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      Diabetes in Older Adults: A Consensus Report

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          Most cited references118

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          Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.

          Type 2 diabetes affects approximately 8 percent of adults in the United States. Some risk factors--elevated plasma glucose concentrations in the fasting state and after an oral glucose load, overweight, and a sedentary lifestyle--are potentially reversible. We hypothesized that modifying these factors with a lifestyle-intervention program or the administration of metformin would prevent or delay the development of diabetes. We randomly assigned 3234 nondiabetic persons with elevated fasting and post-load plasma glucose concentrations to placebo, metformin (850 mg twice daily), or a lifestyle-modification program with the goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week. The mean age of the participants was 51 years, and the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 34.0; 68 percent were women, and 45 percent were members of minority groups. The average follow-up was 2.8 years. The incidence of diabetes was 11.0, 7.8, and 4.8 cases per 100 person-years in the placebo, metformin, and lifestyle groups, respectively. The lifestyle intervention reduced the incidence by 58 percent (95 percent confidence interval, 48 to 66 percent) and metformin by 31 percent (95 percent confidence interval, 17 to 43 percent), as compared with placebo; the lifestyle intervention was significantly more effective than metformin. To prevent one case of diabetes during a period of three years, 6.9 persons would have to participate in the lifestyle-intervention program, and 13.9 would have to receive metformin. Lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk. The lifestyle intervention was more effective than metformin.
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            Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33)

            (1998)
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              10-year follow-up of intensive glucose control in type 2 diabetes.

              During the United Kingdom Prospective Diabetes Study (UKPDS), patients with type 2 diabetes mellitus who received intensive glucose therapy had a lower risk of microvascular complications than did those receiving conventional dietary therapy. We conducted post-trial monitoring to determine whether this improved glucose control persisted and whether such therapy had a long-term effect on macrovascular outcomes. Of 5102 patients with newly diagnosed type 2 diabetes, 4209 were randomly assigned to receive either conventional therapy (dietary restriction) or intensive therapy (either sulfonylurea or insulin or, in overweight patients, metformin) for glucose control. In post-trial monitoring, 3277 patients were asked to attend annual UKPDS clinics for 5 years, but no attempts were made to maintain their previously assigned therapies. Annual questionnaires were used to follow patients who were unable to attend the clinics, and all patients in years 6 to 10 were assessed through questionnaires. We examined seven prespecified aggregate clinical outcomes from the UKPDS on an intention-to-treat basis, according to previous randomization categories. Between-group differences in glycated hemoglobin levels were lost after the first year. In the sulfonylurea-insulin group, relative reductions in risk persisted at 10 years for any diabetes-related end point (9%, P=0.04) and microvascular disease (24%, P=0.001), and risk reductions for myocardial infarction (15%, P=0.01) and death from any cause (13%, P=0.007) emerged over time, as more events occurred. In the metformin group, significant risk reductions persisted for any diabetes-related end point (21%, P=0.01), myocardial infarction (33%, P=0.005), and death from any cause (27%, P=0.002). Despite an early loss of glycemic differences, a continued reduction in microvascular risk and emergent risk reductions for myocardial infarction and death from any cause were observed during 10 years of post-trial follow-up. A continued benefit after metformin therapy was evident among overweight patients. (UKPDS 80; Current Controlled Trials number, ISRCTN75451837.) 2008 Massachusetts Medical Society
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                Author and article information

                Journal
                Journal of the American Geriatrics Society
                J Am Geriatr Soc
                Wiley
                00028614
                December 2012
                December 2012
                October 25 2012
                : 60
                : 12
                : 2342-2356
                Affiliations
                [1 ]Medical Affairs and Community Information; American Diabetes Association; Alexandria; Virginia
                [2 ]Department of Medicine; Vanderbilt University; Nashville; Tennessee
                [3 ]Diabetes Center of Cape Cod; Emerald Physicians; Hyannis; Massachusetts
                [4 ]Miami Veterans Affairs Healthcare System; Geriatric Research, Education and Clinical Center; University of Miami; Miami; Florida
                [5 ]Veterans Affairs Puget Sound Health Care System; Seattle; Washington
                [6 ]Division of Geriatric Medicine; University of Michigan; Ann Arbor; Michigan
                [7 ]Section of General Internal Medicine; The University of Chicago; Chicago; Illinois
                [8 ]Division of Endocrinology; University of Pittsburgh; Pittsburgh; Pennsylvania
                [9 ]Beth Israel Deaconess Medical Center and the Joslin Diabetes Center; Harvard Medical School; Boston; Massachusetts
                [10 ]Department of Pharmacy; University of Washington; Seattle; Washington
                [11 ]Florida Hospital Diabetes Institute; Orlando; Florida
                [12 ]Kadlec Medical Center; Richland; Washington
                Article
                10.1111/jgs.12035
                23106132
                c013eb71-64aa-454c-80a0-9590d8ffd949
                © 2012

                http://doi.wiley.com/10.1002/tdm_license_1.1

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