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Rotherham, United Kingdom

Abdelhafiz A.H.,Rotherham General Hospital | Sinclair A.J.,University of Bedfordshire
Diabetes Therapy | Year: 2013

The prevalence of diabetes is increasing due to aging of the population and increasing obesity. In the developed world, there is an epidemiologic shift from diabetes being a disease of middle age to being a disease of older people due to increased life expectancy. In old age, diabetes is associated with high comorbidity burden and increased prevalence of geriatric syndromes in addition to the traditional vascular complications. Therefore, comprehensive geriatric assessment should be performed on initial diagnosis of diabetes. Due to the heterogeneous nature of older people with diabetes and variations in their functional status, comorbidities, and life expectancy, therapeutic interventions, and glycemic targets should be individualized taking into consideration patients' preferences and putting quality of life at the heart of their care plans. © The Author(s) 2013. Source

Tyagi P.,Rotherham General Hospital
BMJ case reports | Year: 2011

Hypohidrotic ectodermal dysplasia (HED) is a group of rare multisystemic genetic syndromes that affects ectodermal structures such as skin, hair, nails, teeth and sweat glands. The authors present a case of a child with ocular and dermatological signs of HED along with severe involvement of other multiple organ systems. The family history could be traced to four generations and there was an observed trend of increase in severity of signs and symptoms occurring at younger age. The purpose of this case report is to create awareness in ophthalmic community of its diagnosis and clinical manifestations. This case highlights the role of multidisciplinary approach for management of systemic disease, genetic evaluation of affected individuals and carriers and genetic counselling. Source

To study the natural history and predictors of faster glomerular filtration rate (GFR) decline in a referred population of older patients (aged ≥ 65 years) with type 2 diabetes mellitus. A retrospective medical record analysis in an outpatient diabetes clinic for older patients. Baseline characteristics and blood pressure readings for each clinic visit were recorded. All laboratory results were downloaded from the central database of the pathology laboratory. Annual rate of GFR decline was calculated by linear regression analysis as the slope per year for each individual. Patients were then divided into 2 groups on either side of the mean GFR decline. Group 1 had a slower GFR decline (below the mean value) and group 2 had a faster GFR decline (above the mean value). Five variables were investigated as predictors of faster decline in GFR: cardiovascular disease (CVD), hypertension, diabetes control, use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and albuminuria. The study included 100 patients with a mean age of 69.5 (standard deviation [SD], 3.9) years on referral, and 54 patients were men. The mean duration of study was 14.4 (SD, 2.0) years. A total of 3908 GFR results were downloaded during the study. The mean annual rate of GFR decline was 1.5 (SD, 1.2) mL/min/1.73 m2. Glomerular filtration rate values were comparable in both groups on first referral. Mean annual rate of GFR decline was 2.6 (SD, 0.9) mL/min/1.73 m2 in group 2 compared with 0.7 (SD, 0.5) mL/min/1.73 m2 (P < 0.001) in group 1. Development of CVD was the only independent predictor of faster renal function decline (odds ratio, 2.9; 95% CI, 1.1-7.6; P = 0.03). Cardiovascular disease is an independent risk factor for faster decline in GFR in older patients with type 2 diabetes mellitus. Source

To explore whether routinely assessed biochemical markers tested on admission will predict 3 predefined adverse outcomes for hospitalized elderly patients: discharge to a long-term care facility, in-hospital mortality, and prolonged hospital length of stay (> 14 days). A prospective observational study of elderly patients (aged ≥ 75 years) admitted to an acute-care geriatric ward over a 6-month period. Patients were assessed on admission and baseline characteristics were collected. Activities of daily living were assessed by the Barthel Index and cognitive function by the abbreviated mental test. Results from biochemical markers tested on admission were downloaded from the pathology laboratory database using patient details. Patients were followed-up with until discharge or in-hospital mortality. A total of 392 patients formed the study population. Mean (standard deviation) age was 83.2 (± 5.5) years and 283 (72%) patients were men. Thirty-eight (10%) patients were discharged to a long-term care facility, 134 (34%) had a prolonged hospital length of stay, and 33 (8%) died in the hospital. Results from testing 5 biochemical markers independently predicted in-hospital mortality: hypoalbuminemia (adjusted odds ratio [OR], 2.5; 95% CI, 0.9-6.7; P = 0.04), low total cholesterol level (adjusted OR, 2.9; 95% CI, 1.3-6.3; P = 0.01), hyperglycemia (adjusted OR, 2.9; 95% CI, 1.2-7.4; P = 0.02), high C-reactive protein level (adjusted OR, 4.2; 95% CI, 1.3-13.4; P = 0.01), and renal impairment (adjusted OR, 3.8; 95% CI, 1.7-8.7; P = 0.002). High C-reactive protein level independently predicted prolonged hospital length of stay (OR, 1.7; 95% CI, 1.1-2.9; P = 0.03). Hypoalbuminemia predicted discharge to a long-term care facility independent of confounding factors except for physical dysfunction (OR, 2.4; 95% CI, 1.1-5.1; P = 0.03). Significance was reduced after adjustment for Barthel Index score (OR, 1.9; 95% CI, 0.9-4.1; P = 0.08). Testing of routinely assessed biochemical markers on admission predicted adverse hospital outcomes for elderly patients. Their inclusion in a standardized prediction tool may help to create interventions to improve such outcomes. Source

Abdelhafiz A.H.,Rotherham General Hospital | Rodriguez-Manas L.,European University at Madrid | Morley J.E.,Saint Louis University | Sinclair A.J.,University of Bedfordshire
Aging and Disease | Year: 2015

Recurrent hypoglycemia is common in older people with diabetes and is likely to be less recognized and under reported by patients and health care professionals. Hypoglycemia in this age group is associated with significant morbidities leading to both physical and cognitive dysfunction. Repeated hospital admissions due to frequent hypoglycemia are also associated with further deterioration in patients' general health. This negative impact of hypoglycemia is likely to eventually lead to frailty, disability and poor outcomes. It appears that the relationship between hypoglycemia and frailty is bidirectional and mediated through a series of influences including under nutrition. Therefore, attention should be paid to the management of under nutrition in the general elderly population by improving energy intake and maintaining muscle mass. Increasing physical activity and having a more conservative approach to glycemic targets in frail older people with diabetes may be worthwhile. Source

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