Diabetes in Old Age THIRD EDITION " Alan J. Sinclair Primary Author mixed material bibliography India John Willey 2009 monographic en English

E-BOOK

ISBN 978-0-470-06562-4 Foreword xi Preface xv List of Contributors xvii SECTION I EPIDEMIOLOGY AND PATHOPHYSIOLOGY 1 Pathophysiology of Diabetes In The Elderly 3 Graydon S. Meneilly 1.1 Introduction 3 1.2 Diet and diabetes in the elderly 4 1.3 Other factors 5 1.4 Metabolic alterations 5 1.5 Molecular biology studies 8 1.6 Glucose counter-regulation 8 1.7 Conclusions 9 Acknowledgments 9 References 9 2 Diabetes-Related Risk Factors In Older People 13 Stephen Colagiuri and Daniel Davies 2.1 Introduction 13 2.2 Age 13 2.3 Impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) 14 2.4 Body weight 14 2.5 Ethnicity 14 2.6 Gestational diabetes mellitus (GDM) 14 2.7 Family history 14 2.8 Hypertension 15 2.9 Cardiovascular and cerebrovascular disease 15 2.10 Physical inactivity 15 2.11 Antipsychotic medication and Mental Illness 15 2.12 Sleep disorders 16 2.13 Smoking 16 2.14 Conclusions 16 References 16 SECTION II SCREENING AND DIAGNOSIS 3 Diabetes in the Elderly: Diagnosis, Testing and Screening 21 Simon Croxson 3.1 Introduction 21 3.2 Definition of diabetes in the elderly 21 3.3 Why detect diabetes? 23 3.4 The symptoms of diabetes 24 3.5 Glycosuria 25 3.6 Fasting plasma glucose and the modified oral glucose tolerance test 25 3.7 Random and postprandial plasma glucose 27 3.8 Blood glucose meters 28 3.9 Glycosylated haemoglobin 29 3.10 Fructosamine 30 3.11 Diabetes prediction calculators 31 3.12 Known diabetes 31 3.13 Types of diabetes 32 3.14 Metabolic syndrome 33 3.15 Future research 33 3.16 Conclusions 33 References 34 SECTIONIII VASCULAR COMPLICATIONS 4 Peripheral Arterial Disease in Old People with Diabetes 41 Leocadio Rodr´ıguez Ma ˜nas, Cristina Alonso Bouzon and Marta Castro Rodr ´ıguez 4.1 Introduction 41 4.2 Epidemiology of peripheral arterial disease 42 4.3 Pathophysiology 42 4.4 Clinical presentation 45 4.5 Diagnostic methods 46 4.6 Treatment 47 References 48 5 Coronary Heart Disease 51 Ahmed H. Abdelhafiz 5.1 Introduction 51 5.2 Effect of ageing and diabetes on the cardiovascular system 51 5.3 Epidemiology 53 5.4 Cardiovascular risks 53 5.5 Myocardial infarction 61 5.6 Heart failure 63 5.7 Anti-diabetic medications and CHD 64 5.8 Conclusions 66 References 66 6 Stroke and Diabetes 75 Janice E. O’Connell and Christopher S. Gray 6.1 Introduction 75 6.2 Diabetes, hyperglycaemia and stroke risk in older people 76 vi CONTENTS 6.3 Diabetes, post-stroke hyperglycaemia and prognosis after acute stroke 79 6.4 Diabetes, hyperglycaemia and acute stroke treatment 80 6.5 Stroke prevention in type 2 diabetes 84 6.6 Conclusions 87 References 88 7 Diabetes-Related Renal Disease in Older People 93 Latana A. Munang and John M. Starr 7.1 Introduction 93 7.2 Changes in the diabetic kidney 93 7.3 Screening for diabetic renal disease 94 7.4 Chronic kidney disease 95 7.5 Management of diabetic renal disease 95 7.6 Managing cardiovascular risk 97 7.7 Management of CKD and its complications 97 7.8 Conservative management of renal disease 98 7.9 Conclusions 99 References 100 8 Management of Eye Disease and Visual Loss 103 Nina Tumosa 8.1 Introduction 103 8.2 Risk factors 103 8.3 Management of diabetic retinopathy 104 8.4 Treatments of diabetic retinopathy 106 8.5 Conclusions 109 References 110 9 The Diabetic Foot 113 Andrew J. M. Boulton and Matthew J. Young 9.1 Introduction 113 9.2 Peripheral sensorimotor neuropathy 114 9.3 Autonomic neuropathy 116 9.4 Peripheral vascular disease 117 9.5 Limited joint mobility 118 9.6 Foot pressure abnormalities 118 9.7 Other risk factors 119 9.8 The classification of ulceration 120 9.9 The At-risk foot 120 9.10 Superficial ulcers: Wagner/UT Grade 1 121 9.11 Deep ulcers: Wagner/UT Grades 2 and 3 124 9.12 Localized gangrene: Wagner Grade 4 126 9.13 Extensive gangrene: Wagner Grade 5 129 9.14 The diabetic Charcot foot 129 9.15 Conclusions 131 References 131 10 Diabetic Neuropathy 137 Solomon Tesfaye 10.1 Introduction 137 10.2 Epidemiology 137 10.3 Classification of diabetic polyneuropathy 137 10.4 Diabetic peripheral neuropathy (DPN) 137 10.5 Asymmetrical neuropathies 140 10.6 Diabetic amyotrophy 140 10.7 Cranial mononeuropathies 141 10.8 Thoracoabdominal neuropathy 141 10.9 Pressure palsies 141 10.10 Pathogenesis of diabetic peripheral neuropathy 142 10.11 Autonomic neuropathy 142 10.12 Management of painful diabetic neuropathy 144 References 146 11 Erectile Dysfunction 149 Tam´as V ´arkonyi and Peter Kempler 11.1 Introduction 149 11.2 Erectile dysfunction: An observable marker of diabetes mellitus? 