Are there associations between coffee consumption and glucose tolerance in elderly subjects?

OBJECTIVE: To describe the associations between coffee consumption and glucose tolerance among elderly subjects. DESIGN: A survey among an unselected non-institutionalized elderly population. Diabetes was assessed on the basis of self-reports and 2-h oral glucose tolerance test for the subjects on diet treatment or with normal glucose tolerance (NGT). Coffee consumption was assessed by a questionnaire. SETTING: Three municipalities in Northern Finland Subjects: All non-institutionalized subjects with baseline normal glucose tolerance or impaired glucose tolerance (IGT) aged 70 years or over. MAIN OUTCOME MEASURES: Incidence, persistence or impairment of abnormal glucose tolerance (AGT). RESULTS: Forty-two percent of those with NGT and 0-5 cups of coffee daily developed AGT, whereas the corresponding figure was 25% for those who drank more than five cups coffee daily. Fifty-five percent of the subjects with IGT or NGT who drank 0-5 cups coffee daily either persisted in IGT or developed AGT. The corresponding figure was 30% for those drinking more than five cups coffee daily. After adjustment for age, body mass index, cardiovascular disease, smoking, alcohol consumption and physical exercise, among those with NGT, the odds ratio (OR) for developing AGT was 2.3 for those drinking 0-5 cups compared to those drinking more than five cups of coffee daily (95% confidence interval (CI) 0.7-7.2). Correspondingly, low coffee consumption was the most powerful predictor associated with the persistence of IGT or the development of AGT (OR 2.9; 95% CI 1.2-6.9). CONCLUSIONS: Low coffee consumption predicts impairment of AGT or persistence of IGT among elderly subjects.

Are there associations between socio-economic status and known diabetes in an elderly Finnish population?

The aim of the study was to describe the associations between socio-economic status and type 2 diabetes in a non-institutionalised population aged 70 years or over. Diabetes was assessed on the basis of self-reports and additionally 2-h oral glucose tolerance test for the subjects on diet treatment. Socio-economic status was assessed by questions on marital status, number of residents in household, basic education, self-rated income and economic status. In the population of 379 subjects (141 men), 14% (n = 19) of men and 19% (n = 46) of women had known diabetes. Known diabetes was less common among married compared to unmarried, widowed or divorced subjects. Diabetes was also more common among men with higher compared to lower level of basic education, while a reverse trend was seen among women. Women, who had been engaged in manual labour, had diabetes more often compared to those engaged in administrative work. Diabetes was more common among men who rated their income as good, but the opposite was true of women. Higher income among men and lower income among women were the most powerful variables associated with known diabetes. Known diabetes was more common in elderly women with lower socio-economic status, whereas the opposite was true of men. This finding suggests that the impact of the socio-economic changes that have taken place in Finland in the 20th century on the risk factors for diabetes has been greater among men with higher and women with lower socio-economic status.

Does hyperglycaemia cause symptoms in elderly people?

The aim of the present study was to describe the associations between glucose tolerance and symptoms in an unselected non-institutionalised elderly population aged 73 years or over (n = 259, of whom 93 were men). Diabetes was assessed on the basis of self-reports and 2-h oral glucose tolerance tests (1985 WHO criteria). Symptoms were measured with a modified diabetes symptom checklist (DSC-Type 2). The previously diagnosed diabetic patients reported to have more symptoms in all the six dimensions of the symptom checklist than the other study groups. According to the responses to twenty out of 34 items, more of the previously diagnosed diabetic women had symptoms than the other female study groups; the corresponding figure for the previously diagnosed diabetic men being 16/34. The following hyperglycaemic symptoms: "dry mouth", "increasing fatigue in the course of the day", "numbness in the hands", were either weakly or significantly associated with undiagnosed diabetes. Men with IGT reported to have "dry mouth" and "tingling or pricking in the legs or feet" more often than men with NGT. Symptoms of "moodiness" increased along with the deterioration of glucose tolerance, and it seems that depression is associated with type 2 diabetes in elderly people, too. Although the study covered a wide range of symptoms, it did not clearly reveal such symptoms that could be used as potential indicators of undiagnosed diabetes or especially IGT among elderly patients.

Functional ability after hip fracture among patients home-dwelling at the time of fracture.

