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Kirby M.,University of Hertfordshire | Kirby M.,Prostate Center | Kirby M.,Institute of Diabetes for Older People IDOP
Heart and Metabolism | Year: 2015

The UK has made great strides in reducing death from cardiovascular disease (CVD), but there is still room for improvement compared with other Western European Countries. CVD accounts for approximately one-third of all deaths in men and women in the UK. Half of these deaths are related to coronary heart disease (CHD), which is the most common cause of premature death in those under the age of 75 years. Atherosclerotic changes in the coronary arteries eventually lead to CHD, and nine key risk factors have been well recognized. Erectile dysfunction (ED) is an independent risk factor and provides a window of opportunity to identify early CVD. ED and lower urinary tract symptoms (LUTS) share underlying pathophysiological etiological mechanisms and will often drive men to consult. This provides the opportunity to consider what burden of CVD risk factors the patient carries, and to perform an appropriate metabolic screen. © 2013, American Society for Clinical Investigation.


Sinclair A.J.,University of Bedfordshire | Bayer A.J.,University of Cardiff | Burns A.,Institute of Diabetes for Older People IDOP | Forbes A.,Institute of Diabetes for Older People IDOP | And 6 more authors.
Diabetic Medicine | Year: 2014

Both dementia and diabetes mellitus are long-term disabling conditions and each may be a co-morbidity of the other. Type 2 diabetes is associated with a 1.5- to 2-fold higher risk of dementia. Diabetes also may occur for the first time in many individuals with mental ill health, including cognitive impairment and dementia, and this may complicate management and lead to difficulties in self-care. Case finding is often poor for cognitive impairment in medical settings and for diabetes in mental health settings and this needs to be addressed in the development of care pathways for both conditions. Many other deficiencies in quality care (both for dementia and diabetes) currently exist, but we hope that this Best Clinical Practice Statement will provide a platform for further work in this area. We have outlined the key steps in an integrated care pathway for both elements of this clinical relationship, produced guidance on identifying each condition, dealt with the potentially hazardous issue of hypoglycaemia, and have outlined important competencies required of healthcare workers in both medical/diabetes and mental health settings to enhance clinical care. © 2014 Diabetes UK.


Atienzar P.,Albacete University Hospital | Abizanda P.,Albacete University Hospital | Guppy A.,University of Bedfordshire | Sinclair A.J.,Institute of Diabetes for Older People IDOP
British Journal of Diabetes and Vascular Disease | Year: 2012

Frailty and sarcopaenia are commonly used terms in the medical management of older people but their relationship to those with diabetes has not been explored in great detail. In this review, we hypothesise that diabetes and frailty are related conditions, and we attempt to explain the nature of this relationship, and consider the possibility that sarcopaenia is an intermediate step. © 2012 The Author(s).


Atienzar P.,Albacete University Hospital | Abizanda P.,Albacete University Hospital | Guppy A.,University of Bedfordshire | Sinclair A.J.,Institute of Diabetes for Older People IDOP
British Journal of Diabetes and Vascular Disease | Year: 2012

Diabetes and frailty may be causally related and operate through each of the key components of the frailty phenotype or via the associated medical co-morbidities. The presence of frailty in a setting of diabetes increases the level of disability and leads to poorer clinical outcomes. The vascular complications of diabetes (both macro- and microvascular) are implicated in this aetiopathogenesis of frailty and any associated mood disturbance or cognitive impairments worsen the outcome. Research into exploring this relationship further is needed and this may lead to more effective interventional strategies. © 2012 The Author(s).


Sinclair A.J.,University of Bedfordshire | Sinclair A.J.,Institute of Diabetes for Older People IDOP | Morley J.E.,Saint Louis University | Vellas B.,Toulouse University Hospital Center
Pathy's Principles and Practice of Geriatric Medicine: Fifth Edition | Year: 2012

This new edition of the comprehensive and renowned textbook Principles and Practice of Geriatric Medicine offers a fully revised and updated review of geriatric medicine. It covers the full spectrum of the subject, features 41 new chapters, and provides up-to-date, evidence-based, and practical information about the varied medical problems of ageing citizens. The three editors, from UK, USA and France, have ensured that updated chapters provide a global perspective of geriatric medicine, as well as reflect the changes in treatment options and medical conditions which have emerged since publication of the 4th edition in 2006. The book includes expanded sections on acute stroke, dementia, cardiovascular disease, and respiratory diseases, and features a new section on end-of-life care. In the tradition of previous editions, this all-encompassing text continues to be a must-have text for all clinicians who deal with older people, particularly geriatric medical specialists, gerontologists, researchers, and general practitioners. Praise for the 4th edition:"...an excellent reference for learners at all clinical and preclinical levels and a useful contribution to the geriatric medical literature."-Journal of the American Medical Association, November 2006 5th edition selected for 2012 Edition of Doody's Core Titles™. © 2012 John Wiley & Sons, Ltd.


Mistry M.,Paradise Medical Center | Lister N.,Novartis | Andrews C.,Novartis | Geransar P.,Novartis | Sinclair A.,Institute of Diabetes for Older People IDOP
British Journal of Diabetes and Vascular Disease | Year: 2011

In the UK, type 2 diabetes mellitus in patients aged ≥ 65 years is a significant healthcare burden, compounded by an increasing elderly population. Intensive therapies to control blood glucose can be hazardous for this patient group and information is limited about well-tolerated therapies. This retrospective, real-world survey recorded glycated haemoglobin A1c (HbA1C) levels and incidences of hypoglycaemic events in 72 elderly and very elderly patients (65-74 years and ≥ 75 years, respectively) receiving the dipeptidyl peptidase-4 inhibitor vildagliptin as part of combination therapy. After vildagliptin initiation, mean HbA1C levels decreased from 8.2% to 7.4% (p=0.0415), the mean change in the elderly and very elderly subgroups being similar (-0.8%, -0.9%, respectively); the mean incidence of hypoglycaemic events (1.4%) was unchanged. This observational survey provides real-life evidence that in patients aged ≥ 65 years with type 2 diabetes, vildagliptin is an effective, well-tolerated add-on therapy with low hypoglycaemic risk. © 2011 SAGE Publications.