150 11.3 Risk factors of erectile dysfunction 150 11.4 Pathophysiology of ED in diabetes mellitus 151 11.5 Erectile dysfunction: A first sign of cardiovascular disease? 151 11.6 The artery size hypothesis: A macrovascular link between ED and CAD 152 11.7 Other causes of erectile dysfunction 152 11.8 Differentiation between organic and psychogenic erectile dysfunction 153 11.9 Treatment of erectile dysfunction in diabetic patients 153 11.10 Conclusions 158 References 158 SECTIONIV TREATMENT AND CARE ISSUES 12 Metabolic Risk Factors, Obesity and Cardiometabolic Syndrome 165 Raffaele Marfella and Giuseppe Paolisso 12.1 The definition of metabolic syndrome 165 12.2 Pathogenesis of the metabolic syndrome 167 12.3 Metabolic syndrome in older persons 168 12.4 Insulin resistance and dyslipidaemia 168 12.5 Insulin resistance and obesity 169 12.6 Insulin resistance and arterial hypertension 170 12.7 Potential components of the metabolic syndrome in the elderly 171 12.8 Therapeutic perspectives 173 12.9 Conclusions 176 References 176 13 Perspectives on Diabetes Care in Old Age: A Focus on Frailty 183 Andrej Zeyfang and Jeremy D. Walston 13.1 Introduction 183 13.2 The frailty syndrome and its biology 184 13.3 Frailty and diabetes in late life 184 13.4 The biology of late-life diabetes 185 13.5 Geriatric syndromes and diabetes 187 13.6 Approaches for improving care for frail, older diabetics 188 13.7 Drug therapy in the frail elderly 189 13.8 Summary 191 References 191 14 Metabolic Decompensation in the Elderly 195 Giuseppe Paolisso and Michelangela Barbieri 14.1 Introduction 195 CONTENTS vii 14.2 Hypoglycaemia 195 14.3 Diabetic ketoacidosis and hyperosmolar hyperglycaemic state in the elderly 198 14.4 Pathogenesis of DKA and HHS 199 14.5 Diagnosis of DKA and HHS 200 14.6 Treatment of DKA and HHS 201 14.7 Treatment-related complications 204 14.8 Conclusions 205 References 205 15 Nutritional Perspectives: Diabetes in Older People 209 Bego˜na Molina and Alan J. Sinclair 15.1 Introduction 209 15.2 Basis of nutritional support 210 15.3 Nutritional assessment 214 15.4 Energy intake: carbohydrates and fats 218 15.5 Nutritional oral supplements 223 15.6 Artificial nutrition 223 15.7 Enteral tube feeding [43, 69] 225 15.8 Parenteral nutrition [43, 69] 227 15.9 A specific nutrition support formula for elderly patients? 228 15.10 Ethical issues 228 15.11 Conclusions 229 References 229 16 Early Management of Type 2 Diabetes 233 Alan Sinclair 16.1 Introduction 233 16.2 Developing the case for high-quality diabetes care 234 16.3 Aims in the early management 235 16.4 Initial treatment 237 16.5 Establishing an individual diabetes care plan 241 16.6 Conclusions 242 References 242 17 Drug Therapy: Current and Emerging Agents for Hyperglycaemia 245 Joe M. Chehade and Arshag D. Mooradian 17.1 Introduction 245 17.2 Sulphonylureas 246 17.3 Biguanides 248 17.4 Alpha-glucosidase inhibitors 249 17.5 Thiazolidinediones 250 17.6 Meglitinides 251 17.7 Incretin mimetics and enhancers: Glucagon-like peptide-1 and dipeptidyl peptidase IV inhibitors 252 17.8 Amylin analogues 253 17.9 Insulin and insulin analogues 255 17.10 The choice of an anti-diabetic agent in elderly people 257 References 259 18 Insulin Therapy 265 Dennis Yue and Marg McGill 18.1 Introduction 265 18.2 What glycaemic threshold should trigger insulin therapy in the elderly? 266 18.3 Other indications for insulin therapy in the elderly 266 18.4 Some of special considerations of elderly people and insulin therapy 267 18.5 Glucose-lowering medications and the introduction of insulin therapy 268 18.6 Which insulin regimen should be used in the elderly? 