scholarly journals Assessment of Risk Factors for Fractures in Patients with Type 2 Diabetes over 60 Years Old: A Cross-Sectional Study from Northeast China

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Yan Guo ◽  
Yingfang Wang ◽  
Feng Chen ◽  
Jiabei Wang ◽  
Difei Wang

Aims. Previous evidence has demonstrated an increased fracture risk among the population with type 2 diabetes mellitus (T2DM). This study investigated the prevalence of bone fractures in elderly subjects (with and without type 2 diabetes) and identified any fracture risk factors, especially the risk factors for common known fractures in particular diabetic populations. Methods. This cross-sectional study was conducted with community-dwelling people over 60 years old in nine communities from the city of Shenyang, which is the capital of Northeast China’s Liaoning Province. A total of 3430 elderly adults (2201 females, mean±standard deviation age 68.16±6.1 years; 1229 males, 69.16±6.7 years) were included. Our study measured the heel bone mineral density (BMD) and used the timed “up and go” (TUG) test and other indicators. In addition, we performed logistic regression analysis to explore the risk factors for fractures in the general population and the diabetic population and to analyze the differences. Results. The results revealed that a total of 201 elderly persons (5.8%), with an average age of 70.05±6.54 years, suffered from a history of fragility fractures, which affected more females (74.6%) than males (p=0.001). The prevalence of fractures in the T2DM population was 7.3%, which was much higher than the 5.2% in non-T2DM population (p<0.05). In the non-T2DM population, the BMD was lower and the TUG time was longer in the fracture group than in the nonfracture group (p<0.001). However, in the T2DM population, the BMD and TUG values were similar between the fracture group and the nonfracture group (p>0.05). Logistic regression analysis showed that the female sex (OR 1.835), TUG time>10.2 s (OR 1.602), and T‐score≤−2.5 (OR 1.750) were independent risk factors for fragility fractures in the non-T2DM population, but they were not risk factors in the T2DM population. Conclusions. This study found that low BMD and slow TUG time were independent risk factors for fractures in non-T2DM patients, while no associations were found in the T2DM population. Patients with T2DM have a higher risk for fractures even when they have sufficient BMD and a short TUG time. TUG and BMD underestimated the risk for fractures in the T2DM population.

2021 ◽  
Author(s):  
Qi Dai ◽  
Nan Chen ◽  
Ling Zeng ◽  
Xin-Jie Lin ◽  
Feng-Xiu Jiang ◽  
...  

Abstract Background: Normoalbuminuric diabetic kidney disease (NADKD) is a newly defined DKD, the clinical features and pathogenesis for which are still being understood. This study aimed to investigate the features and risk factors for NADKD in patients with type 2 diabetes mellitus (T2DM).Methods: A retrospective cross-sectional study was conducted. The related clinical and laboratory data of patients with T2DM hospitalized between August 2012 and January 2020 were collected for statistical analysis. We classified the patients with T2DM into four groups on the basis of the presence or absence of albuminuria and reduced estimated glomerular filtration rate (eGFR). Analysis of variance, the Kruskal–Wallis test, and the chi-square test were used to compare the groups. Binary logistic regression analyses with a forward stepwise method were performed to explore the risk factors for renal dysfunction in hospitalized patients with normoalbuminuric T2DM.Results: Among the 1620 patients evaluated, 500 (30.9%) had DKD, of which 9% had NADKD. The prevalence of stroke, cardiovascular events, carotid plaque, and peripheral arterial disease in NADKD was significantly higher than in a non-DKD control group (normoalbuminuric T2DM patients with eGFR of ≥60 ml/min/1.73 m2). Regression analyses revealed that three significant independent factors were associated with NADKD: age (OR = 1.089, confidence interval [CI] 95% [1.055−1.123], p < 0.001), previous use of renin−angiotensin system inhibitors (RASIs; OR = 2.330, CI 95% [1.212−4.481], p = 0.011), and glycated hemoglobin (HbA1c; OR = 0.839, CI 95% [0.716−0.983], p = 0.03). Conclusions: NADKD is mainly associated with macrovascular rather than microvascular complications. NADKD is more common in patients with normoalbuminuric T2DM with older age, previous use of RASIs, and good glycemic control.


