Title: Study of 100 Cases of Hypoglycaemia in Elderly Patients of Diabetes Mellitus
Authors: Dr T.V.S.R.Raghu MD, Dr P.B.Prasanth Babu
DOI: https://dx.doi.org/10.18535/jmscr/v4i12.66
Abstract
Demographic ageing is a global phenomenon. The average life expectancy and the prevalence of diabetes are continuing to rise. Amongst the elderly population, type 2 diabetes mellitus is a growing problem, and a larger proportion of newly diagnosed diabetics are older. As the prevalence of diabetes mellitus increases and as treatment guidelines call for more rigorous glycaemic control, rates of hypoglcaemia are on the rise. Hypoglycaemia is often a risk of diabetes treatment in the elderly. Hypoglycaemia has serious consequences in terms of mortality and morbidity. Globally diabetes mellitus affects 10-20% of the elderly in the age group of 65-74 years & about 40% of the elderly over the age of 80 years. Type 2 DM is characterized by impaired insulin secretion, insulin resistance, excessive hepatic glucose production, and abnormal fat metabolism. Lifestyle factors such as individuals who are obese, who consume diets that are high in saturated fat and low in complex carbohydrates, or are inactive are more likely to develop diabetes as they age. Functional status of the study patients was assessed by using Katz index of activities of daily living. The altered counter regulatory effect may contribute to the altered cognitive response to reductions in blood glucose. Thus, the lower glycemic threshold to Hypoglycaemia in older people may limit the time available to self-treat and thereby increase the risk of developing neuroglycopenia. Additionally, these neurological symptoms of Hypoglycaemia may be misinterpreted in older patients because of coexisting illnesses, such as cerebrovascular diseases or dementia.
Keywords: Hypoglycemia, elderly, counteregulator hormones, neuroglycopenia.
References
1. Ingle GK and Nath A. Concerns and solutions for problems in geriatric health in India. Indian Journal of Community Medicine October 2008; Vol. 33, Issue 4:214 -218
2. Chau D, Edelman SV. Clinical Management of Diabetes in the Elderly. Clinical Diabetes 2001 October; vol. 19 : 4172-175
3. http://www.cdc.gov/diabetes/statistics/age/fig1.htm - Diabetes Public Health Resource CDC
4. IDF Diabetes Atlas Sixth edition - accessed online https://www.idf.org/sit-es/default/files/EN_6E_Atlas_Full_0.pdf page 11 - fig Number of people with diabetes by IDF Region, 2013
5. Harrisons princples of internal medicine 19e 2015 Chapter 417 Diabetes Mellitus: Diagnosis, Classification, and Pathophysiology page 240.
6. Diabetes is predicted to become the 7th leading cause of death in the world by the year 2030 ref : http://www.who.int-/features/factfiles/diabetes/facts/en/index1.html.
7. National Policy for Older Persons Year 1999 accessed online at http://socialj-ustice.nic.in/npopcomplete.php?pageid=
8. http://www.censusindia.gov.in/2011census/C-series/C-14.html National Policy on
Senior Citizens 2011
9. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3920109/
10. Menielly G S, Tessier D.Diabetes in Elderly Adults. Journal of Gerontology medical science 2001; vol 56A, no 1: M5 – M15
11. American Diabetes Association: Diabetes Care 37(Suppl 1):S14,2014.
12. Gu .K,Cowei CC,Harris MJ. Mortality in adults with and without diabetes in a national cohort of US population 1971-1993.Diabetes Care, 1998; 21:1138-1145
13. Rosenthal MJ, Fajardo M, Gilmore S, Morley JE, Naliboff BD. Hospitalization and mortality of diabetes in older adults. Diabetes Care 1998;21: 231-255
14. Tarriot PN, Ogden MA, Cox C Williams TF. Diabetes and Dementia in long term care.J Am Geriatr Soc, 1997;47: 423 -429
15. Harrisons princples of internal medicine 19e 2015 Chapter 420 Hypoglycaemia page 2430
16. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993;329:977–86.
17. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998;352: 837–53
18. Vanessa J. Briscoe, PhD, and Stephen N. Davis, MD. Hypoglycaemia in Type 1 and
Type 2 Diabetes: Physiology, Pathophys-iology and Management. Clinical Diabetes 2006; Volume 24, Number 3.
19. Cryer PE: Hypoglycaemia risk reduction in type 1 diabetes. Exp Clin Endocrinol
Diabetes 2001;109: S412–S423.
20. Cryer PE. Current concepts: Diverse causes of Hypoglycaemia-associated autonomic failure in diabetes. N Engl J Med2004;350: 2272–2279.