Increase in Number of Depression Symptoms Over Time is Related to Worse Cognitive Outcomes in Older Adults With Type 2 Diabetes

Abstract Using Medicare fee-for-service data from 2013-17, we identified a cohort of patients with type 2 diabetes (T2D) who initiated a glucose-lowering drug (mean [SD] age, 74.8 (6.9) years). Amongst frail patients (CFI≥0.20), metformin use remained stable from 29.1% to 29.4%, whereas sulfonylureas (25.8% to 22.1%) and insulin (21.2% to 19.0%) use declined. Amongst non-frail patients (CFI <0.20), metformin (35.3% to 33.1%) and sulfonylurea (26.2% to 22.2%) use decreased whereas insulin (11.7% to 10.6%) use remained stable. DPP-4i and glitazones use remained stable whereas the use of newer agents such as SGLT-2i and GLP-1 RA increased steadily over the study period in both frail and non-frail patients, though their use remains low ( <8%). In conclusion, sulfonylureas and insulin accounted for about one-third of initiated glucose-lowering medications and were more frequently used by frail patients, though their use declined steadily over time with the availability of newer agents.

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Racial/Ethnic Differences in Glycemic Control in Older Adults with Type 2 Diabetes: United States 2003–2014

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17030950 ◽

2020 ◽

Vol 17 (3) ◽

pp. 950 ◽

Cited By ~ 1

Author(s):

Brittany L. Smalls ◽

Tiarney D. Ritchwood ◽

Kinfe G. Bishu ◽

Leonard E. Egede

Keyword(s):

Type 2 Diabetes ◽

Older Adults ◽

Glycemic Control ◽

Racial Differences ◽

Mexican Americans ◽

Racial Minorities ◽

Older Age ◽

Increased Risk ◽

Over Time

The aim of this study was to determine whether racial differences in HbA1c persist in older adults (≥65 years) living with type 2 diabetes. Data from The National Health and Nutrition Examination Survey (NHANES) 2003–2014 were used to examine the association between HbA1c and older adults (≥65 years) over time. Compared to non-Hispanic Whites, Mexican Americans had the greatest difference in average HbA1c among minority groups, followed by those with unspecified/mixed ethnicities and non-Hispanic Blacks. In the adjusted linear model, racial minorities had a statistically significant relationship with HbA1c. There was no relationship between HbA1c and older age and insulin use. Trends in mean HbA1c over time increased for non-Hispanic Blacks and Mexican Americans and decreased for non-Hispanic Whites. The findings suggest that racial differences in HbA1c persist into older age and compared to non-Hispanic Whites, non-Hispanic Blacks and Mexican Americans are at an increased risk of morbidity, mortality, and disability due to high HbA1c. Furthermore, alternate measures of glycemic control may be needed to screen and manage T2DM in racial minorities.

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Associations Between Diagnosis with Type 2 Diabetes and Changes in Physical Activity among Middle-Aged and Older Adults in the United States

Innovation in Aging ◽

10.1093/geroni/igz048 ◽

2020 ◽

Vol 4 (1) ◽

Cited By ~ 1

Author(s):

Emily J Nicklett ◽

Jieling Chen ◽

Xiaoling Xiang ◽

Leah R Abrams ◽

Amanda J Sonnega ◽

...

Keyword(s):

Physical Activity ◽

Type 2 Diabetes ◽

Older Adults ◽

Health Behavior Change ◽

The United States ◽

Age At Diagnosis ◽

Metabolic Equivalents ◽

Race Ethnicity ◽

Over Time

Abstract Background and Objectives Physical activity (PA) is an effective strategy for diabetes self-management and is central to the diabetes regimen. Diagnostic events present an opportunity for health behavior change; however, many older adults with type 2 diabetes (T2D) do not engage in regular PA. The relationships between diagnosis events and subsequent changes in PA are not well understood. Drawing upon life-course theory, this is the first study to examine whether the diagnosis of T2D is followed by a change in PA, whether these changes are sustained, and the sociodemographic characteristics associated with these changes. Research Design and Methods We examined associations between T2D diagnosis and PA changes among 2,394 adults ages 51+ from the Health and Retirement Study (2004–2014). PA changes were measured using metabolic equivalents of task (METs) estimated values accounting for the vigor and frequency of self-reported PA. Using piecewise mixed models, we examined initial and sustained changes in METs over time and tested whether these changes were modified by race/ethnicity, educational level, gender, and age at diagnosis. Results Across participants, a significant postdiagnosis increase was observed in self-reported PA following the diagnostic event (β: 0.54, 95% CI: 0.10, 0.97). The steepness of decline in PA participation over time did not change significantly following T2D diagnosis. Age at diagnosis and race/ethnicity significantly moderated these relationships: participants diagnosed at older ages were less likely to improve PA following diagnosis and non-Hispanic whites experienced relatively steeper rates of decline following diagnosis with T2D. Discussion and Implications Modest diagnosis-related increases in PA were observed among participants overall. The usual rate of decline in PA appears unaffected by diagnosis overall. Age at diagnosis and race/ethnicity moderated these relationships. Key implications for future research and clinical practice are discussed.

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The Effect of High-Intensity Power Training on Habitual, Intervention and Total Physical Activity Levels in Older Adults with Type 2 Diabetes: Secondary Outcomes of the GREAT2DO Randomized Controlled Trial

Geriatrics ◽

10.3390/geriatrics6010015 ◽

2021 ◽

Vol 6 (1) ◽

pp. 15

Author(s):

Marjan Mosalman Haghighi ◽

Yorgi Mavros ◽

Shelley Kay ◽

Kylie A. Simpson ◽

Michael K. Baker ◽

...

Keyword(s):

Physical Activity ◽

Type 2 Diabetes ◽

Older Adults ◽

High Intensity ◽

Controlled Trial ◽

Glycosylated Hemoglobin ◽

Total Physical Activity ◽

Power Training ◽

Over Time

Background: We examined the effect of power training on habitual, intervention and total physical activity (PA) levels in older adults with type 2 diabetes and their relationship to metabolic control. Materials and Methods: 103 adults with type 2 diabetes were randomized to receive supervised power training or sham exercise three times/week for 12 months. Habitual, intervention, and total PA, as well as insulin resistance (HOMA2-IR) and glycosylated hemoglobin (HbA1c), were measured. Results: Participants were aged 67.9 ± 5.5 yrs, with well-controlled diabetes (HbA1c = 7.1%) and higher than average habitual PA levels compared to healthy peers. Habitual PA did not change significantly over 12 months (p = 0.74), and there was no effect of group assignment on change over time in habitual PA over 0–6 (p = 0.16) or 0–6–12 months (p = 0.51). By contrast, intervention PA, leg press tonnage and total PA increased over both 6- and 12-month timepoints (p = 0.0001), and these changes were significantly greater in the power training compared to the sham exercise group across timepoints (p = 0.0001). However, there were no associations between changes in any PA measures over time and changes in metabolic profile. Conclusion: Structured high-intensity power training may be an effective strategy to enhance overall PA in this high-risk cohort.

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