ABSTRACT
AIM: To compare clinical characteristics and outcomes in adults with type 1 diabetes aged ≥ 60 years using continuous subcutaneous insulin infusion (CSII) vs. insulin injection therapy. Further, to determine the percentage of older adults with type 1 diabetes using CSII. RESEARCH DESIGN AND METHODS: Retrospective study using data of the Diabetes Prospective Follow-up Registry (DPV). Including percentage CSII use from 2008 to 2018, and the characteristics of 9547 individuals extracted from the DPV in March 2019 (N = 1404 CSII; N = 8143 insulin injection therapy). Wilcoxon rank sum tests were used for continuous variables and chi-square tests for categorical variables to compare clinical characteristics of people using CSII vs. insulin injection therapy. Adjusted analyses used generalized linear models to compare diabetes-related outcomes. RESULTS: CSII usage has increased in older adults (from 12% in 2008 to 23% in 2018). After adjustment, CSII was associated with lower HbA1c [60.7 mmol/mol (7.7 ± 0.1%) vs. 62.8% (7.9 ± 0.1%)], lower daily insulin dose (0.49 ± 0.02 vs. 0.61 ± 0.01 IU/kg), fewer days in hospital (8.1 ± 0.12 vs. 11.2 ± 0.11 days/person-year), fewer severe hypoglycaemic events (0.16 ± 0.02 vs. 0.21 ± 0.03 events/person-year) and fewer diabetic ketoacidosis (0.06 ± 0.01 vs. 0.08 ± 0.01 events/person-year). Individuals on CSII showed lower rates of microalbuminuria and also have a diagnosis of depression and neuropathy. CONCLUSIONS: A growing number of older adults are using insulin pumps. Older age in itself should not be seen as a contraindication for CSII.
Subject(s)
Diabetes Mellitus, Type 1/drug therapy , Hypoglycemic Agents/administration & dosage , Infusion Pumps, Implantable , Injections, Subcutaneous , Insulin Infusion Systems , Insulin/administration & dosage , Age Factors , Aged , Aged, 80 and over , Albuminuria/epidemiology , Albuminuria/etiology , Depression/epidemiology , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/metabolism , Diabetic Neuropathies/epidemiology , Diabetic Neuropathies/etiology , Female , Glycated Hemoglobin/metabolism , Hospitalization/statistics & numerical data , Humans , Infusions, Subcutaneous , Male , Middle Aged , Registries , Sex FactorsSubject(s)
Bile Duct Neoplasms/diagnosis , Carcinoma, Hepatocellular/diagnosis , Cholangiopancreatography, Endoscopic Retrograde , Cholestasis, Extrahepatic/diagnosis , Gallstones/diagnosis , Hepatic Duct, Common , Liver Neoplasms/diagnosis , Ultrasonography , Aged, 80 and over , Cholestasis, Extrahepatic/therapy , Contrast Media/administration & dosage , Diabetes Mellitus, Type 2/complications , Diagnosis, Differential , Female , Gallstones/therapy , Hepatitis C, Chronic/complications , Humans , LithotripsyABSTRACT
A 56-year old man was admitted with a tumour-like lesion located in the retroperitoneal space with adherence to the left adrenal gland. An extensive diagnostic procedure could neither establish the diagnosis nor differentiate the lesion from the adrenal gland. After tumour biopsy by ultrasound surgery was recommended and performed and the final diagnosis--mature teratoma--was established. In this article we discuss the genesis and therapeutic possibilities of mature teratoma in adults.
