Diabetes Treatment Approaches and Blood Glucose Regulation in Elderly Patients - Retrospective Study

Öz

 

Objective: Diabetes mellitus is one of the most common disorders in the geriatric population. In these cases, it is difficult to regulate blood sugar and determine the clinical follow-up planing due to comorbidities, cognitive dysfunction and polypharmacy.

 In this study, we wanted to evaluate the diabetic regulation status and selected treatment modalities in diabetic geriatric patients.

 

Material and Methods: Seventy-five patients who met the inclusion criteria were included in the study. Fasting blood glucose, Hba1c levels and treatment modalities were recorded. The number of outpatient applications and related branches were also evaluated.

 

Results: The mean age of the patients was 71 ± 5 years. Mean fasting blood glucose and Hba1c levels were 133 ± 33 mg / dl and 6.98 ± 0.96, respectively. There was a positive correlation between fasting blood glucose levels and Hba1c levels and between LDL cholesterol and triglyceride levels (p <0.001). Vitamin B12 levels were found to be significantly lower in patients with high serum glucose (p = 0.005). 37 patients (49.3%) were under treatment with oral antidiabetics and 30 patients (40%) with oral antidiabetic and insulin. The number of hospital admissions was 1-15 times (4 ± 2). In the last 6 months along with diabetes polyclinic, most of the patients were admitted to ophthalmology.

 

Conclusion: In this study, we determined that the glucose regulation of the geriatric diabetic patients was acceptable. However, for the optimal treatment, follow-up methods for diabetes-related complications and standard scales like atherosclerosis risk scores are necessary.

Anahtar Kelimeler

• Diabetes mellitus,elderly

Geriatrik Diabetes Mellitus Olgularında Kan Şekeri Regülasyon Durumu ve Tedavi Yaklaşımlarını İçeren Retrospektif Değerlendirme

Öz

Amaç: Diabetes mellitus, geriatrik popülasyonda sık görülen kronik hastalıklardan birisidir. Bu olgularda eşlik eden komorbiditeler, kognitif disfonksiyon ve polifarmasi nedeni ile kan şekerini regüle etmek ve klinik takip planını belirlemek zor olmaktadır. Bu çalışmada diyabetik geriatrik olguların kan şekeri regülasyonlarını ve kullanılan tedavi yöntemlerini değerlendirmeyi amaçladık.

 

Gereç ve Yöntemler: Diyabet polikliniğine başvuran ve dahil edilme kriterlerini karşılayan 75 hasta çalışmaya alındı. Tüm hastaların başvuru sırasındaki açlık kan şekeri, Hba1c düzeyleri ve kullanılan tedavi yöntemleri kayıt edildi. Son 6 ay içerisinde başvuru yapılmış olan poliklinik sayısı ve ilgili branşlar değerlendirildi. 

 

Bulgular: Hastaların yaş ortalaması 71 ± 5 yıldı. Ortalama açlık kan şekeri ve Hba1c düzeyi sırası ile 133 ± 33 mg/dl, 6,98 ± 0,96 şeklindeydi. Açlık kan şekeri ile Hba1c düzeyleri arasında ve LDL kolesterol ile trigliserid düzeyleri arasında pozitif yönde bir korelasyon vardı (p<0,001). Serum glukozu yüksek olan hastalarda vitamin B12 düzeyi istatistiksel olarak anlamlı daha düşük saptandı (p=0,005). 37 hasta (%49,3) sadece oral antidiyabetik, 30 hasta (%40) ise oral antidiyabetik ve insülin kombinasyonu kullanıyordu. Hastaneye başvuru sayısı 1-15 kez (4±2) şeklindeydi. Diyabet polikliniğinden sonra son 6 ay içerisinde en sık göz hastalıkları polikliniğine başvuru yapılmıştı.

 

Sonuç: Bu çalışma ile kliniğimizde takip edilen geriatrik diyabetik olguların kan şeker regülasyonlarının kabul edilebilir düzeyde olduğunu saptadık. Ancak bu olgularda optimal tedavi planı için ateroskleroz risk faktörleri, diyabet ilişkili morbidite ve komplikasyonların değerlendirildiği standart ölçek ve takip yöntemlerinin kullanılmasına ihtiyaç vardır.