2020 ◽  
Author(s):  
Toshihiko Yanase ◽  
Ikumi Yanagita ◽  
Yuya Fujihara ◽  
Chikayo Iwaya ◽  
Yuichi Kitajima ◽  
...  

Abstract Background: Relatively low dehydroepiandrosterone sulfate (DHEA-S) and high cortisol/DHEA ratio have been suggested to be associated with frailty, evaluated using a physical scale. However, the significance of these two hormones for frailty in elderly patients with type 2 diabetes mellitus (T2DM) has not been assessed using a wider range of measures of frailty, including physical, mental, and social indices. Methods: We performed a cross-sectional study to investigate the significance of these two hormones for frailty in elderly T2DM patients (n=148; ≥65 years), using a broad assessment, the clinical frailty scale, and to reevaluate the risk factors for frailty in elderly T2DM patients. We compared parameters between the non-frail and frail groups using the unpaired t and Mann-Whitney U tests. The Jonckheere-Therpstra test was used to identify relationships with the severity of frailty and risk factors were identified using binary regression analysis. Results: Simple regression analysis identified a number of significant risk factors for frailty, including DHEAS <70 µg/dL and cortisol/DHEA-S ratio ≥0.2. Multiple regression analysis showed that low albumin (<4.0 g/dl) (odds ratio [OR]=5.79, p <0.001), low aspartate aminotransferase (AST) activity (<25 IU/L) (OR=4.34, p =0.009), and low body mass (BM) (<53 kg) (OR=3.85, p =0.012) were independent risk factors for frailty. A significant decrease in DHEA-S and a significant increase in the cortisol/DHEA-S ratio occurred alongside increases in the severity of frailty. DHEA-S concentration positively correlated with both serum albumin and BM. Conclusions: Hypoalbuminemia, low AST, and low BM are independent risk factors for frailty in elderly T2DM patients, strongly implying relative malnutrition in these frail patients. DHEA-S may be important for the maintenance of liver function and BM. A decrease in DHEA-S and an increase in the cortisol/DHEAS ratio may be involved in the mechanism of the effect of malnutrition in elderly T2DM patients.


2021 ◽  
Author(s):  
Wu Chao ◽  
Ge Yiling ◽  
Zhang Xinyan ◽  
Liu Mingchao ◽  
Heng Chunni ◽  
...  

Abstract Purpose This study aims to explore the incidence of hypoglycemia in patients with type 2 diabetes mellitus (T2DM) and the influence of hypoglycemia on the specific quality of life in T2DM patients.Methods It was a comparative cross-sectional study consisting of 519 T2DM patients in Xi'an, China and patients were investigated by self-reported hypoglycemia and specific quality of life questionnaires during September 2019 to January 2020. Descriptive analysis, t-test, Chi-square test, hierarchical regression analysis and stepwise multiple regression analysis were used to assess the influence of hypoglycemia on the specific quality of life. Results The incidence of hypoglycemia in T2DM patients was 32.18%. The mean score of specific quality of life in diabetes without hypoglycemia was 57.33±15.36 and was 61.56±17.50 in those with hypoglycemia, which indicated that hypoglycemia had a serious impact on the quality of life diabetics (t=-5.172, p=0.000). In the Univariate analysis of specific quality of life, age, education background, marital status, living status, duration of diabetes, monthly income per capita were independent and significant factors associated with specific quality of life of two groups of T2DM patients (P<0.05). In the hierarchical regression analysis, the duration of the diabetes more than 11 years and the frequency of hypoglycemia more than 6 times in half a year entered the equation of specific quality of life of 519 diabetics respectively (P<0.001). In multiple linear regression analysis, age, marital status and income both entered the regression equation of quality of life of the two groups (P<0.05).Conclusion Hypoglycemia will have a serious impact on the quality of life of T2DM patients. In order to improve the living quality in diabetics, effective measurements should be taken to strengthen the management of blood glucose and avoid hypoglycemia.


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