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1.
Diabet Med ; 40(8): e15088, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36929728

RESUMO

Older adults with diabetes may carry a substantial health burden in Western ageing societies, occupy more than one in four beds in care homes, and are a highly vulnerable group who often require complex nursing and medical care. The global pandemic (COVID-19) had its epicentre in care homes and revealed many shortfalls in diabetes care resulting in hospital admissions and considerable mortality and comorbid illness. The purpose of this work was to develop a national Strategic Document of Diabetes Care for Care Homes which would bring about worthwhile, sustainable and effective quality diabetes care improvements, and address the shortfalls in care provided. A large diverse and multidisciplinary group of stakeholders (NAPCHD) defined 11 areas of interest where recommendations were needed and using a subgroup allocation approach were set tasks to produce a set of primary recommendations. Each subgroup was given 5 starter questions to begin their work and a format to provide responses. During the initial phase, 16 key findings were identified. Overall, after a period of 18 months, 49 primary recommendations were made, and 7 major conclusions were drawn from these. A model of community and integrated diabetes care for care home residents with diabetes was proposed, and a series of 5 'quick-wins' were created to begin implementation of some of the recommendations that would not require significant funding. The work of the NAPCHD is ongoing but we hope that this current resource will help leaders to make these required changes happen.


Assuntos
COVID-19 , Diabetes Mellitus , Humanos , Idoso , COVID-19/epidemiologia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Envelhecimento , Comorbidade
2.
Diabet Med ; 37(7): 1090-1093, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32369634

RESUMO

The National Diabetes Stakeholders Covid-19 Response Group was formed in early April 2020 as a rapid action by the Joint British Diabetes Societies for Inpatient Care, Diabetes UK, the Association of British Clinical Diabetologists, and Diabetes Frail to address and support the special needs of residents with diabetes in UK care homes during Covid-19. It was obvious that the care home sector was becoming a second wave of Covid-19 infection and that those with diabetes residing in care homes were at increased risk not only of susceptibility to infection but also to poorer outcomes. Its key purposes included minimising the morbidity and mortality associated with Covid-19 and assisting care staff to identify those residents with diabetes at highest risk of Covid-19 infection. The guidance was particularly created for care home managers, other care home staff, and specialist and non-specialist community nursing teams. The guidance covers the management of hyperglycaemia by discussion of various clinical scenarios that could arise, the management of hypoglycaemia, foot care and end of life care. In addition, it outlines the conditions where hospital admission is required. The guidance should be regarded as interim and will be updated as further medical and scientific evidence becomes available.


Assuntos
Infecções por Coronavirus/terapia , Atenção à Saúde/métodos , Diabetes Mellitus/terapia , Casas de Saúde , Pneumonia Viral/terapia , Betacoronavirus , COVID-19 , Comorbidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/metabolismo , Complicações do Diabetes/epidemiologia , Diabetes Mellitus/epidemiologia , Gerenciamento Clínico , Fragilidade , Glucocorticoides/uso terapêutico , Humanos , Expectativa de Vida , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/metabolismo , Fatores de Risco , SARS-CoV-2 , Reino Unido/epidemiologia
3.
Diabet Med ; 36(4): 399-413, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30411402

RESUMO

In our ageing society diabetes imposes a significant burden in terms of the numbers of people with the condition, diabetes-related complications including disability, and health and social care expenditure. Older people with diabetes can represent some of the more complex and difficult challenges facing the clinician working in different settings, and the recognition that we have only a relatively small (but increasing) evidence base to guide us in diabetes management is a limitation of our current approaches. Nevertheless, in this review we attempt to explore what evidence there is to guide us in a comprehensive scheme of treatment for older adults, often in a high-risk clinical state, in terms of glucose lowering, blood pressure and lipid management, frailty care and lifestyle interventions. We strive towards individualized care and make a call for action for more high-quality research using different trial designs.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Prática Clínica Baseada em Evidências , Serviços de Saúde para Idosos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Complicações do Diabetes/epidemiologia , Complicações do Diabetes/prevenção & controle , Diabetes Mellitus Tipo 2/epidemiologia , Prática Clínica Baseada em Evidências/normas , Serviços de Saúde para Idosos/normas , Humanos
4.
Curr Diab Rep ; 19(4): 15, 2019 02 26.
Artigo em Inglês | MEDLINE | ID: mdl-30806826

