Nutritional challenges in the elderly with diabetes

Adults age 60 and older will comprise two-thirds of the diabetic population by the year 2025. Older patients with diabetes are more likely to have coexistent chronic conditions like hypertension, dyslipide-mia, and cardiovascular disease that may impact their nutritional requirements. The issue of attainment and maintenance of an optimal body weight in elderly diabetic persons may not be as straightforward as in other age groups, and the risk-benefit ratio may be different as well. Although increased prevalence of overweight and obesity in the elderly contributes to insulin resistance and hyperglycemia, older inhabitants of long-term care facilities who suffer from diabetes tend to be underweight. Both may signify inadequate nutritional status and lead to increased morbidity and mortality. The attendant problems of appetite changes, palatability of food, dietary restrictions, loneliness, and depression may affect the type and quantity of food consumed by elderly persons. Structured screening tools may identify nutrition-related issues that warrant evidence-based interventions. Although glucose control and health concerns are important factors in diet modification in the older population, other considerations include quality of life and individual preferences. Customizing of nutritional guidelines to the needs of the older diabetic patient makes sense

Assessing the prevalence, quantification and morphological composition of coronary atherosclerosis in patients with type 2 diabetes and the metabolic syndrome via 64-Slice CT angiography

We determined the prevalence, morphology, and severity of coronary artery plaque in high-risk patients via 64-slice cardiovascular computed tomography [CVCT]. Based on chart review, 101 subjects having a 64-slice CVCT were assigned to one of three groups: type 2 diabetes, metabolic syndrome, or comparison. Disease severity was classified as: no disease, subclinical disease [lesions <70%], or clinically significant disease [lesions >70%]. Plaque morphology was stratified as either vulnerable or stable plaque by Houndsfield units and established American Heart Association criteria. Diabetic subjects had the highest prevalence of CAD [78%], compared to 65% in the metabolic syndrome subjects and 55% in the comparison group [p<.05]. Diabetic subjects were also most likely to have both significant CAD [41%], and stable plaque [52%] followed by metabolic syndrome subjects [33% and 25%] and the comparison group [15% and 20%] [p < 0.05]. The metabolic syndrome group was most likely to have vulnerable lesions [36%] potentially placing them at increased risk of acute events. 22% of subjects in the diabetes group, 35% in the metabolic syndrome group, and 45% in the comparison cohort were disease-free. 64-slice CVCT allows non-invasive diagnosis and stratification of subjects with diabetes and the metabolic syndrome, providing relevant information regarding coronary disease prevalence, severity, and plaque composition, that are statistically different among these high risk patient cohorts

Multiple-dose insulin injection therapy in patients with type 2 diabetes using a basal-bolus regimen, team management, and nutrition education

We determined the efficacy of basal-bolus insulin therapy delivered through team education and nutrition counseling formanagement of type 2 diabetes in 17 patients treated with a regimen of once-daily insulin glargine and either insulin aspart or lispro three times a day. They received written instructions and specific education about 'basal-bolus' insulin administration, use of a 'forced-titration' schedule for glargine dose adjustment, and calculation of rapid-acting pre-meal bolus insulin. The average hemoglobin Ale level decreased from 8.7 +/- 2.06% to 7.0 +/- 1.07%, a significant reduction of 1.7% [p<0.05] over 3 months or more. 7 patients [41%] reported improvement in hypoglycemic events. In conclusion, an intensive multidose basal-bolus insulin treatment using self-titration and flexibility through carbohydrate counting confers beneficial effects in patients with type 2 diabetes, including better glycemic control and reduced hypoglycemia. These results are best achieved through multi-disciplinary patient care involving the nurse educator and dietician as part of a diabetes care team