Dunning T.,Deakin University | Dunning T.,International Diabetes Federation | Sinclair A.,University of Bedfordshire | Sinclair A.,Institute of Diabetes for Older People IDOP
Journal of Diabetes Nursing | Year: 2014

Managing older people with diabetes is complex due to multimorbidities, functional changes and polypharmacy, and there is little randomised control trial evidence to support recommendations. Significantly, there is a global lack of awareness about the effects of diabetes on ageing and vice versa. The International Diabetes Federation (IDF) Global Guideline for Managing Older People with Type 2 Diabetes seeks to address these issues. The guideline was launched by the IDF President, Sir Michael Hirst during a satellite symposium about diabetes in older people held in association with the World Diabetes Congress in Melbourne in December 2013. This article provides an overview of the IDF Guideline and suggests some ways DSNs and practice nurses can implement the guidelines in practice.


Sinclair A.J.,Institute of Diabetes for Older People IDOP
Diabetic Medicine | Year: 2011

A Task and Finish Group of Diabetes UK was convened over 14months to undertake a systematic review of the original 1999 British Diabetic Association guidance on care home diabetes, incorporate new research findings and produce a set of recommendations that are evidenced-based, practical and implementable within UK care home settings. The anticipation of Diabetes UK is that these guidelines will represent a national policy of good clinical practice for diabetes care within care homes. This executive summary demonstrates how the full guidelines should provide a framework of assessment of the quality of diabetes care within care homes, for use by regulatory bodies who have responsibility for this provision of diabetes care. This document is primarily based on recommendations for adults living within British care home environments and its focus, by virtue of the nature and characteristics of residents, is on older adults. Improvements in diabetes care within residential and nursing homes are likely to follow a sustained commitment by health and social care professionals to ensure that the well-being of residents with diabetes is paramount, that high-quality policies of diabetes care are implemented and monitored and effective diabetes education is a mandatory and integral part of care home staff training. © 2011 The Author. Diabetic Medicine © 2011 Diabetes UK.


Sanz C.M.,Toulouse University Hospital Center | Sanz C.M.,French Institute of Health and Medical Research | Sanz C.M.,University Paul Sabatier | Hanaire H.,Toulouse University Hospital Center | And 8 more authors.
Diabetic Medicine | Year: 2012

Aims To determine whether diabetes mellitus influences functional status in patients with Alzheimer's disease. Methods We studied 608 community-dwelling patients with Alzheimer's disease from a prospective multicenter cohort. Diabetes was assessed at baseline. Functional status was assessed twice yearly with the Activities of Daily Living scale. Each patient had a baseline functional disability if their Activities of Daily Living score was <6. Progression of functional disability was defined by a decreased Activities of Daily Living score over 4years of follow-up visits. Results At baseline, diabetes was present in 63 participants (10.4%) and, compared with those without diabetes, was associated with functional impairment [age- and sex-adjusted OR=2.73 (95%CI 1.41-5.28)]. After controlling for confounders, the association remained significant [OR=2.04 (95%CI 1.02-4.11)]. Follow-up demonstrated a significant interaction between duration of Alzheimer's disease and diabetes, which was associated with progression of functional impairment in patients who had been diagnosed with Alzheimer's disease for less than 1year [age- and sex-adjusted hazard ratio=1.52 (95%CI 1.01-2.30), P=0.048], but not in those who had been diagnosed with Alzheimer's disease for more than 1year [age- and sex-adjusted hazard ratio=0.78 (95%CI 0.47-1.28), P=0.32]. Abnormal one-leg balance, polymedication and obesity seem to be important factors explaining the association between diabetes and functional status. Conclusions At baseline, the presence of diabetes significantly increases the risk of functional disability in patients with Alzheimer's disease; our longitudinal data confirm that in patients with a recent diagnosis of Alzheimer's disease (but not in those who have had Alzheimer's disease for longer than 1year), diabetes continues to worsen functional status. © 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK.


Abdelhafiz A.H.,Rotherham General Hospital | Sinclair A.J.,Institute of Diabetes for Older People IDOP | Sinclair A.J.,University of Bedfordshire
Aging and Disease | Year: 2015

Diabetes mellitus is increasingly becoming an older person disease due to the increased survival and aging of the population. Previous studies which showed benefits of tight glycemic control and a linear relationship between HbA1c and mortality have largely included younger patients newly diagnosed with diabetes and with less comorbidities. Recent studies, which included older population with diabetes, have shown a U-shaped relationship of increased mortality associated with low HbA1c. The mechanism of such relationship is unclear. There was no direct causal link between low HbA1c and mortality. It appears that malnutrition, inflammation and functional decline are characteristics shared by the populations that showed increased mortality and low HbA1c. In these studies functional status, disability or frailty was not routinely measured. Therefore, although adjustment for comorbidities was made there may be a residual confounding by unmeasured factors such as frailty. Thus, frailty or decline in functional reserve may be the main confounding factor explaining the relationship between increased mortality risk and low HbA1c.

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