RESUMO

PURPOSE OF REVIEW: To highlight the central role of hypoglycaemia in the causation of cognitive frailty and explore ways of recognition and prevention of hypoglycaemia. RECENT FINDINGS: Cognitive frailty is an emerging new concept defined as the concomitant presence of physical frailty and cognitive impairment. In older people with diabetes, cognitive frailty is associated with an increased risk of mortality greater than from either physical frailty or cognitive impairment alone. Hypoglycaemia is directly associated with increased risk of cognitive impairment and physical frailty which are the two components of cognitive frailty. The incidence of hypoglycaemia in older people with diabetes is rising and hypoglycaemia-related hospitalisation has overtaken that of hyperglycaemia. Recognition of hypoglycaemic episodes in old age remains challenging which leads to misdiagnoses and under-reporting. Therefore, hypoglycaemia prevention strategies are needed. Research is still required to investigate whether prevention of hypoglycaemia would lead to a reduction in the incidence of cognitive frailty.


Assuntos
Disfunção Cognitiva/etiologia , Diabetes Mellitus Tipo 2/complicações , Fragilidade/etiologia , Hipoglicemia/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/prevenção & controle , Humanos , Hipoglicemia/diagnóstico , Hipoglicemia/etiologia
5.
Diabet Med ; 2018 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-29873423

RESUMO

In residential care homes and aged-care facilities globally, between one in three and one in four residents may have diabetes, an often complex highly co-morbid illness that leads to frailty, dependency, disability and reduced life expectancy. Residents with diabetes also have a high risk of hypoglycaemia, avoidable hospital admissions, and represent one of the most difficult challenges to health professionals and care staff in optimizing their diabetes and medical care. This detailed review examines the literature relating to care home diabetes over the last 25 years to assess what has been achieved in characterizing residents with diabetes, and what we know about the various but limited intervention studies that have been carried out internationally. The guidance and guidelines that have been published to assist clinicians in planning effective and safe care for this rather vulnerable group of people with diabetes are also reviewed. The review presents the first diagrammatic representation of a likely physiological cascade depicting the mainly irreversible functional decline a resident with diabetes might experience, provides modern principles of care for each resident with diabetes, and identifies what priority recommendations are required to be implemented if diabetes care is to improve. The review concludes that action is required since diabetes care still remains fragmented, sub-optimal, and in need of investment, otherwise care home residents with diabetes will continue to have their needs unfulfilled.

6.
J R Coll Physicians Edinb ; : 14782715241290309, 2024 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-39390814

RESUMO

Spontaneous vertebral artery dissection (VAD) is common after minor neck trauma or abrupt neck manipulation, which may result in stroke. However, violent cough is a less recognised cause of VAD. Only a few cases are reported in the literature. We review the literature and report a case of a 62-year-old man who presented with a headache and neck pain following a period of intermittent coughing, which led to VAD and a cerebellar ischaemic stroke. He responded well to medical treatment and made a full recovery. Therefore, VAD should be considered in the differential diagnosis for patients presenting with neck pain and headache after episodes of violent coughing.

7.
Hosp Pract (1995) ; 52(3): 113-118, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38758681

RESUMO

Myositis is a clinical condition with a wide spectrum of clinical presentation. We present the case of 33 years old woman with acute history of pain and swelling of both legs. Investigations confirmed acute bilateral myositis of both calf muscles. She responded well to conservative management with full recovery. Benign acute myositis is more common in children and usually follows viral infection. Although our case may represent an adult form of benign acute childhood myositis, she had no history of preceding infections. Benign acute myositis is increasingly reported in adults. It appears to be self-limited with spontaneous full recovery. The diagnosis is largely based on clinical features. Therefore, clinicians should be aware of this type of myositis to avoid unnecessary invasive investigations.