269 18.7 Titrating the insulin dosage and monitoring progress 270 18.8 What should patients be told on the day they start insulin? 270 18.9 When should more complex insulin regimens be introduced? 271 18.10 Favourable outcomes 271 References 271 19 Treatment of Hypertension 273 Peter Fasching 19.1 Introduction 273 19.2 Risk assessment from observational studies 273 19.3 Target values for hypertension treatment in patients with diabetes 274 19.4 Available evidence from randomized controlled trials 275 19.5 Antihypertensive therapy as SECTION of a multifactorial intervention 278 19.6 Pharmacological therapy of hypertension in diabetes 278 References 278 20 Treatment of Dyslipidaemia 281 Peter Fasching 20.1 Introduction 281 20.2 Risk assessment and treatment targets 281 20.3 Available evidence from randomized controlled trials 282 20.4 Eligibility for lipid-lowering therapy 284 References 284 21 Hypoglycaemia 287 Vincent McAulay and Brian M. Frier 21.1 Introduction 287 21.2 Physiological responses to hypoglycaemia 288 21.3 Acquired hypoglycaemia syndromes in type 1 diabetes 290 21.4 Effects of age on physiological responses to hypoglycaemia 292 21.5 Effects of type 2 diabetes on responses to hypoglycaemia 294 21.6 Epidemiology of hypoglycaemia in elderly people with diabetes 296 21.7 Adverse effects of hypoglycaemia in the elderly 299 21.8 Risk factors for hypoglycaemia in the elderly 300 21.9 Treatment 302 21.10 Knowledge of symptoms 304 21.11 Prevention of hypoglycaemia 304 21.12 Summary and conclusions 305 References 305 viii CONTENTS 22 Diabetes in Care Homes 311 Alan Sinclair and Terry Aspray 22.1 Introduction 311 22.2 The United Kingdom as a model of care home reform 311 22.3 Epidemiology 312 22.4 Complications and comorbidity 313 22.5 Common management problems 314 22.6 Organization of diabetes care in residential settings 315 22.7 Sustaining effective diabetes care 321 22.8 Conclusions 322 References 322 23 Primary and Community Care of Diabetes in Older People 325 Roger Gadsby 23.1 Introduction 325 23.2 The shift of diabetes care from the hospital to the community 326 23.3 The primary care diabetes team 327 23.4 Routine care of people with diabetes by the primary care diabetes team 327 23.5 Which strategies to prevent CVD are appropriate for older people with diabetes? 328 23.6 Preventive health care in older people: Further debate 331 23.7 Delivering appropriate diabetes care 331 23.8 Problems of polypharmacy and medication concordance in older people with diabetes 333 23.9 Conclusions 334 References 334 24 Diabetes Care in Special Circumstances 337 I Acute Hospital Admission: Jay Chillala 24.1 Introduction 337 24.2 Hyperosmolar hyperglycaemic state and diabetic ketoacidosis insulin regimes 337 24.3 Factors which affect management 338 24.4 Discharge planning 338 II Serious Infections: Jay Chillala 24.5 Introduction 340 24.6 How is the treatment of elderly patients different? 340 24.7 Management 341 24.8 Precautions for the medical management of infections in the elderly 341 24.9 When should the microbiologist be called? 342 III Minor Ethnic Populations: Gurch Randhawa 24.10 Introduction 344 24.11 Epidemiology of diabetes among minority ethnic groups in the UK 344 24.12 Improving access to services 345 24.13 Looking to the future 345 24.14 Conclusions 346 References 346 25 Managing Surgery in the Elderly Diabetic Patient 349 Geoffrey Gill and Susan Benbow 25.1 Introduction 349 25.2 Metabolic and other problems induced by surgery 349 25.3 Implications for management of surgery in diabetic patients 350 25.4 Potential risks of surgery in diabetic patients 351 25.5 Special problems in the elderly 352 25.6 New diabetes therapies and surgical management 352 25.7 The practical management of surgery in diabetic patients 353 25.8 Conclusions 358 References 358 SECTION V MANAGEMENT OF ASSOCIATED COMPLICATIONS 26 The Implications of the Evolving Diabetes Epidemic for