Type 2 diabetes in patients older than 70 years — aspects of metabolic control
Abstract
Background. The differences in the clinical manifestation and course of diabetes observed in older individuals should translate into various options of treatment and management of the elderly diabetic patients. Of particular importance is the early detection of disease complications due to its impact on the physical and mental health of elderly patients.
Material and methods. All participants were hospitalised in the Department of Internal Medicine, University Hospital No. 1 between the year 2012–2016. Based on the medical records, the consecutively presenting patients diagnosed with type 2 diabetes were divided into three basic groups: group 1 aged 37–58 years (30 individuals), group 2 aged 70–79 years (30 individuals) and group 3 aged ≥ 80 years (50 individuals). The exclusion criteria were lack of logical verbal contact and substantial impairment of physical activity verified with the Katz Basic Activities of Daily Living (ADL) scale. Based on the medical history and documentation, the duration of diabetes, the BMI and frequency of hypoglycaemia were established. Among patients, as part of their stay and regardless of the study conducted, the main parameters were determined referring to metabolic control of type 2 diabetes mellitus (percentage of glycated haemoglobin, lipid profile) and blood pressure measurement.
Results. The particular groups of patients differed in terms of the mean disease duration (p < 0.001), i.e. 5 ± 6.4 years in group 1, 16.1 ± 8.6 years in group 2 and 14.6 ± 9 years in group 3. There were statistically significant inter-group differences in mean body weight (BW) and BMI (patients ≥ 80: BW — 70.7 ± 14.3 (kg), BMI: 27.5 ± 4.3 (kg/m2); 70–79 years of age group: BW: 77.1 ± 16.4 (kg), BMI: 28.9 ± 6 (kg/m2); group 1 (BW: 92.4 ± 21.4 (kg), BMI: 31.5 ± 7.0 (kg/m2). The best glucose control was observed amongst patients ≥ 80 (group 3), as compared to group 1 — 47 patients (84%) vs. 4 patients (13.3%) (p < 0.001). The percentages of HbA1c were as follows: 8.7 ± 2.3 (%) in group 1, 7.3 ± 1.2 (%) in group 2 and 6.9 ± 0.9 in group 3, respectively (p < 0.001). There were no statistically significant differences in the blood pressure between particular groups of patients. Hypoglycaemia did not occur more frequently in any of the studied groups.
Conclusions. Elderly patients suffering from type 2 diabetes vary in numerous aspects from younger patients. The basic differences were observed in relation to anthropometric indices and average duration of the disease. Treatment of type 2 diabetes in elderly patients leads to excessive control with respect to the carbohydrate metabolism although patients do not report hypoglycaemia more frequently.
Keywords: type 2 diabetesmetabolic controlhypoglycaemia
References
- Górska-Ciebiada M, Ciebiada M, Barylski M, et al. Cukrzyca u osób w wieku podeszłym w świetle nowych wytycznych Polskiego Towarzystwa Diabetologicznego. Geriatria. 2009; 3: 228–233.
- Zalecenia kliniczne dotyczące postępowania u chorych na cukrzycę 2016. Stanowisko Polskiego Towarzystwa Diabetologicznego. Diabetol Prakt. 2016; 5: Suplement.
- Global Global Guideline for Managing Older People with Type 2 Diabetes. International Diabetes Federationfor Managing Older People with Type 2 Diabetes. 2013.
- Harris MI, Flegal KM, Cowie CC, et al. Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S. adults. The Third National Health and Nutrition Examination Survey, 1988-1994. Diabetes Care. 1998; 21(4): 518–524.
- Gerstein HC, Miller ME, Byington RP, et al. Action to Control Cardiovascular Risk in Diabetes Study Group. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008; 358(24): 2545–2559.
- Syvänne M, Taskinen MR. Lipids and lipoproteins as coronary risk factors in non-insulin-dependent diabetes mellitus. Lancet. 1997; 350 Suppl 1: SI20–SI23.
- Hokanson JE, Austin MA. Plasma triglyceride level is a risk factor for cardiovascular disease independent of high-density lipoprotein cholesterol level: a meta-analysis of population-based prospective studies. J Cardiovasc Risk. 1996; 3(2): 213–219.
- Assmann G, Schulte H. Relation of high-density lipoprotein cholesterol and triglycerides to incidence of atherosclerotic coronary artery disease (the PROCAM experience). Am J Cardiol. 1992; 70(7): 733–737.
- Castelli WP. The triglyceride issue: a view from Framingham. Am Heart J. 1986; 112(2): 432–437.
- Diabetes Atorvastatin Lipid Intervention (DALI) Study Group. Porównanie intensywnego i standardowego obniżania stężenia lipidów za pomocą atorwastatyny u chorych z dyslipidemią cukrzycową. Diabetes Care. 2001; 24(8): 1335–1341.