Insulin sensitivity and secretion differ between elderly-onset and habitual-onset type 2 diabetes in older patients.
(2014) Journées d’Automne - Société belge de gériatrie et gérontologie (SBGG) — Location: Liège, BE
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- Introduction Hypoglycemic events should be avoided in older patients with type 2 diabetes mellitus (DM2). Such events largely depend on the prescribed glucose-lowering therapy as well as the patient's insulin secretion and sensitivity. If these latter two metabolic variables differ according to whether DM2 is diagnosed before or after the age of 65 years, such an observation should be taken into account in order to aim at appropriate glucose management in older diabetic patients. Methods Cross-sectional study including 333 consecutive subjects aged 75 years or more, followed for DM2 at the outpatient diabetes clinic of an academic hospital in Brussels by one of us (MPH). DM2 was classified as habitual-onset diabetes (HODM2) when diagnosed Results Patients with EODM2 (n=95; 82±5 years), as compared to HODM2 (n=238, 77±6 years), had a shorter history of DM2 (10±5 vs. 22±10 years). Both groups were similar in terms of cardio-vascular risk factors and metabolic syndrome profile. The prevalence of complications was lower at the micro-vascular level (43 vs. 67%, p=0.0001) but similar at the macro-vascular one (47 vs. 51%). EODM2 patients significantly differed from HODM2 in four anthropometric and metabolic characteristics: lower BMI (26.8 vs. 29.0 kg/m2), lower body fat mass (24.1 vs. 26.7 kg), higher insulin sensitivity (67 vs. 56%) and higher residual β-cell secretion (67 vs. 56%). EODM2 patients, as compared to HODM2 ones, received significantly less intensive anti-diabetic regimens, specifically oral ones (none: 19 vs. 2%; or one: 29 vs. 11%) and insulin (30 vs. 60%, p<0.001) at a lower mean daily dosage (0.47 vs. 0.61 IU/kg), with one single daily injection (38 vs. 20%). Overtime, the average HbA1c was not different in EODM2 and HODM2 patients (7.3±1.3 vs. 7.6±1.3%). Conclusion EODM2 patients significantly differ from HODM2, as they present with lower fat mass, higher insulin sensitivity, and higher insulin residual secretion. Such metabolic features might expose EODM2 patients to a higher risk of hypoglycemia when prescribed glucose-lowering drug regimens similar to those used in HODM2 patients. In EODM2 patients, recommended HbA1c target (7%≤ HbA1c ≤8.5%) can be attained using light anti-diabetic drug regimens.
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Christiaens, A., Jonas, C., Ahn, S. A., Rousseau, M., Boland, B., & Hermans, M. (2014). Insulin sensitivity and secretion differ between elderly-onset and habitual-onset type 2 diabetes in older patients. Geriatrie et Psychologie Neuropsychiatrie du Vieillissement, 12(Suppl. 3), 15-16. https://hdl.handle.net/2078.5/124914 (Original work published 2014)