Disability in Older Adults 363 Edward W. Gregg and Linda Geiss 26.1 Diabetes and older adults: The magnitude and character of the problem 363 26.2 Diabetes and functional disability 365 26.3 Modifiable factors explaining diabetes and disability 366 26.4 Interventions to reduce disability risk 367 26.5 Trends in disability among the diabetic population 368 26.6 Summary 368 References 369 27 Diabetes and Cognitive Dysfunction 373 Alan J. Sinclair and Koula G. Asimakopoulou 27.1 Introduction 373 27.2 Evidence of association between diabetes and cognitive dysfunction 374 27.3 Cognitive dysfunction and glycaemic control 376 27.4 The importance of detecting cognitive dysfunction 377 27.5 The importance of excluding depression 380 27.6 Further investigations 380 27.7 Conclusions 380 References 381 28 Depression and Diabetes in Older Adults 385 Arie Nouwen and Jan R. Oyebode 28.1 Defining depression 385 28.2 Depression in older people 387 28.3 Epidemiology of depression in diabetes 387 28.4 Depression in diabetes: Associated problems 388 28.5 Possible mechanisms for the aetiology of depression 389 28.6 The assessment of depression in older adults with diabetes 390 28.7 The treatment of clinical depression 393 CONTENTS ix 28.8 Case studies 395 28.9 Summary 397 References 397 29 Diabetes and Falls 403 Christine T. Cigolle and Caroline S. Blaum 29.1 Introduction 403 29.2 Definition 403 29.3 Epidemiology 404 29.4 Pathophysiology of, and risk factors for, falling 405 29.5 Risk factors for fall injury 408 29.6 Evaluation of older adults with diabetes who fall 408 29.7 Management of older adults with diabetes who fall 410 29.8 Patient safety and quality of care 413 References 413 SECTIONVI OPTIMIZING DIABETES CARE IN OLDER PEOPLE 30 The Role of Specialist Nurses and Other Members of the Multidisciplinary Team (MDT) 419 Carolin D. Taylor and Timothy J. Hendra 30.1 Introduction 419 30.2 The relationship of the diabetes MDT with other services for older people 420 30.3 The changing role of the MDT in service delivery 420 30.4 The ‘‘Patient’’ 420 30.5 The roles of the individual team members 422 30.6 The role of the MDT in specific situations 424 30.7 Summary 425 References 425 31 Diabetes Education in the Elderly 427 Charles Fox and Anne Kilvert 31.1 Introduction 427 31.2 Principles of adult diabetes education 428 31.3 How should education be delivered? 428 31.4 Empowerment in diabetes care 429 31.5 The development of structured education: What to teach people about diabetes 434 31.6 Adaptations of educational principles for the elderly 437 31.7 Assessment of the educational needs of the individual 439 31.8 Specific cases 439 31.9 Conclusions 441 31.10 Acknowledgments 441 References 441 32 Supporting the Family and Informal Carers 443 Antony Bayer and Alan Sinclair 32.1 Introduction 443 32.2 Who are the carers? 444 32.3 What do carers do? 445 32.4 What effect can caring have on the carer? 447 32.5 What do carers want? 448 32.6 What are the benefits of carer intervention? 449 References 449 33 Diabetes Mellitus Care Models for Older People 453 I The European Perspective: Isabelle Bourdel-Marchasson 33.1 Introduction 453 33.2 Current clinical guidelines in Europe 454 33.3 Care organization 456 33.4 Call for audit of quality of care 457 33.5 Perspectives 458 II The United States Perspective: John E. Morley 33.6 Introduction 459 33.7 Specific issues in older diabetics 459 33.8 Management of diabetes 460 33.9 Conclusions 461 Acknowledgments 462 References 462 34 Further Initiatives to Enhance Diabetes Care in Older People 465 Alan Sinclair 34.1 Introduction 465 34.2 Improving inpatient diabetes care 466 34.3 The use of a diabetes minimum dataset (MDS) to enhance care 468 34.4 Conclusions 471 References 471 Index 473 Nourishing the soul The challenge for the profession 610.73/SIN/d PERPUSTAKAAN POLTEKKES KEMENKES GORONTALO POLTEKKES KEMENKES GORONTALO 610.73/SIN/d 07-EB2018-P7 My Library (Referensi) 610.73 SIN d E-BOOK : Diabetes in Old Age THIRD EDITION " B7.jpg.jpg 1295 2018-04-16 09:12:06 2019-02-06 09:26:03 machine generated