Effectiveness of a multimodal intervention in functionally impaired older people with type 2 diabetes mellitus

Background: Type 2 diabetes, a highly prevalent chronic disease, is associated with increasing frailty and functional decline in older people. We aimed to evaluate the effectiveness of a multimodal intervention on functional performance in frail and pre-frail participants aged >= 70 years with type 2 diabetes mellitus. Methods: The MID-Frail study was a cluster-randomized multicenter clinical trial conducted in 74 trial sites across seven European countries. The trial recruited 964 participants who were aged >70 years [mean age in intervention group, 78.4 (SD 5.6) years, 49.2% male and 77.6 (SD 5.29) years, 52.4% male in usual care group], with type diabetes mellitus and determined to be frail or pre-frail using Fried's frailty phenotype. Participants were allocated by trial site to follow either usual care (UCG) or intervention procedures (IG). Intervention group participants received a multimodal intervention composed of (i) an individualized and progressive resistance exercise programme for 16 weeks; (ii) a structured diabetes and nutritional educational programme over seven sessions; and (iii) Investigator-linked training to ensure optimal diabetes care. Short Physical Performance Battery (SPPB) scores were used to assess change in functional performance at 12 months between the groups. An analysis of the cost-effectiveness of the intervention was undertaken using the incremental cost-effectiveness ratio (ICER). Secondary outcomes included mortality, hospitalization, institutionalization, quality of life, burden on caregivers, the frequency and severity of hypoglycaemia episodes, and the cost-effectiveness of the intervention. Results: After 12 months, IG participants had mean SPPB scores 0.85 points higher than those in the UCG (95% CI, 0.44 to 1.26, P < 0.0001). Dropouts were higher in frail participants and in the intervention group, but significant differences in SPPB between treatment groups remained consistent after sensitivity analysis. Estimates suggest a mean saving following intervention of 428.02 EUR (2016) per patient per year, with ICER analysis indicating a consistent benefit of the described health care intervention over usual care. No statistically significant differences between groups were detected in any of the other secondary outcomes. Conclusions: We have demonstrated that a 12 month structured multimodal intervention programme across several clinical settings in different European countries leads to a clinically relevant and cost-effective improvement in the functional status of older frail and pre-frail participants with type 2 diabetes mellitus

Importance of chromium, copper, selenium and zinc in diabetes mellitus type 1 and type 2 with late disease

Chromaktiviert die Wirkung von Insulin. Bei Typ-1- undTyp-2-Diabetikern reflektierten verminderte Chromgehalte in Leukozyten eine verminderte Chromversorgung. Je schlechter die Diabeteseinstellung, umso niedriger ward er Chromstatus bei Typ-2-Diabetikern. Daher sollte bei diesen Patienten – besonders bei Typ-2-Diabetikern mit schlechter Einstellbarkeit – eine Chromsupplementation erwogen werden, wenn eine sichere Bestimmung der Chromversorgung nicht gewährleistet ist. Kupferionenbesitzen anti- und auch prooxidative Eigenschaften. Hohe Kupferplasmawerte korrelieren mit der Entstehung einer Arteriosklerose. Die Kupferkonzentrationen im Plasma waren bei beiden Diabetikergruppen erhöht, weitererhöhte Werte zeigten Typ-2-Diabetiker mit Hyperlipidämie oder diabetischen Folgeerkrankungen. Um das Risiko für Mikro- und Makroangiopathie oder Nephropathie zu vermindern, sollten Diabetiker eine hohe Kupferzufuhr vermeiden. Selen wirkt antioxidativ, immunstimulierend und antiatherogen. Der Selengehalt im Plasma reflektiert die Selenzufuhr. Die Selenplasmawerte waren bei beiden Diabetesgruppen geringfügig vermindert und auffällig vermindert bei Patienten mit Folgeerkrankungen. Eine selenreiche Ernährung oder Selengaben zur Prävention von Spätfolgen könnten bei Diabetikern daher sinnvoll sein. Patienten mit Nephropathie und eingeschränkter Zufuhr an tierischem, selen- und zinkreichem Protein profitieren möglicherweise von einer Selensupplementation. Zink ist an der Wundheilung, der Immunfunktion und der Aktivierung und Speicherung von Insulin beteiligt. Der Elementgehalt war beiTyp-1-Diabetikern in Leukozyten, dem bestem Indikator der Zinkversorgung, vermindert. Bei Patienten mit Nephropathie, Mikroangiopathie oder Neuropathie war das Zinkdefizit noch deutlicher ausgeprägt. Eine hochwertige, proteinreiche Ernährung könnte die Versorgungslage ver-bessern, auch eine Zinksupplementation wäre möglicherweise von Nutzen.Chromium activates the effect of insulin. A decreased chromium content in leucocytes reflected a reduced chromium supply in diabetics type 1 and type 2. The poorer the metabolic control of diabetics type 2, the lower was the chromium status. Thus these patients – especially type 2 diabetics with metabolic disorders – should consider a chromium supplementation, especially if an accurate determination of the chromium status is not guaranteed. Copper ions have anti- and prooxidative properties. High copper values in plasma correlate with the development of arteriosclerosis. The copper concentrations in plasma were increased in both diabetic groups, further pronounced increases were found in type 2 diabetics with hyperlipidemia or late disease. In order to lower the risk of developing vascular disease or nephropathy, diabetics should avoid a high copper intake. Selenium has antioxidative, immune stimulating and antiatherogenic properties. The selenium content in plasma reflects the intake of the element. The selenium concentrations in plasma were slightly decreased in both diabetic groups and markedly decreased in patients with late disease. A selenium-rich diet or a selenium supplementation could be useful in the prevention of late disease in diabetics. Patients with nephropathy and a restricted intake of selenium- and zinc-rich animal protein possibly profit from selenium supplementation. Zinc is involved in wound healing, immune function and activation and storage of insulin. The content of the element in leucocytes is the best indicator of the zinc supply. It was decreased in type 1 diabetics. In patients with nephropathy, microangiopathy or neuropathy, the deficiency of zinc was still more pronounced. A high-quality, proteinrich diet could improve the supply with zinc; possibly, a supplementation of the element may also be useful

