RESUMO
BACKGROUND: This study investigated the characteristics associated with an increased risk of hypoglycemia, in elderly patients with type 1 diabetes mellitus (T1D) using automated insulin delivery (AID) systems. METHODS: Cross-sectional observational study including patients >60 years, using sensor-augmented insulin pump therapy with predictive low-glucose management (SAPT-PLGM), hybrid closed-loop (HCL), and advanced hybrid closed-loop (AHCL), for more than three months. A geriatric assessment was performed, and body composition was determined to investigate its association with achieving time below range (TBR) <70 mg/dL goals. RESULTS: The study included 59 patients (47.5% of men, mean age of 67.6 years, glycated hemoglobin [HbA1c] of 7.5 ± 0.6%, time in range (TIR) 77.8 ± 9.9%). Time below range <70 and <54 mg/dL were 2.2 ± 2.3% and 0.4 ± 0.81%, respectively. Patients with elevated TBR <70 mg/dL (>1%) had higher HbA1c levels, lower TIR, elevated time above range (TAR), and high glycemic variability. Regarding body composition, greater muscle mass, grip strength, and visceral fat were associated with a lower TBR <70 mg/dL. These factors were independent of the type of technology used, but TIR was higher when using AHCL systems compared with SAPT-PLGM and HCL systems. CONCLUSIONS: In elderly patients treated with AID systems with good functional status, lower lean mass, lower grip strength, and lower visceral fat percentage were associated with TBR greater than 1%, regardless of the device used. A similar finding along was found with CGM indicators such as higher HbA1c levels, lower TIR, higher TAR, and higher CV. Geriatric assessment is crucial for personalizing patient management.
RESUMO
BACKGROUND: In dementia, functional status depends on multiple factors in addition to cognition. Nutritional status is a potentially modifiable factor related to homeostasis and proper functioning of body systems and may contribute to cognitive and functional decline. OBJECTIVE: This paper aims to analyze the association of malnutrition with the course of cognitive and functional decline in people living with dementia. METHODS: This is an analysis of a longitudinal cohort study, the Dementia Study of Western Norway. Data of 202 patients diagnosed with mild dementia were analyzed; Alzheimer's disease (AD) (nâ=â103), Lewy body dementia (LBD) (nâ=â74), and other dementias (OD) (nâ=â25). Cognition was assessed with the Mini-Mental State Examination and functional decline through the activities of daily living included in the Rapid Disability Rating Scale. The Global Leadership Initiative on Malnutrition Index was used to determine nutritional status. Associations of nutritional status with cognitive and functional decline were evaluated through adjusted linear mixed models. RESULTS: At baseline, the prevalence of general malnutrition was 28.7%; 17.3% were classified as moderate malnutrition and 11.38% as severe malnutrition (there were no significant differences between AD and LBD). Malnutrition at diagnosis and over follow-up was a significant predictor of functional-decline, but not of cognitive decline. CONCLUSION: According to our results malnutrition was associated with faster functional loss but, not cognitive decline in older adults with dementia. A more comprehensive dementia approach including nutritional assessments could improve prognosis.
Assuntos
Disfunção Cognitiva/epidemiologia , Demência/complicações , Estado Funcional , Desnutrição/complicações , Desnutrição/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Noruega , PrevalênciaRESUMO
Hyponatraemia is the most common electrolyte disturbance in the elderly. It can be asymptomatic or produce a spectrum of symptoms, particularly in the central nervous system, such as altered state of consciousness, lethargy, headache, seizures and gait disturbances, all of which are a common reason for consultation in this population. This condition has a high impact on the functionality of the patient given the need for multiple hospital stays, as well as on mortality. Its aetiology is multifactorial and its most common causes include low salt intake, chronic diseases such as kidney disease and heart failure, and the syndrome of inappropriate antidiuretic hormone secretion (SIADH), which is commonly caused by the chronic use of certain drugs, such as antidepressants, diuretics and antipsychotics, which are the most forgotten in clinical practice. The following clinical case presents the diagnostic approach of hyponatraemia and the importance of the medical history as a key tool to detect the aetiology of this clinical entity.