Assuntos
Miosite , Adulto , Feminino , Humanos , Doença Aguda , Diagnóstico Diferencial , Perna (Membro) , Miosite/diagnóstico , Miosite/terapia
8.
J Diabetes Complications ; 36(4): 108144, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35151546

RESUMO

BACKGROUND: Dysglycaemia (hyperglycaemia and hypoglycaemia) increase the risk of frailty in older people with diabetes, which appears contradictory. However, the characteristics of patients included in these studies are different and may reflect different metabolic phenotypes of frailty that may explain this apparent contradiction. AIMS: To review the characteristics of frail patients included in clinical studies that reported an association between dysglycaemia and frailty in order to explore whether there is any metabolic differences in the profile of these patients. METHODS: A systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Key words around older people, type 2 diabetes mellitus, frailty, hyperglycaemia and low glycaemia were used in the literature search. RESULTS: Only 8 studies met the inclusion criteria. Four studies investigated the risk of frailty associated with low glycaemia. Two studies showed that hypoglycaemia increased the risk of frailty by 44% (HR 1.60, 95% CI 1.14 to 2.42) and predicted greater level of dependency (p < 0.001), respectively. The other two studies reported that HbA1c inversely correlated with clinical frailty scale (r = -0.31, p < 0.01) and HbA1c < 6.0% was associated with increased risk of disability (3.45, 1.02 to 11.6), respectively. Compared with non-frail patients, those with frailty tended to have lower body weight or body mass index (BMI), have features of malnutrition such as low serum albumin or low total cholesterol and suffer from more comorbidities including dementia. Four studies explored the association of high glycaemia with frailty. Higher HbA1c predicted frailty (OR 1.43, 95% CI 1.045 to 1.97) and positively correlated with Edmonton frail score (r = 0.44, p < 0.001), respectively in two studies. The other two studies found that subjects with HbA1c ≥ 6.5% had the greatest prevalence of frailty (70.3%) and subjects with higher HbA1c at baseline to have a higher frailty level throughout later life, respectively. Compared with non-frail patients, those with frailty tended to have higher body weight, waist circumference and BMI. They also have less physical activity, higher cholesterol level and have more comorbidities. CONCLUSIONS: Dysglycaemia increases the risk of frailty but the characteristics of patients in these studies suggest different metabolic phenotypes of frailty. Therefore, these metabolic differences in frailty should be taken into consideration in the management of older people with diabetes.


Assuntos
Diabetes Mellitus Tipo 2 , Fragilidade , Hiperglicemia , Hipoglicemia , Idoso , Peso Corporal , Colesterol , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Idoso Fragilizado , Fragilidade/complicações , Fragilidade/epidemiologia , Hemoglobinas Glicadas , Humanos , Hiperglicemia/epidemiologia , Hipoglicemia/epidemiologia , Fenótipo
10.
Diabetes Res Clin Pract ; 181: 109085, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34634389

RESUMO

AIMS: To explore risk of frailty and functional decline associated with low glycaemia in older people with type 2 diabetes. METHODS: Systematic review. RESULTS: 11 studies included. Six studies investigated risk of frailty or physical decline with hypoglycaemia. Hypoglycaemia increased risk of incident frailty (HR 1.60, 95% CI 1.14 to 2.42) in one study and risk of fractures in four studies (2.24, 1.56 to 3.21, 1.24, 1.13 to 1.37, 1.94, 1.67 to 2.24 and 1.71, 1.35 to 2.16 respectively). In sixth study, hypoglycaemia associated with dependency (P < 0.001). Five studies explored association of low blood glucose/HbA1c with frailty. One study showed that mean blood glucose decreased with increasing frailty (p = 0.003). Two studies reported that HbA1c inversely correlated with clinical frailty scale (r = -0.31, p < 0.01) and HbA1c < 6.9% increased risk of frailty (HR, 1.41 95% CI 1.12 to 1.78) respectively. Last two studies showed that HbA1c < 6.5% associated with risk of any fracture (HR 1.08, 95% CI 1.06 to 1.11) and HbA1c < 6.0% associated with increased risk of care need (3.45, 1.02 to 11.6) respectively. CONCLUSIONS: Low glycaemia increases risk of frailty and functional decline in older people with type 2 diabetes. Management should minimise incidence of low glycaemia in these patients.


Assuntos
Diabetes Mellitus Tipo 2 , Fragilidade , Hipoglicemia , Idoso , Glicemia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Fragilidade/epidemiologia , Humanos , Hipoglicemia/epidemiologia , Hipoglicemiantes , Incidência
11.
Diabetes Res Clin Pract ; 169: 108438, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32920102

