind randomised controlled trial comparing home-based intervention by a nurse with usual care. Subjects: patients aged 65 years or over discharged home after hospitalisation with suspected myocardial infarction (n= 324). Intervention: home-based intervention (n= 163) consisted of home visits at 1-2 and 6-8 weeks after hospital discharge by a nurse who encouraged compliance with and knowledge of their treatment regimen, offered support and guidance about resuming daily activities, and involved other community services as appropriate. Measurements: up to 100 days after admission, data were collected on deaths, hospital readmissions and use of outpatient services. Survivors were sent a postal questionnaire to assess activities of daily living and quality of life. Results: at 100 day follow-up there was no difference in deaths, activities of daily living or overall quality of life, but those in the intervention group scored significantly better on the confidence and self-esteem subsections. The intervention group had fewer hospital readmissions (35 versus 51, relative risk 0.68, 95% CI 0.47-0.98, P<0.05) and fewer days of hospitalisation after initial discharge (mean difference -1.7, 95% CI-2.09 to -1.31, P<0.05). A total of 42/43 individuals in the intervention group had resumed driving at follow-up, compared with 32/43 in the usual care group (observed difference between proportions 23%, 95% CI 9-37%, P<0.05). Conclusion: amongst older patients discharged home after hospitalisation for suspected myocardial infarction, home-based nurse intervention may improve confidence and self-esteem, and reduce early hospital readmissions. [ABSTRACT FROM AUTHOR]

Comments on the findings of the report `United Kingdom Prospective Diabetes Study' on type 2 diabetes mellitus among older people. Results of the glucose reduction study; Aim of the blood pressure study; Conclusions and recommendations.

Provides information on a study which examined the effect of diabetes in increasing the likelihood of visual impairment among older patients. Methodology; Results; Discussion on the study findings.

Presents information on a study which discussed the properties and therapeutic potentials of carnosine. Synthesis and metabolism of carnosine; Antioxidant and buffering activities; Membrane protection properties of carnosine; Other properties.

Provides information on the complex interaction of diseases and other external environmental factors, which make it difficult to design experimental studies of ageing, the premature ageing syndromes as models of ageing. Characterization of the condition; Reference to researches carried out.

Presents the final report of the Saint Vincent Joint Task Force for diabetes regarding improvement of care among elderly diabetic patients in Great Britain. Importance of achieving uniform standards for diabetic care; Involvement of geriatricians in diabetes service advisory group; Care facilities for elderly patients between primary and secondary sectors.