Goal Attainment Rate for Parameters of Metabolic Adjustment in Elderly Patients with Type 2 Diabetes Taking a Hypoglycemic Agent / 임상당뇨병

BACKGROUND: This study aimed to investigate the goal attainment rates for hemoglobin A1c (HbA1c), blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C) in elderly patients with type 2 diabetes. METHODS: The subjects were 762 over 65 years old patients with type 2 diabetes taking a hypoglycemic agent. Data were collected by reviewing medical records and included general characteristics, biochemical tests, prescribed pharmacologic agents, and complications. RESULTS: The goal attainment rates (mean value) for HbA1c, BP, and LDL-C were 50.4% (7.3% ± 1.2%), 78.9% (126.0 ± 15.1/72.1 ± 10.0 mm Hg), and 60.6% (88.6 ± 29.9 mg/dL). Diabetes-related complications for retinopathy, nephropathy, neuropathy, and cardio-cerebral vascular disease were 36.3%, 37.2%, 23.6%, and 31.9%, respectively. Life habit-related variables positively associated with goal attainment were not drinking alcohol and exercise for HbA1c, not smoking for BP and not drinking alcohol for LDL-C. Metabolic adjustment indicator-related significant variables for complications were HbA1c in retinopathy, BP in nephropathy, and LDL-C in cardio-cerebral disease. CONCLUSION: We found that goal attainment rates for parameters of metabolic adjustment were not high in elderly patients with type 2 diabetes. Thus, diabetes educators should be concerned about metabolic adjustment indicators. Also, case management guidelines according to elderly patient health and functional status should be developed to help manage metabolic adjustment.

Management of Elderly Diabetes Patients Who Are Unable to Self-Care / 임상당뇨병

Modern medical advances have led to an aging society with longer life expectancy, and now the health awareness of the elderly is increasing, presuming an average age of 100 years. The elderly present with various clinical symptoms, delirium, falls, senility, dizziness, syncope, and urinary incontinence, which are defined as elderly syndromes not distinguished by separate diseases. In addition, 91% of people aged 65 or older have chronic diseases, 31.9% of which are limited by one or more of the six basic activities of daily living, while 3.5% do not perform their basic activities of daily living. In particular, the diabetes prevalence rate in the elderly has been reported to be around 30%, and since older adults with diabetes have a number of disturbing factors that cannot be self-controlled, we want to analyze them and consider alternative measures. The medical, social, mental, and functional approaches to diabetes assessment of patients inform the development of individualized treatments. Diabetes patients believe that personal and social efforts are very necessary to improve their quality of life and restore their physical and social functions through adequate self-care.

Current Status of Management in Type 2 Diabetes Mellitus at General Hospitals in South Korea

BACKGROUND: In Korea, the prevalence, complications, and mortality rate of diabetes are rapidly increasing. However, investigations on the actual condition of diabetes management are very limited due to lack of nation-wide research or multicenter study. Hence, we have minutely inquired the current status of diabetes management and achievement of glucose target goal in general hospital offering education program. That way, we are able to furnish data for policy making of diabetes education and draw up guideline which may allow us to reduce the morbidity and mortality of diabetes. METHODS: The subjects consisted of 2,610 patients with type 2 diabetes who visited the 13 general hospital in Seoul or Gyeonggi region from March 19 to May 29, 2013. General characteristics, associated diseases, complications, and management status were investigated. RESULTS: The mean age was 61.0+/-11.6 years, body mass index was 25.0+/-3.3 kg/m2, and family history of diabetes was 50.5%. The mean duration of diabetes was 10.7+/-7.9 years and 53% received education about diabetes. The prevalence of hypertension and dyslipidemia were 59.2% and 65.5%, respectively, and 18.3% of the subjects were accompanied by liver disease. Diabetic retinopathy appeared in 31.6%, nephropathy in 28.1%, and neuropathy in 19.9% of the subjects. The mean glycosylated hemoglobin (HbA1c) level was 7.3%+/-1.3% and the achieving rate based on Korean Diabetes Association guideline (HbA1c <6.5%) was 24.8%, blood pressure (130/80 mm Hg or less) was 49.4%, and low density lipoprotein cholesterol (<100 mg/dL) was 63.6%. The reaching rate to the target level in four parameters (blood glucose, blood pressure, lipids, and body weight) was 7.8%. CONCLUSION: The blood glucose control rate was lower than other parameters, and the implementation rate of diabetes education was only 53%. Thus more appropriate glucose control and systematic diabetes education are imperative.

The Association of Hyperinsulinemia with Other Cardiovascular Risk Factors / 한국역학회지

BACKGROUND: Hypertension, obesity, non-insulin dependent diabetes(NIDDM), and dyslipidemia are common metaolic disorders that afflict the majority of the elderly who live in Westernized societies. To explore whether the hyperinsulinemia associated with other cardiovascular risk factors in Asian populations such as Koreans. METHODS: In this cross-sectional study we evaluated the association of hyperinsulinemia with hypertension, obesity, diabetes and hyperlipidemia. Subjects were 600 men and 396 women at least 20 years old who visited the prevention center at St. Mary's Hospital in Seoul, between March and August 1997 for a multiphasic health examination. RESULTS: In hyperinsulinemia group( >90 percentile of fasting blood insulin 10.01uU/ml in men and 8.54 uU/mlin women), body mass index(BMI), fasting blood sugar, and triglyceride and systolic or diastolic blood pressure were significantly higher than normal insulin goup in both of men and women. The major contributable risk factor to blood insulin concentration was BMI(14% in men, 13% in women). In person with the highest tertile of insulin concentration compared with those in the lowest tertile, age adjusted odds ratio of hypertension, obesity, and hypertriglyceride were 2.22(95% Confidence Interval: 1.38-3.63), 6.96(4.31-11.51), and 4.05(1.88-9.75) in men, and 2.05(95% CI: 1.10-3.86), 4.34(2.39-8.16) and 6.84(1.18-129.40) in women. Age adjusted odds ratio for clusterin of cardiovascular risk factors in the higest tertile of insulin compared with those in lower insulin than that level were 8.74(2.82-29.27) in men and 4.91(1.19-21.79) in women. CONCLUSION: The hyperinsulinemia was associated with hypertension, obesity, NIDDM and hypertriglyceridemia. Further prospective studies are required to investigate the effects of intervetion to improve insulin sensitivity such as calorie restriction and exercise.