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Management of Type 2 Diabetes Mellitus in Older Adults
Kyung Soo Kim, Soo Kyung Kim, Kyung Mi Sung, Yong Wook Cho, Seok Won Park
Diabetes Metab J. 2012;36(5):336-344.   Published online October 18, 2012
DOI: https://doi.org/10.4093/dmj.2012.36.5.336
  • 6,439 View
  • 88 Download
  • 45 Crossref
AbstractAbstract PDFPubReader   

In the near future, the majority of patients with diabetes will be adults aged 65 or older. Unlike young adults with diabetes, elderly diabetic people may be affected by a variety of comorbid conditions such as depression, cognitive impairment, muscle weakness (sarcopenia), falls and fractures, and physical frailty. These geriatric syndromes should be considered in the establishment of treatment goals in older adults with diabetes. Although there are several guidelines for the management of diabetes, only a few are specifically designed for the elderly with diabetes. In this review, we present specific conditions of elderly diabetes which should be taken into account in the management of diabetes in older adults. We also present advantages and disadvantages of various glucose-lowering agents that should be considered when choosing a proper regimen for older adults with diabetes.

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Original Articles
Effects of Comprehensive Support on Glycemic Control Using Community Networks in Low- Income Elderly Patients with Diabetes.
Nam Hoon Kim, Yun Jeong Lee, Hye Ok Kim, Cho Rong Oh, Ju Ri Park, Soo Yoen Park, Hee Young Kim, Ji A Seo, Nan Hee Kim, Kyung Mook Choi, Sei Hyun Baik, Dong Seop Choi, Sin Gon Kim
Korean Diabetes J. 2008;32(5):453-461.   Published online October 1, 2008
DOI: https://doi.org/10.4093/kdj.2008.32.5.453
  • 2,446 View
  • 31 Download
  • 7 Crossref
AbstractAbstract PDF
BACKGROUND
Diabetes is common among elderly, and low-income is associated with poor adherence to treatment and increased mortality. We evaluated whether comprehensive support using community networks improves glycemic control among low-income elderly patients with diabetes. METHODS: A total of 49 low-income elderly patients with type 2 diabetes, mean age 73 years, were enrolled. For 1 year, study subjects underwent various lifestyle modification programs provided by community networks. The biochemical data including glycemic markers and anthropometric data were obtained at the baseline and at the end of the study. Also, the patients were asked to complete a questionnaire about their quality of life, self-confidence and self-care behavior. RESULTS: After lifestyle modification program, overall changes of fasting plasma glucose, HbA1c, blood pressure, body weight, and other biochemical markers were not significantly different. In a subgroup analysis of 21 patients with poorly controlled diabetes (fasting glucose > 140 mg/dL or HbA1c > 7.5%), fasting plasma glucose was significantly reduced (P = 0.030). Among patients with baseline HbA1c level > or = 8%, HbA1c levels after intervention decreased from 9.33 +/- 1.07% to 8.27 +/- 1.15% (P = 0.092). The results of the questionnaires revealed significant increases in the scores of quality of life, self-confidence and self-care behavior (P < 0.05). CONCLUSION: Among low-income, elderly patients with type 2 diabetes, lifestyle modification through community networks showed no significant changes in glycemic control markers. More intensive and precise interventions using community networks are needed for the glycemic control of low-income, elderly patients with type 2 diabetes.

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    Ki wol Sung, Hye Seung Kang, Ji Ran Nam, Mi Kyung Park, Ji Hyeon Park
    Journal of Korean Academy of Nursing.2018; 48(2): 182.     CrossRef
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Current Status of Self-management and Barriers in Elderly Diabetic Patient.