Psychological insulin resistance in geriatric patients with diabetes mellitus

Objective To determine the extent to which geriatric patients with diabetes mellitus experience psychological insulin resistance (PIR). Methods A total of 67 unselected geriatric patients with diabetes (mean age 82.8 ± 6.7 years, diabetes duration 12.2 [0.04–47.2] years, 70.1% female) were recruited in a geriatric care center of a university hospital. A comprehensive geriatric assessment (CGA) was performed including WHO-5, Hospital Anxiety and Depression Scale (HADS), Mini Mental State Examination (MMSE) and Barthel-Index. We assessed PIR using the Barriers of Insulin Treatment Questionnaire (BIT) and the Insulin Treatment Appraisal Scale in a face-to-face interview. Results Insulin-naïve patients (INP) showed higher PIR scores than patients already on insulin therapy (BIT-sum score: 4.3 ± 1.4 vs. 3.2 ± 1.0; p < 0.001). INP reported in the BIT increased fear of injection and self-testing (2.4 ± 2.4 vs. 1.3 ± 0.8; p = 0.016), expect disadvantages from insulin treatment (2.7 ± 1.6 vs. 1.9 ± 1.4; p = 0.04), and fear of stigmatization by insulin injection (5.2 ± 2.3 vs. 3.6 ± 2.6; p = 0.008). Fear of hypoglycemia, however, did not differ significantly (6.3 ± 2.8 vs. 5.1 ± 3.1; p = 0.11). Depression was not shown to be a barrier to insulin therapy. Conclusion INP with diabetes have a significantly more negative attitude toward insulin therapy in comparison to patients already on insulin. Practice implications Systematic assessment of barriers of insulin therapy, individualized diabetes treatment plans and information of patients may help to overcome such negative attitudes, leading to quicker initiation of therapy, improved adherence to treatment and a better quality of life

SGS: a structured treatment and teaching programme for older patients with diabetes mellitus : a prospective randomised controlled multi-centre trial

Objectives: evaluation of the effectiveness of a new structured diabetes teaching and treatment programme (DTTP) with specific didactical approaches and topics for geriatric patients with diabetes mellitus. Design: a prospective randomised controlled multi-centre trial. Setting and participants: a total of 155 geriatric patients were randomly admitted to either the new DTTP SGS (n = 83) or the standard DTTP (n = 72) for insulin-treated patients with type 2 diabetes mellitus (HbA1c 8.0 ± 1.4%, age 76.2 ± 6.3 years). Measurements: biometrical data, metabolic control, acute complications, diabetes knowledge, self-management. Results: SGS participants showed improved levels of HbA1c 6 months after the DTTP, and less acute complications than the standard group (P<0.009). Both groups demonstrated a good capacity for diabetes self-management and improvement in diabetes knowledge after the DTTP (P<0.01). Conclusion: the new SGS diabetes education programme, focusing on the learning capabilities and the particular needs of older persons, is effective in improving metabolic control and in maintaining auto-sufficiency in geriatric patients with diabetes mellitus

Aging Clin Exp Res

We present an executive summary of a guideline for management of type 2 diabetes mellitus in primary care written by the European Geriatric Medicine Society, the European Diabetes Working Party for Older People with contributions from primary care practitioners and participation of a patient's advocate. This consensus document relies where possible on evidence-based recommendations and expert opinions in the fields where evidences are lacking. The full text includes 4 parts: a general strategy based on comprehensive assessment to enhance quality and individualised care plan, treatments decision guidance, management of complications, and care in case of special conditions. Screening for frailty and cognitive impairment is recommended as well as a comprehensive assessment all health conditions are concerned, including end of life situations

Essential steps in primary care management of older people with Type 2 diabetes: an executive summary on behalf of the European geriatric medicine society (EuGMS) and the European diabetes working party for older people (EDWPOP) collaboration

We present an executive summary of a guideline for management of type 2 diabetes mellitus in primary care written by the European Geriatric Medicine Society, the European Diabetes Working Party for Older People with contributions from primary care practitioners and participation of a patient's advocate. This consensus document relies where possible on evidence-based recommendations and expert opinions in the fields where evidences are lacking. The full text includes 4 parts: a general strategy based on comprehensive assessment to enhance quality and individualised care plan, treatments decision guidance, management of complications, and care in case of special conditions. Screening for frailty and cognitive impairment is recommended as well as a comprehensive assessment all health conditions are concerned, including end of life situations. The full text is available online at the following address: essential_steps_inprimary_care_in_older_people_with_diabetes_-_EuGMS-EDWPOP___3_.pdf. [Abstract copyright: © 2023. The Author(s).