Anahtar Kelimeler

• yaşlı,multidisipliner yaklaşım,diabetes mellitus

Kaynakça

1. REFERANSLAR
2. 1- Lakey WC, Barnard K, Batch BC, Chiswell K, Tasneem A, Green JB. Are current clinical trials in diabetes addressing important issues in diabetes care? Diabetologia. 2013; 56: 1226-1235.
3. 2- Huang ES, Laiteerapong N, Liu JY, John PM, Moffet HH, Karter AJ. Rates of complications and mortality in older patients with diabetes mellitus: the diabetes and aging study. JAMA Intern Med. 2014; 174: 251–258.
4. 3- Huang ES. Appropriate application of evidence to the care of elderly patients with diabetes. Curr Diabetes Rev. 2007; 3: 260-263.
5. 4- Chen LK, Chen YM, Lin MH, Peng LN, Hwang SJ. Care of elderly patients with diabetes mellitus: a focus on frailty. Ageing Res Rev. 2010; 9: 18-22.
6. 5- Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, Peters AL, Tsapas A, Wender R, Matthews DR; American Diabetes Association (ADA); European Association for the Study of Diabetes (EASD). Management of hyperglycemia in type2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2012; 35:1364-1379
7. 6- Kirkman MS, Briscoe VJ, Clark N, Florez H, Haas LB, Halter JB, Huang ES, Korytkowski MT, Munshi MN, Odegard PS, Pratley RE, Swift CS. Diabetes in older adults. Diabetes Care. 2012; 35 :2650-2664
8. 7- UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998; 352: 837–853.

9. 8- Patel A, MacMahon S, Chalmers J, et al. ADVANCE Collaborative Group. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008; 358: 2560–2572.
10. 9- American Diabetes Association. Standards of medical care in diabetes—2015. Diabetes Care. 2015; 38: e174.
11. 10- Morley JE. An overview of diabetes mellitus in older persons. Clin Geriatr Med 1999;15: 211–224.
12. 11- Zeyda M, Stulnig TM. Obesity, inflammation, and insulin resistance–a mini-review. Gerontology 2009; 55: 379–386.
13. 12- Dandona P. Vascular reactivity in diabetes mellitus. Endocrinol Nutr 2009; 56: 12–1
14. 13- Kodl CT, Seaquist ER. Cognitive dysfunction and diabetes mellitus. Endocr Rev. 2008;29: 494‐511.
15. 14- Miller ME, Bonds DE, Gerstein HC, Seaquist ER, Bergenstal RM, Calles‐Escandon J, Childress RD, Craven TE, Cuddihy RM, Dailey G, Feinglos MN, Ismail‐Beigi F, Largay JF, et al. The effects of baseline characteristics, glycaemia treatment approach, and glycated haemoglobin concentration on the risk of severe hypoglycaemia: post hoc epidemiological analysis of the ACCORD study. BMJ. 2010; 340:1‐12.
16. 15- Whitmer RA, Karter AJ, Yaffe K, Quesenberry CP Jr, Selby JV. Hypoglycemic episodes and risk of dementia in older patients with type 2 diabetes mellitus. JAMA. 2009;301:1565‐1572.
17. 16- Abdelhafiz AH, Sinclair AJ. Tailor treatment in the older patient with type 2 diabetes. Practitioner. 2013; 257: 21‐25.
18. 17- Ismail‐Beigi F, Moghissi E, Tiktin M, Hirsch IB, Inzucchi SE, Genuth S. Individualizing glycemic targets in type 2 diabetes mellitus: implications of recent clinical trials. Ann Intern Med. 2011; 154: 554‐559.
19. 18- Lee SJ, Eng C. Goals of glycemic control in frail older patients with diabetes. JAMA. 2011;305:1350‐1351.
20. 19- De Jager J, Kooy A, Lehert P, Wulffelé MG, van der Kolk J, Bets D, Verburg J, Donker AJ, Stehouwer CD. Long-term treatment with metformin in patients with type 2 diabetes and risk of vitamin B‐12 deficiency: a randomized placebo-controlled trial. BMJ. 2010;340:1‐7
21. 20- Chelliah A, Burge MR. Hypoglycemia in elderly patients with diabetes mellitus: causes and strategies for prevention. Drugs Aging. 2004; 21: 511‐530.
22. 21- Scheen AJ. Cardiovascular effects of dipeptidyl peptidase‐4 inhibitors: from risk factors to clinical outcomes. Postgrad Med. 2013;125:7‐20.
23. 22- Angela Dardano, Giuseppe Penno, Stefano Del Prato, and Roberto Miccoli. Optimal therapy of type 2 diabetes: a controversial challenge AGING, 2014; 6: 3
24. 23- Simons LA, Simons J, Friedlander Y, McCallum J, Palaniappan L. Risk functions for prediction of cardiovascular disease in elderly Australians: the Dubbo Study. Med J Aust. 2003;178:113–116.
25. 24- Leya M, Stone NJ. Statin Prescribing in the Elderly: Special Considerations. Curr Atheroscler Rep. 2017; 19: 47.