Gyong Ae Choi, Soo Mi Jang, Hong Woo Nam
Korean Diabetes J. 2008;32(3):280-289.   Published online June 1, 2008
DOI: https://doi.org/10.4093/kdj.2008.32.3.280
  • 2,620 View
  • 80 Download
  • 28 Crossref
AbstractAbstract PDF
BACKGROUND
Diabetes has a critical effect on elderly diabetic patients' quality of life. Elderly diabetic patients have many difficulties in diabetes self-management because their physical, psychological and social functions are decreased as a result of the aging process. Therefore, we evaluated the current status of self-management and barriers in elderly diabetic patients METHODS: The sample was 124 elderly diabetic patients (over 61 years) who visited a hospital and two senior welfare centers in Seoul from July to August 2006. The results of the study were analyzed by descriptive statistics, ANOVA, T-test, and hierarchical regression. RESULTS: 1) Diabetes self-management was composed of insulin injection, diet, exercise, foot management, smoking and drinking alcohol. An average score of self-management in the elderly diabetic patients was 4.5784. In demographic variables, only job status showed a significant effect on self-management. 2) Barriers such as 'forgetting taking diet and medication', 'being interrupted by others', and 'lack of family and social support' were significant factors in diabetes self-management. 3) These barriers for diabetes self-management were still significant in the case of controlling demographic and clinical variables. CONCLUSION: Diabetic educator should identify the significant factors that affect patient's self-management such as whether they have a full-time job, or the type of their job. In addition, diabetes education should focus on assertiveness training to deal with various interpersonal barriers and empowerment for enhancing patient's self-efficacy. These approaches would benefit patients who experience barriers of diabetes self-management

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    Gi Yeon Lee
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    Tae Hyung Kwon, Min Seong Kim, Jun Ho Jeon, Dong Il Jeong, Sang Seok Yun, Yong Kyu Lee
    Journal of the Korean Geriatrics Society.2013; 17(2): 95.     CrossRef
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Association between Apolipoprotein E Polymorphism and Type 2 Diabetes in Subjects Aged 65 or Over.
You Jin Lee, Hak Chul Jang, Eun Hye Kim, Hye Jin Kim, Seok Bum Lee, Sung Hee Choi, Soo Lim, Kyoung Un Park, Young Joo Park, Ki Woong Kim
Korean Diabetes J. 2008;32(1):30-37.   Published online February 1, 2008
DOI: https://doi.org/10.4093/kdj.2008.32.1.30
  • 2,306 View
  • 27 Download
  • 2 Crossref
AbstractAbstract PDF
BACKGROUND
Increased prevalence of diabetes in recent years is linked with increased cardiovascular morbidity and mortality. Apolipoprotein E (apo E) polymorphism is well known to be related to hyperlipidemia and coronary heart disease, but only a few studies investigated the association between apo E polymorphism and diabetes or insulin resistance. In Korea, two studies with relatively small subjects reported controversial results. Therefore, we investigated the association between apo E polymorphism and diabetes in elderly community population. METHODS: 982 elderly people aged 65 or over in Seongnam city were enrolled. We measured anthropometric variables and blood pressure and performed biochemical tests including fasting glucose, fasting insulin, HbA1c, and lipid profiles. Apo E polymorphism was determined by PCR-RFLP method. RESULTS: Frequencies of apo E isoforms and alleles were similar to those of other reports. Subjects with e4 allele had significantly higher total and LDL-cholesterol levels. However, there were no differences in cholesterol levels between normal subjects and diabetes. Diabetes was not related to apo E polymorphism. CONCLUSION: In Korean aged 65 or over, subjects with diabetes didn't have increased total or LDL-cholesterol, triglyceride, and decreased HDL-cholesterol levels. Diabetes and apo E polymorphism were not related.

Citations

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    Jung Yeon Seo, Byeong Ju Youn, Hyun Sub Cheong, Hyoung Doo Shin
    Genes & Genomics.2021; 43(7): 725.     CrossRef
  • Sarcopenia, Frailty, and Diabetes in Older Adults
    Hak Chul Jang
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The Correlation between Central Obesity and Glucose, Lipid Metabolism and Macrovascular Complication in Elderly Type 2 Diabetes.
