Tag Archives: Conditions and Diseases

Middle-Age Diabetics Carry Double the Risk for Developing Geriatric Ailments

Diabetes affects multiple organ systems and has the potential to contribute significantly to the development of a number of issues that we associate with aging. A new study has found that adults between 51 and 70 with diabetes develop age-related ailments like cognitive impairment, incontinence, falls, dizziness, vision impairment and pain at a faster rate than those without diabetes.

For adults aged 51-60 with diabetes, the odds of developing new geriatric conditions were nearly double those of their counterparts who didn’t have diabetes. By the time people with and without diabetes reach 80, the overall effects of aging and impact of other diseases start to reduce the disparities between the two groups, the researchers found.

The research was based on nationally representative data from the University of Michigan Health and Retirement Study and the results published in the March issue of the Journal of General Internal Medicine.

“The findings suggest that adults with diabetes should be monitored for the development of these conditions beginning at a younger age than we previously thought… “If we know to start looking for these conditions earlier, we can manage and treat them more effectively,” said lead author Christine Cigolle, M.D., M.P.H., an assistant professor of family medicine and internal medicine at the University of Michigan Medical System and research scientist at the VA Ann Arbor Healthcare System

These findings echo the findings of another study published in the journal Diabetes last year. Margaret Gatz and researchers from Sweden showed that getting diabetes before the age of 65 corresponds to a 125 percent increased risk for Alzheimer’s disease.

This risk of Alzheimer’s disease or other dementia was significant for mid-life diabetics — as opposed to those who develop diabetes after 65 — even when controlling for family factors. In other studies, genetic factors and childhood poverty have been shown to independently contribute to the risk of both diabetes and dementia.

Indeed, the chances of a diabetic developing Alzheimer’s disease may be even greater in real life than in the study, the researchers said. They identified several factors that might have led them to underestimate the risk of dementia and Alzheimer’s among those who develop diabetes before the age of 65.

Diabetes usually appears at a younger age than dementia does, the researchers noted. Diabetes is also associated with a higher mortality rate, which may reduce the size of the sample of older adults. In addition, approximately 30 percent of older adults with diabetes had not been diagnosed.

The results of the study implicate adult choices such as exercise, diet and smoking, as well as glycemic control in patients with diabetes, in affecting risk for Alzheimer’s disease and diabetes, according to the researchers.

In fact, researchers from Mayo Clinic’s Florida campus say that dementia in some diabetics appears to be caused often by vascular disease in the brain, and the dementia that develops in people without diabetes is more likely associated with deposition of the plaque seen in people with Alzheimer’s disease.

“This helps in understanding diabetes and dementia. It suggests that the vascular dementia seen in diabetics, which appears to be related to small blood vessel disease and strokes, can potentially be averted if development of diabetes is prevented,” says Mayo neurologist Neill Graff-Radford, M.D.

The results agree with a number of autopsy studies conducted on patients with dementia and diabetes, in which vascular abnormalities were found to be related to the dementia but the Alzheimer’s pathology of plaque and tangles was not, he says.

The findings also suggest that an experimental blood test to predict development of Alzheimer’s disease may be more accurate than some studies of people with dementia have suggested, because those studies included participants with diabetes, says Dr. Graff-Radford. “We now propose that future studies of this test should take into account diabetic status,” he says.

The test is based on discoveries made by Mayo neuroscientists, which measure the ratio of two different kinds of amyloid beta proteins in blood. Plaque found in the brains of Alzheimer’s disease patients at autopsy started when the toxic form of amyloid beta, known as Aβ42, began to be deposited.

The findings also make sense biologically, Dr. Graff-Radford says. Both the insulin hormone and amyloid beta proteins are degraded by the insulin-degrading enzyme (IDE). He adds that if the blood contains excess insulin, as is the case in diabetics, then IDE preferentially degrades insulin instead of amyloid. “That means there would be higher levels of both Aβ42 and Aβ40 in the blood of diabetics,” he says.

Indeed, patients with dementia and diabetes appear to display a different pattern of injuries in their brains than patients with dementia but without diabetes, Joshua A. Sonnen, M.D. of the University of Washington, Seattle, discovered. The association between diabetes mellitus and increased risk for dementia in the elderly is well documented. Several possible mechanisms have been proposed for this association, including the direct effects of high blood glucose and insulin, the build-up of beta-amyloid plaques in the brain and the effects of diabetes-related vascular disease on blood vessels in the brain.

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Depression Sufferers Live With Higher Risk of Diabetes

Depression can heighten the risk of developing type 2 diabetes as the mental illness also increases the likelihood of obesity and failing to take enough exercise, a study carried out by the German Diabetes Association (DDG) has shown, reports DPA.

Bouts of depression can also lead to higher levels of the stress hormone cortisol in the blood. Cortisol, also known as hydrocortisone, counteracts insulin and contributes to type 2 diabetes, which is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency.

It is recommended that those suffering from depression undergo tests for the disease as they are 11 times more likely to suffer vascular complications than people battling diabetes alone. The risk of damage to arteries, which could lead to a heart attack, is between two and five times as high.

According to the DDG, not only are people with depression at increased risk of developing type 2 diabetes, those with diabetes are also at increased risk of developing depression.

The consequences can be serious as treatment for diabetes requires the active involvement of the patient. “Depression is a major barrier in such instances,” explains Bernhard Kulzer, chairman of the DDG’s psychology council.

Complications that can result from improperly managed type 2 diabetes include renal failure, blindness and arterial disease, including coronary artery disease. The DDG recommends that diabetics suffering from depression undergo psychological treatment.

How Long Does it Take to Lower Your A1C Levels?

Red blood cells and the hemoglobin they contain have an average life span of 120 days during which glucose molecules are exposed to the red blood cells and form glycated hemoglobin. Therefore, in theory, changes in your A1C levels won’t be apparent for at least the 120 days it takes for the affected red blood cells to complete a life cycle.

The amount of time it takes to lower your A1C depends on how big of a change you are trying to achieve. If your A1C is in the double digits, it may take a matter of 2 or 3 months to see a significant change if your diabetes management is consistent and tight. If your A1C is a point or two away from ADA/AACE recommendations, getting to goal may take a little longer.

“Lowering your HbA1c from a [high] number to an 8.0 or 7.5 is much easier than lowering it from a 7.5 to 6.5,” said dLife Expert CDE Claire Blum in response to a question about lowering A1C levels. “Tightening of control that occurs at the lower numbers takes a lot of fine tuning. Our bodies also require some time to adapt to the change of improved [levels].”

There are no special tricks to getting your A1C to a level more acceptable to you and your doctor. Lowering your A1C is doing just what your doctor has always told you was best for good diabetes management.

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