The aim of the study was to assess the change in function and residential status four months after hip fracture in patients over 50 years of age and living independently at home at the time of fracture. All consecutive hip fracture patients treated at Oulu University Hospital during 1989--1999 were followed up. Data collection was done on standardized hip fracture forms, which were filled in at admission and at four months postoperatively. The forms included demographic data, place of residence, locomotor ability, use of walking aids, data on the fracture and its treatment, hospital stay, place of discharge and pain. At four months, 16.0% of the men and 14.3% of the women were permanently institutionalized. Preoperatively, 81.1% of the patients had been able to walk out of doors either alone or accompanied, while at 4 months, less than half of the patients (149 men, 391 women) were able to do so. Two thirds of the hip fracture patients had been able to walk without walking aids before the fracture, the corresponding proportion being one fifth at four months after the fracture. Cumulative mortality at 4 months was 9.9%, being higher among the male (15.5%, n=53) than the female patients (7.9%, n=75). The original study population was also divided into two subgroups operated at different period of time (1989--92 and 1993--99), the functional results seemed to improve with time. Hip fracture leads to the institutionalization of every seventh patient able to live at home at the time of fracture and impairs markedly one's functional capacity. To restore the pre-fracture status as well as possible and to reduce the burden of the consequences of hip fracture, it might be beneficial to evaluate and improve the existing rehabilitation system.

Glucose tolerance and cognitive impairment in an elderly population.

We investigated the associations between abnormal glucose tolerance and cognitive impairment in elderly subjects, taking into account some other known determinants of cognitive function. The study population consisted of community-living northern Finnish subjects aged 70 y or over (n=379, of whom were 141 men). Thirty-one percent of the men and women (n=43 for the men and n=75 for the women) scored 23 or less in the Mini Mental State Examination. A low level of basic education and high age were the most powerful predictors of impaired cognition. When adjusted for age, gender, educational level, presence of cardiovascular disease (or hypertension), use of alcohol, number of depressive symptoms and poor vision, abnormal glucose tolerance (including IGT) was also weakly associated with impaired cognitive function among these elderly subjects.

Does glucose tolerance affect elderly persons' balance, gait or muscle strength?

The aim of this study was to find out if there are associations between the deterioration of glucose tolerance and balance, gait or muscle strength among non-institutionalised northern Finnish subjects aged 70 years or over. 79% of the eligible 483 subjects participated in the study (n = 379; of whom 141 were men). 14 % (n = 19) of the men had previously diagnosed diabetes, 9% had undiagnosed diabetes, and 32% had impaired glucose tolerance (IGT). The corresponding figures for the women were 19% (n = 46), 9% (n = 21) and 35% (n = 84). The proportion of the female subjects with good balance tended to decrease along with the deterioration of the glucose tolerance status and there was a trend that disturbances in gait (walking speed, step length among the women) increased along with the deterioration of glucose tolerance. A greater proportion of the previously diagnosed diabetic subjects had decreased thenar (p = 0.09), interosseus (p = 0.00), tibialis anterior (p = 0.003), tibialis posterior (p = 0.07) and peroneus (p = 0.03) muscle strength and decreased or missing biceps (p = 0.019) and quadriceps (p = 0.010) tendon reflexes. More of the subjects with abnormal glucose tolerance had weakening of the abdominal muscles compared to the persons with normal glucose tolerance (NGT) (p = 0.001). A greater proportion of the previously diagnosed diabetic subjects had abnormal vibration sense in the sternum compared to the subjects with NGT (p = 0.028) and the tendency was similar for undiagnosed diabetes. As a majority of the abnormal findings in this study were made among the previously diagnosed diabetic patients, the long duration of hyperglycemia probably contributes to the development of these disturbances. Therefore, early detection and active treatment of hyperglycemia might prevent or at least delay the development of signs of diabetic neuropathy among elderly subjects.

Effects of the WHO 1985 criteria and the proposed new diagnostic criteria on the prevalence of diabetes in an elderly population.

Population data suggest that a fasting blood glucose level of > or = 6.1 mmol/l corresponds best to a two-hour blood glucose level of > or = 11.1 mmol/l, which is associated with an increased risk of developing microvascular complications. The proposed new criteria, and the WHO 1985 criteria for diabetes, were applied in an elderly population, which underwent a two-hour oral glucose tolerance test. The prevalence of diabetes was higher when the proposed new criteria were used than when the old criteria were used. In calculating the prevalence of diabetes, the fasting blood glucose > or = 6.1 mmol/l corresponded better to the combination of fasting and/or two-hour values than did fasting blood glucose > or = 6.7 mmol/l. The prevalence obtained by using either of these fasting values alone or in combination with two-hour values corresponded poorly to that obtained by using mere two-hour blood glucose values.