Eui Dal Jung, Jihyun Lee, Ho Sang Shon
Korean Diabetes J. 2007;31(4):343-350.   Published online July 1, 2007
DOI: https://doi.org/10.4093/jkda.2007.31.4.343
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AbstractAbstract PDF
BACKGROUND
Obesity is related to abnormal lipid metabolism and macrovascular complication and accumulated fat on the abdomen in elderly diabetic patients. The aim of this study was to compare elderly diabetic patients' body fat composition with middle-aged patients and evaluate the role of central obesity on glucose and lipid metabolism and macrovascular complications in elderly type 2 diabetic patients. METHODS: We defined elderly patients who are over 65 years old and who waist circumference is over than 90 cm in men and 85 cm in women and waist-hip ratio (WHR) was over than 0.90 in men and 0.85 in women defined central obesity. % body fat were measured a bioimpedence analysis using DSM (Direct Segmental Measurement by 8-point electrode) method (Inbody 3.0, Biospace, Seoul, Korea) in two hundred two type 2 diabetes. Laboratory parameters such as fasting blood glucose, HbA1c, and lipid profile were included in this study and also investigated the macrovascular complication. RESULTS: 1) The ninety-five elderly diabetic patients, compared with middle-aged diabetic patients, were similar BMI and % of body fat but significantly increased waist circumference (P < 0.05) and WHR (P < 0.001). 2) In pearson's correlations, waist circumference was correlated with BMI (r = 0.927, P < 0.001), WHR (r = 0.851, P < 0.001), % body fat (r = 0.519, P < 0.001), total cholesterol (r = 0.255, P < 0.05), triglyceride (r = 0.365, P < 0.001), and LDL-cholesterol (r = 0.271, P < 0.05) in elderly diabetic patients. And WHR was also correlated with BMI (r = 0.744, P < 0.001), waist circumference (r = 0.851, P < 0.001), % body fat (r = 0.425, P < 0.001), total cholesterol (r = 0.372, P < 0.001), triglyceride (r = 0.408, P < 0.001), and LDL-cholesterol (r = 0.386, P < 0.001). 3) The obese elderly diabetic patients had increased triglyceride, total cholesterol and LDL-cholesterol but not related with macrovascular complication compared with lean elderly patients. CONCLUSION: In elderly type 2 diabetic patients are more central obesity although the same weight compared with middle-aged patients. Waist circumference and WHR were highly correlated with body fat composition and lipid profile in elderly diabetes. In obese elderly patients have abnormal lipid profile but not more macrovascular complication.

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  • A Nationwide Survey about the Current Status of Glycemic Control and Complications in Diabetic Patients in 2006 - The Committee of the Korean Diabetes Association on the Epidemiology of Diabetes Mellitus -
    Soo Lim, Dae Jung Kim, In-Kyung Jeong, Hyun Shik Son, Choon Hee Chung, Gwanpyo Koh, Dae Ho Lee, Kyu Chang Won, Jeong Hyun Park, Tae Sun Park, Jihyun Ahn, Jaetaek Kim, Keun-Gyu Park, Seung Hyun Ko, Yu-Bae Ahn, Inkyu Lee
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Relations between Insulin Resistance and Hematologic Parameters in Elderly Koreans: Southwest Seoul (SWS) Study.
Kye Won Lee, Hye Jin Yoo, Soo Yeon Park, Ohk Hyun Ryu, Sang Soo Park, Soon Beom Kwon, Hee Young Kim, Ji A Seo, Jeong Heon Oh, Dong Hyun Shin, Sin Gon Kim, Nan Hee Kim, Kyung Mook Choi, Sei Hyun Baik, Dong Seop Choi, Hyoung Jin Kim
Korean Diabetes J. 2003;27(4):352-361.   Published online August 1, 2003
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AbstractAbstract PDF
BACKGROUND
The clustering of cardiovascular risk factors is known as insulin resistance syndrome. Hyperinsulinemia has been suggested as a cardiovascular risk factor due to the capacity of insulin to induce vascular endothelial proliferation and atherosclerosis. Insulin also has been shown to stimulate erythroid colony formation independently of erythropoietin. WBC count is one of the major components of the inflammatory process and is increased by IL-6, which is high in those with features of insulin resistance. In this study, we investigated whether insulin resistance affects hematological parameters. METHODS: In this study, 1,314, randomly selected, non-diabetic, elderly subjects over 60 years living in the southwest area of Seoul were recruited. Subjects underwent 75 g OGTT and careful physical examinations during evaluation, and were interviewed using a standardized questionnaire. Biochemical data and hematologic parameters were also measured. Insulin resistance was calculated by HOMA (homeostasis model assessment) method. Analysis of variance, Duncan's multiple comparisons and multiple linear regression analysis were carried out. RESULTS: In the male non-smoking group we found a correlation between insulin resistance and hemoglobin concentration (r=0.20, p=0.0186). In the female non- smoking group we found correlations between insulin resistance and both hemoglobin concentration (r=0.10, p=0.0017) and white blood cell (WBC) count (r=0.15, p=0.001). Hemoglobin concentration and WBC count were also correlated with BMI, systolic and diastolic blood pressure, lipid profiles and fasting insulin levels in female non-smokers. In multiple regression analysis, using HOMA IR as a dependent variable, we found significance in the variables of hemoglobin concentration, WBC count, age, BMI and triglyceride level. CONCLUSION: Our study provided evidence for a relation between insulin resistance and hematological parameters such as hemoglobin concentration and WBC count in elderly Koreans. This suggests that increased hemoglobin level and WBC count could be considered as novel aspects of the met.