RESUMO

Frail older people are largely excluded from clinical trials and therefore glycaemic targets and optimum hypoglycaemic therapy in this group has not been fully investigated. Guidelines generally recommend tight glycaemic control in functionally fit individuals and relaxed targets in frail ones mainly due to the fear of hypoglycaemia. The newly introduced sodium glucose cotransporter-2 inhibitors and the glucagon like peptide-1 receptor agonists have shown benefit that is independent of glycaemic control and a minimal risk of hypoglycaemia. However, guidelines still express caution about its use in frail older people due to fear of other side effects such as weight loss, hypotension and falls. Some frail older people will miss out on the benefits of this new therapy if frailty is considered as a one entity with a blanket application of guidelines. We propose that frailty should be viewed as two distinct metabolically different phenotypes, the sarcopenic-obese, in which new therapy will improve their metabolic profile and should be liberally used if no contraindications, and the anorexic-malnourished phenotype in which the new therapy should be cautiously considered. In other words, glycaemic targets should be driven by individual's overall function but the use of new therapy should be driven by frailty phenotype.


Assuntos
Glicemia/metabolismo , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemia/terapia , Idoso , Idoso de 80 Anos ou mais , Idoso Fragilizado , Estado Funcional , Humanos , Masculino , Fenótipo
12.
Diabetes Res Clin Pract ; 161: 108065, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32044347

RESUMO

Frailty is emerging as a new category complication of diabetes in older people. Clinically, frailty is still not well defined and mostly viewed as a decline in solely the physical domain. However, frailty is a multidimensional syndrome and the newly introduced concept of "triad of impairment" (physical, cognitive and emotional) may be a more representative of the broad nature of frailty. The components of the triad of impairment (TOI) commonly coexist and demonstrate a reciprocal relation. Diabetes in old age appears to increase the risk of the triad of impairment, which may eventually progress to disability. Therefore, older people with diabetes should be regularly assessed for the presence of these three key components. Adequate nutrition and regular resistance exercise training have been shown to have a positive impact on the long-term outcome in this population. However, the role of good glycaemic control and the use of current hypoglycaemic medications in reducing the incidence of this triad are less clear. Future research is needed to develop novel hypoglycaemic medications that not only focus on glycaemic control and cardiovascular safety but also on reducing the risk of the triad of impairment.


Assuntos
Demência/epidemiologia , Depressão/epidemiologia , Diabetes Mellitus/epidemiologia , Fragilidade/complicações , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino
13.
SN Compr Clin Med ; 2(8): 1218-1222, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32838171

RESUMO

The COVID-19 pandemic initially started in China then spread to Europe. It is not known whether COVID-19 affects patients differently across the two continents. We aimed to describe our cohort of patients admitted to a single British centre with COVID-19 in comparison to a Chinese cohort of similar size and admitted over a similar time period to Chinese centres. We present a comparison of 62 Chinese and 71 British cases hospitalised for COVID-19. Cases in both sites were confirmed by a positive RT-PCR of nasopharyngeal swabs. Comparison analysis highlighted some differences between both populations. The most striking difference is the significantly older age of the British population (72% of the British ≥ 66 years compared to only 3% of the Chinese patients, difference of 69%, 95% confidence interval (CI) 68.3% to 69.7%, respectively) and the associated significant premorbid conditions (85% of patients vs 32%, difference of 53%, 95% CI 52 to 54%, respectively). Gastrointestinal and general symptoms were more common clinical presentation in the British while respiratory symptoms were more prominent in the Chinese cohort. Mortality was significantly higher in the British cohort 14% compared to none in the Chinese cohort (difference of 14%, 95% CI 13.7 to 14.3%). We conclude that COVID-19 does present differently in these two cohorts, but the apparent differences in the clinical presentations could be explained by the inherent differences in the demographics and case mix between both countries.

