Metabolic control in insulin-treated type 2-diabetic patients aged over 80 years and without participation in a structured diabetic teaching program.

BACKGROUND: It is well-known that elderly patients with insulin therapy need an age-adapted diabetes teaching program (DTP). In this study we investigated how many newly insulinized type 2-diabetic patients aged over 80 years were not fit for a structured DTP and why. Moreover, we evaluated the vascular risk profile and the prevalence of vascular diseases in the patients with and without DTP. In addition, we compared the metabolic control after 3 months and the patient survival after 2 years in both patient groups. All type 2-diabetic patients aged 80 years and beyond, in whom insulin therapy was initiated in our hospital during the year 2000, were recruited for the study. PATIENTS AND METHODS: Patients who participated in DTP performed metabolic self-monitoring at home. In patients who were not fit for DTP, metabolic control and insulin therapy were performed by mobile nurses. The ability of patients to participate in DTP was judged by the diabetes teaching team (teaching doctor and nurse) at the start of insulin therapy. A total of 43 patients were included in the study; patients were separated into two groups, with and without DTP. We measured vascular risk factors, and compared the prevalence of vascular diseases. RESULTS: Twenty one (49%) of the newly insulin-treated type 2 diabetic patients > or = 80 years participated in the DTP, 22 patients (51%) did not due to impaired cognitive function (n = 19) and/or reduced compliance (n = 3). In both patient groups there was no difference between the mean HbA1c- and blood pressure values or cholesterol- and triglyceride levels. In addition, the prevalence of vascular complications and diabetic nephropathy was not significantly different in either group. Those diabetic patients who participated in DTP performed blood glucose measurements more frequently than the patients without DTP (1.3 +/- 0.5 versus 0.9 +/- 0.2 controls/day p < 0.05). The HbA1c-values after 3 months were 8.3 +/- 1.2 versus 8.1 +/- 1.2% (NS), the incidence of hypoglycemia was the same in both groups. The 2-year survival was 52 versus 48% (NS). CONCLUSION: Approximately 50% of newly insulin-treated type 2 diabetic patients aged over 80 years were suitable for participation in DTP. The prevalence of vascular risk profile and vascular diseases was the same in both groups. Blood glucose self-monitoring was performed more frequently in patients with DTP, but the quality of metabolic control was similar in patients with and without DTP. The 2-year survival rate was equally low in both groups.

Ankylosing spondylitis, psoriatic arthritis, and reactive arthritis show increased bone resorption, but differ with regard to bone formation.

OBJECTIVE: To test if markers of bone metabolism are altered in patients with seronegative spondyloarthropathies (SSpA). METHODS: We studied biochemical markers of bone resorption and bone formation, osteoprotegerin (OPG), and bone mineral density (BMD) in patients with psoriatic arthritis (PsA), ankylosing spondylitis (AS), and reactive arthritis (ReA) and healthy volunteers. RESULTS: The bone resorption markers urinary deoxypyridinoline and crosslinked telopeptide of collagen-I were significantly increased in patients with AS, PsA, and ReA; in PsA they correlated with the acute phase response (C-reactive protein and erythrocyte sedimentation rate). The bone formation markers were divergent: bone-specific alkaline phosphatase was increased in PsA, but not in AS or ReA. Osteocalcin levels were only elevated in AS. Serum levels of OPG were significantly increased in both AS and PsA. Dual energy x-ray absorptiometry (DEXA) measurements of lumbar spine and femoral neck revealed osteopenia in patients with AS, whereas the DEXA distribution was within normal range in PsA. CONCLUSION: Our data indicate high and, particularly in AS, unbalanced bone turnover in SSpA, consistent with the decrease in BMD found in patients with AS.