Serum Proinsulin, Proinsulin/Total Insulin Ratio and Insulin Resistance in Elderly-onset Type 2 Diabetes.
Yoon Ju Oh, Young Ju Park, Young Wan Kim, Sung Ki Kim, Seong Bin Hong, Yoe Joo Kim, Mi Rim Kim, Moon Suk Nam, Yong Seong Kim
Korean Diabetes J. 2001;25(2):113-124.   Published online April 1, 2001
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BACKGROUND
It is well known that the concentration of serum proinsulin and the ratio of proinsulin/total insulin (P/I) are elevated in type 2 diabetes. Proinsulin is produced by the ribosome in pancreatic beta cells, undergoes maturation in Golgi body and exists in the form of secretory granules. Immature granules possess disproportionately large amount of proinsulin. When there is increased demand of insulin caused by diabetes, higher level of proinsulin is secreted from immature granules of dysfunctioning beta cells. Thus, the elevated concentration of proinsulin and the increased ratio of P/I are considered to be the markers of pancreatic dysfunction and predictors for the future development of diabetes. The elderly-onset type 2 diabetes is also thought to develop due to both dysfunction of insulin secretion by impaired beta cell with aging and increased insulin resistance in peripheral tissue due to less muscle mass and more fat. However, it is still controversial as to which mechanism is predominant in the development of type 2 diabetes. METHODS: We measured the levels of fasting blood glucose, serum proinsulin and specific human insulin by using radioimmunoassay kit, and calculated the P/I ratio and insulin sensitivity index in normal adults (40or=60, n=35) and also in the newly-diagnosed elderly type 2 diabetes (age>or=60, n=24). RESULTS: The concentration of serum proinsulin and the ratio of P/I in normal adults over age 40 were 7.70+/-6.08 pmol/L and 0.13+/-0.10, respectively. The concentration of proinsulin in the normal adult, normal elderly and elderly diabetes group were 6.50+/-3.71, 11.17+/-8.30 and 16.75+/-11.68 pmol/L. The differences among three groups were statistically significant (p= 0.0001). The P/I ratios for each of the three groups were 0.11+/-0.05, 0.17+/-0.12 and 0.16+/-0.08 (p=0.0004). P/I ratios in the elderly control and elderly diabetes were higher than that of the normal adult group. Insulin sensitivity index (ISI, 10,000/(basal glucose X basal insulin)) of elderly diabetes (1.19+/-0.89) was lower when compared with the indices of other groups (40or=60 control; 2.27+/-1.11, p=0.0001). CONCLUSION: Although the age-related reduction of pancreatic insulin secretory function attributes to the pathogenesis of old-age onset type 2 diabetes, it appears that the decreased insulin sensitivity may serve as more important factor in the development of the disease.
HbA1c Concentration of Elderly Diabetic Patients with the Hypoglycemic Shock who were Admitted via Emergency Room.