14.
Diabetes Res Clin Pract ; 169: 108460, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32971153

RESUMO

OBJECTIVES: Diabetes has been shown to be a risk factor for corona virus disease-2019 (COVID-19) infection. The characteristics of patients with diabetes vulnerable to this infection are less specified. We aim to present the characteristics of patients with diabetes admitted to hospital with COVID-19. DESIGN: A retrospective case series. SETTING: A single clinical centre in the UK. METHODS: We have retrospectively collected the demographics, medical characteristics and outcome of all patients with diabetes admitted to hospital over two-week period with COVID-19 infection. All cases were diagnosed by a reverse transcription polymerase chain reaction (RT-PCR) of pharyngeal and nasal swabs. RESULTS: A total of 71 COVID-19 patients were admitted during the study period of whom 16 (22.5%) patients had diabetes and were included in this case series. There was no significant difference between patients with compared to those without diabetes regarding age, gender or clinical presentation. However, comorbidities were more common in patients with diabetes specially hypertension {75% v 36.4%, a difference of 38.6%, 95% confidence interval (CI) 6.5-58.3} and chronic kidney disease (37.5 v 5.5, a difference of 32% (1.6-51.6). Patients with diabetes were significantly more obese than those without diabetes (56.2% v 21.8% a difference of 34.4%, 95% CI 7.7-61.1). About one third (31.3%) of patients with diabetes were frail. Mean {standard deviation (SD)} duration of diabetes was 10 (2.8) years and mean (SD) HbA1c was 60.3 (15.6) mmol/mol. The use of angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) and non-steroidal anti-inflammatory drugs (NSAIDs) was common (37.5%, 25% and 18.8% respectively). There was no significant difference in the outcomes between patients with compared to those without diabetes. CONCLUSION: Patients with diabetes hospitalised for COVID-19 were significantly more obese and had high prevalence of comorbidities than those without diabetes. Other features of patients with diabetes and COVID-19 infection included long duration of diabetes, less tight glycaemic control and common use of ACE inhibitors, ARBs and NSAIDs.


Assuntos
COVID-19/complicações , Diabetes Mellitus/epidemiologia , Hospitalização/estatística & dados numéricos , Hipertensão/epidemiologia , SARS-CoV-2/isolamento & purificação , Adulto , Idoso , Idoso de 80 Anos ou mais , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , COVID-19/virologia , Estudos de Casos e Controles , Comorbidade , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/virologia , Feminino , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/virologia , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco
16.
J Diabetes Complications ; 32(4): 444-450, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29274807

RESUMO

IMPORTANCE: Intensive treatment of older people with diabetes is common placing them at increased risk of adverse events such as hypoglycaemia and hospitalisation for drug errors. Little is known about when, how or for whom to deintensify hypoglycaemic medications. OBJECTIVE: To explore the characteristics of patients for whom deintensification is appropriate and to determine the outcome of deintensification. EVIDENCE REVIEW: Medline, Google scholar and EmBase search from 1997 to present was performed using keywords relating to diabetes mellitus, polypharmacy, hypoglycaemia, hospitalisation, deintensification, deprescribing and reduction, simplification or withdrawal of hypoglycaemic medications. Only English language articles were selected. Articles were reviewed for relevance by abstract. A manual review of citations in retrieved articles was performed in addition to the electronic literature search. FINDINGS: Those who are over treated appear to be of older age group, frail with weight loss and have multiple medical morbidities especially renal impairment and dementia. Simplification, reduction or even complete withdrawal of hypoglycaemic medications in these patients appears to be feasible without deterioration of glycaemic control. CONCLUSIONS: Over treatment is common in frail older people with multiple comorbidities and deintensification appears safe in this group of patients. Current recommendations emphasise preventing underuse rather than overuse of medications, and therefore, a change in guidelines advice may be warranted.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemia/prevenção & controle , Hipoglicemiantes/administração & dosagem , Uso Excessivo dos Serviços de Saúde/prevenção & controle , Guias de Prática Clínica como Assunto/normas , Fatores Etários , Glicemia/análise , Diabetes Mellitus Tipo 2/sangue , Hemoglobinas Glicadas/análise , Humanos , Hipoglicemia/sangue , Hipoglicemia/induzido quimicamente , Hipoglicemiantes/efeitos adversos , Hipoglicemiantes/uso terapêutico
17.
Top Stroke Rehabil ; 25(3): 214-223, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29105583

RESUMO

Introduction Stroke-associated pneumonia (SAP) is common, however, data on the economic impact of SAP are scarce. This study aimed to prospectively evaluate the impact of SAP on acute stroke care costs in a UK setting. Methods Prospective cohort study of 213 consecutive patients with stroke (196 ischemic, 17 hemorrhagic) was admitted to a UK hospital over 1 year. Socio demographic and clinical characteristics were recorded along with all treatments and rehabilitation activity. Patients were classified as having SAP if they fulfilled criteria for "probable" or "definite" respiratory tract infection according to the Centres for Disease Control and Prevention definition, within the first seven days following stroke. Resource use was calculated using a "bottom up" approach of cumulative unit costs. Univariate and multivariate regression analyses were used to establish independent predictors of direct costs. Results Probable or definite SAP occurred in 13.2% (28/213) of patients. Patients with SAP experienced greater inpatient stays (31 days vs. 9 days, p ≤ 0.001) and higher in-hospital mortality (29.2% vs. 10.2%, p = 0.007). Mean (SD) acute care costs per patient was £7035 (6767), but costs were significantly greater for patients with SAP than without [£14,371 (9484) versus £6,103 (5,735); p ≤ 0.001]. SAP was an independent predictor of costs along with increasing stroke severity (NIHSS) and age. Occurrence of SAP resulted in an adjusted incremental additional cost of £5817 (95% CI 4945-6689; p = 0.001) per patient. Conclusions SAP increased acute care costs for stroke by approximately 80%. This provides further impetus for research aimed at reducing SAP, and will inform cost-effectiveness analyses of potential therapeutic strategies.


