Risk of Progression to Diabetes Among Older Adults With Prediabetes

Rooney MR, Rawlings AM, Pankow JS, et al. | 2021| Risk of Progression to Diabetes Among Older Adults With Prediabetes. JAMA Intern Med. doi:10.1001/jamainternmed.2020.8774

This study explores the question: What is the risk of progression to diabetes among older adults with prediabetes (based on glycated hemoglobin level of 5.7 per cent-6.4 per cent, fasting glucose levels of 100-125 mg/dL, either, or both) in a community-based population?

It sought to compare the prevalence of prediabetes—based on glycated hemoglobin (HbA1c) levels, fasting glucose (FG) levels, either, or both—and examine progression from normoglycemia to prediabetes or diabetes and progression from prediabetes to diabetes in a community-based cohort of older adults from the Atherosclerosis Risk in Communities (ARIC) Study.

The cohort study followed more than 3 000 adults the prevalence of prediabetes (mean [SD] age, 75.6 [5.2] years) was high and differed substantially depending on the definition used, with estimates ranging from 29 per cent for glycated hemoglobin levels of 5.7 per cent to 6.4 per cent to 73 per cent for either glycated hemoglobin levels of 5.7 per cent to 6.4 per cent or fasting glucose levels of 100 to 125 mg/dL. During the 6 years of follow-up, death or regression to normoglycemia from prediabetes was more frequent than progression to diabetes.

They find that prediabetes may not be a robust diagnostic entity in older age. As although prediabetes was common, during the 6.5-year follow-up period, fewer than 12 per cent of older adults progressed from prediabetes to diabetes, regardless of the definition of prediabetes. In addition, a substantial proportion of individuals with prediabetes at baseline regressed to normoglycemia at the follow-up visit (1 among those with fasting glucose levels of 100-125 mg/dL). Indeed, in older adults with prediabetes, regression to normoglycemia or death was more common than progression to diabetes during the study period.

Paper available from JAMA Internal Medicine

Family support among older persons in diabetes mellitus self-management

Results of new study highlight the importance of family support in diabetes mellitus self-management in older persons | BMC Geriatrics

Background
The aging process has functional consequences for older persons, such as degenerative processes of the pancreas resulting in diabetes mellitus. The increasing age of the population will eventually lead to increasing health problems of older persons, including diabetes mellitus. Diabetes mellitus is a chronic disease that requires long-term care through self-management. Diabetes self-management in older persons is influenced by family support as the main support system. This study aimed to explore perceived family support by older persons in diabetes mellitus self-management.

Methods
This study applied descriptive phenomenology method. The data were collected through in-depth interviews. There were nine older persons with diabetes mellitus as participants. Data consisted of in-depth interview recordings and field notes. Data were transcribed and analyzed using Colaizzi’s method.

Results
The results identified that family support as perceived by older persons included daily activity assistance, assistance with obtaining health services, food preparation, financial support, attention, guidance, and problem solving. The response to family support was pleasure as expressed by the older persons.

Conclusions
Physical and economic limitations were a significant hindrance to self-management of diabetes mellitus in older persons; therefore, they require family support to optimize their independence. The results of this study highlight the importance of family support in diabetes mellitus self-management in older persons.

Full reference: Niko Dima Kristianingrum et al. | Perceived family support among older persons in diabetes mellitus self-management BMC Geriatrics | 2018, 18 (Suppl 1) :304 | published 19 December 2018

Type 2 diabetes mellitus in older people: key principles of modern day management

Strain, W. et al. |Type 2 diabetes mellitus in older people: a brief statement of key principles of modern day management including the assessment of frailty. A national collaborative stakeholder initiative | Diabetic Medicine | Volume35, Issue 7 | July 2018 | p838-845

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Abstract

Rates of population ageing are unprecedented and this, combined with the progressive urbanization of lifestyles, has led to a dramatic shift in the epidemiology of diabetes towards old age, particularly to those aged 60–79 years.

Both ageing and diabetes are recognized as important risk factors for the development of functional decline and disability. In addition, diabetes is associated with a high economic, social and health burden.

Traditional macrovascular and microvascular complications of diabetes appear to account for less than half of the diabetes‐related disability observed in older people. Despite this, older adults are under‐represented in clinical trials.

Guidelines from organizations such as the National Institute for Health and Care Excellence (NICE), the European Association for the Study of Diabetes, and the American Diabetes Association acknowledge the need for individualized care, but the glycaemic targets that are suggested to constitute good control are too tight for frail older individuals.

We present a framework for the assessment of older adults and guidelines for the management of this population according to their frailty status, with the intention of reducing complications and improving quality of life for these people.

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