Assuntos
Antipsicóticos/efeitos adversos , Hiponatremia/induzido quimicamente , Hiponatremia/diagnóstico , Fumarato de Quetiapina/efeitos adversos , Idoso de 80 Anos ou mais , Humanos , Masculino , AnamneseRESUMO
La hiponatremia es la alteración electrolítica más frecuente en el anciano y puede ser asintomática o producir un espectro de síntomas, especialmente del sistema nervioso central, tales como alteración del estado de conciencia, letargia, cefalea, convulsiones y alteraciones en la marcha, los cuales son un motivo frecuente de consulta de esta población. Esta entidad tiene un alto impacto en la funcionalidad del paciente, pues requiere múltiples hospitalizaciones, e incluso en mortalidad. Su etiología es multifactorial; entre sus causas más comunes están la baja ingesta de sal, las enfermedades crónicas como la nefropatía y la insuficiencia cardiaca y el síndrome de secreción inadecuada de hormona antidiurética (SIADH), que a su vez se produce comúnmente por el uso crónico de determinados fármacos, como los antidepresivos, los diuréticos y los antipsicóticos, que son los más olvidados en el abordaje clínico. Se presenta en este caso clínico el abordaje diagnóstico de la hiponatremia y la importancia de la anamnesis como instrumento clave para detectar la etiología de esta entidad clínica.
Hyponatraemia is the most common electrolyte disturbance in the elderly. It can be asymptomatic or produce a spectrum of symptoms, particularly in the central nervous system, such as altered state of consciousness, lethargy, headache, seizures and gait disturbances, all of which are a common reason for consultation in this population. This condition has a high impact on the functionality of the patient given the need formultiple hospital stays, as well as on mortality. Its aetiology ismultifactorial and its most common causes include low salt intake, chronic diseases such as kidney disease and heart failure, and the syndrome of inappropriate antidiuretic hormone secretion (SIADH), which is commonly caused by the chronic use of certain drugs, such as antidepressants, diuretics and antipsychotics, which are the most forgotten in clinical practice. The following clinical case presents the diagnostic approach of hyponatraemia and the importance of the medical history as a key tool to detect the aetiology of this clinical entity.
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We propose a set of qualitative indicators for monitoring practices of social appropriation of science and technology. The design of this set is based on the Maloka case, but it can be of use to multiple actors involved in the social appropriation of science and technology (referred to by its Spanish acronym, ASCyT). The introduction discusses the concept of ASCyT. The first section provides a review of the literature about measuring activities that link science and society. The second section explains why it is important to develop this type of measurement. The third section lays out the methodology used in designing the indicators. The fourth section explains the set of indicators and the fifth reflects on that process.
RESUMO
Resumen Se presenta una propuesta de indicadores cualitativos para hacer un seguimiento de las prácticas de apropiación social de la ciencia y la tecnología. La batería se diseñó a partir del caso de Maloka, pero puede ser de utilidad para múltiples actores que realizan ejercicios de ASCyT. La introducción presenta una discusión sobre el concepto de ASCyT. La primera sección muestra una revisión bibliográfica sobre la medición de actividades que vinculan ciencia y sociedad. La segunda explica por qué es importante el desarrollo de este tipo de mediciones. La tercera muestra la metodología seguida para el diseño de la batería. La cuarta explica la batería de indicadores y la quinta reflexiona sobre este proceso.
Abstract We propose a set of qualitative indicators for monitoring practices of social appropriation of science and technology. The design of this set is based on the Maloka case, but it can be of use to multiple actors involved in the social appropriation of science and technology (referred to by its Spanish acronym, ASCyT). The introduction discusses the concept of ASCyT. The first section provides a review of the literature about measuring activities that link science and society. The second section explains why it is important to develop this type of measurement. The third section lays out the methodology used in designing the indicators. The fourth section explains the set of indicators and the fifth reflects on that process.