Assuntos
Hospitalização/economia , Pneumonia , Acidente Vascular Cerebral , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia/economia , Pneumonia/etiologia , Pneumonia/terapia , Estudos Prospectivos , Índice de Gravidade de Doença , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/economia , Acidente Vascular Cerebral/terapia , Reino Unido
18.
J Frailty Aging ; 7(1): 10-20, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29412437

RESUMO

AIM: The International Position Statement provides the opportunity to summarise all existing clinical trial and best practice evidence for older people with frailty and diabetes. It is the first document of its kind and is intended to support clinical decisions that will enhance safety in management and promote high quality care. METHODS: The Review Group sought evidence from a wide range of studies that provide sufficient confidence (in the absence of grading) for the basis of each recommendation. This was supported by a given rationale and key references for our recommendations in each section, all of which have been reviewed by leading international experts. Searches for any relevant clinical evidence were generally limited to English language citations over the previous 15 years. The following databases were examined: Embase, Medline/PubMed, Cochrane Trials Register, Cinahl, and Science Citation. Hand searching of 16 key major peer-reviewed journals was undertaken by two reviewers (AJS and AA) and these included Lancet, Diabetes, Diabetologia, Diabetes Care, British Medical Journal, New England Journal of Medicine, Journal of the American Medical Association, Journal of Frailty and Aging, Journal of the American Medical Directors Association, and Journals of Gerontology - Series A Biological Sciences and Medical Sciences. RESULTS: Two scientific supporting statements have been provided that relate to the area of frailty and diabetes; this is accompanied by evidence-based decisions in 9 clinical domains. The Summary has been supported by diagrammatic figures and a table relating to the inter-relations between frailty and diabetes, a frailty assessment pathway, an exercise-based programme of intervention, a glucose-lowering algorithm with a description of available therapies. CONCLUSIONS: We have provided an up to date evidence-based approach to practical decision-making for older adults with frailty and diabetes. This Summary document includes a user-friendly set of recommendations that should be considered for implementation in primary, community-based and secondary care settings.


Assuntos
Diabetes Mellitus/prevenção & controle , Gerenciamento Clínico , Idoso Fragilizado , Serviços de Saúde para Idosos , Idoso , Idoso de 80 Anos ou mais , Consenso , Medicina Baseada em Evidências , Humanos
19.
J Frailty Aging ; 5(3): 162-7, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-29239594

RESUMO

Ageing is associated with hyperglycaemic tendency due to the change in body composition leading to accumulation of visceral fat and increased insulin resistance on the one hand and reduced insulin secretion due to decreased number and function of the ß-cells of the pancreas on the other. However, with the emergence of frailty there may be a tendency towards normoglycaemia or even hypoglycaemia due to malnutrition, weight loss and reduced physiologic reserve. This shift in glucose metabolism induced by frailty may change the natural history of type 2 diabetes from a progressive to a regressive course. Studies which showed increased risk of mortality with low HbA1c included frail patients in the lower HbA1c categories and healthier patients in the higher HbA1c categories suggesting that frailty is a possible confounding factor. Therefore, hypoglycemia may be a prognostic tool to identify vulnerable patients who may be at increased risk of mortality. The metabolic changes of insulin/glucose dynamics associated with frailty need further research.


Assuntos
Envelhecimento/fisiologia , Diabetes Mellitus Tipo 2/fisiopatologia , Idoso Fragilizado , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Glicemia/metabolismo , Composição Corporal , Diabetes Mellitus Tipo 2/mortalidade , Humanos , Resistência à Insulina , Fatores de Risco
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