Jin Cheol Park, Hyung Joon Yoo, Hae Seang Yim, Yong Tae Kim, Do Kyun Jin, Hyun Kyu Kim, Doo Man Kim, Jae Myung Yoo, Sung Hee Ihm, Moon Gi Choi, Sung Woo Park
Korean Diabetes J. 1998;22(4):546-551.   Published online January 1, 2001
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AbstractAbstract PDF
BACKGROUND
Mild degree of hypoglycemia is not unusual during drug therapy in elderly diabetic patients. However it is very difficult that the precise incidence of hypoglycemia is measured in elderly patients because the decreased cognitive function and autonomic dysfunction contribute to atypical hypoglycemic symptoms and signs. Therefore, most cases of elderly diabetic patients with hypoglycemia are discovered in comatose mental state. We did this study to evaluate the clinical charaeteristics of elderly diabetic patients with the hypoglycemic shock who were admitted via emergency room. METHODS: We analyzed the precipitating factors, mental status, and blood chemistries of the adult group(n=22, age 51+3.6 year, BMI-19 kg/m2) and elderly group(n=37, age=72+4.3 year, BMI=23 kg/m) that were classified by the point of 65 years old who were admitted via emergency room in state of the hypoglycemic shock. RESULTS: 1) In the precipitating factor of hypoglycemia, irregular oral intake was found in 64%(14/22) of the adult group and 64%(23/37) of the elderly group, and drug overdose was found in 27 %(1.6/22) of the adult group and 24%(9/37) of the elderly group. But there, was no significant difference between the adult and elderly group. 2) Those who arrived at the emerency room in comatose mental status were found in 45.5 % of adult group and 54.1 % of elderly group, that was no difference stastically. 3) HbA 1c was 5.8 +- 0.27% in elderly group and 8.0 +- 0.63% in the adult group who arrived at the emergency room, which was stastically significant difference between two groups. CONCLUSION: We concluded that lower HbA 1c in the elderly group than adult group who arrived at the emergency room suggest there was probability of unrecognized mild hypoglycemia before the onset of hypoglycemic shock.
Prognostic Factors in the Elderly Diabetic Hyperosmolar Non-ketotic Coma.
Min Sook Park, Hyung Joon Yoo, Sun Hwa Jung, Kwon Yeop Lee, Cheol Soo Park, Cheol Hong Kim, Hyun Gyu Kim, Jae Myeog Yoo, Du Man Kim, Sung Hee Ihm, Moon Gi Choi, Sung Woo Park
Korean Diabetes J. 1997;21(2):194-199.   Published online January 1, 2001
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OBJECTIVES
: The diabetic hyperosmolar non-ketotic coma represents an acute complication of diabetes affecting mostly elderly persons with non-insulin dependent diabetes rnellitus. It is characterized by marked hyperglycemia, hyperosmolarity, severe dehydration, occasional neurologic signs, obtunded sensorium, and absence of ketonemia or acidosis. Most investigators have evaluated the relationship of predisposing conditions with HNKC, to evaluate outcome of the elderly HNKC we studied the prognostic factors in the elderly HNKC. Patients and METHODS: We retrospectively studied 43 patients with HNKC admitted to Hospital of Hallym University during an 6-year period, 1990 through 1995. All medical records of elderly patients (65 years old or more) discharged with the diagnosis of HNKC, were reviewed. To be included as a case, patients had to have a serum glucose level greater than 500mg/dL, measured plasma osmolarity greater than 320mOsm/L, pH greater than 7.30 and disoriented sensorium. 1nformation that was gathered age, glucose, blood urea nitrigen, creatinine, Na+, K+, HCO3-, anion gap, plasma osmolarity, urine osmolarity and whether the patients was discharged alive or died in the hospital. Data were analyzed by one-factor ANOVA and significance of difference between proportions was calculated by Newman-Keuls test. RESULTS: Survivors of 43 elderly HNKC were 22 patients and non-survivors were 21 patients. Mortality was 49%. Analysis revealed that the plasma osmolarity was significantly higher among those who non-survivors (376 +/- 10.8versus 331 +/- 5.0mOsm/L, p 0.01). Non-survivors also had significantly higher serum creatinine level than survivors (2.1+/-0.41versus 1.6 +/- 0.18mg/dL, p = 0.024) Conelusion: These results suggest that the prognostic factors of elderly HNKC were plasma osrnolarity and serum creatinine level.

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