AMDSID Lombardia Coccaglio 2017 Il Paziente anziano Il

AMD-SID Lombardia Coccaglio 2017

Il Paziente anziano Il Paziente fragile

dobbiamo adottare una linea di pensiero logico e agire di conseguenza

Per la tutela della persona con diabete, specie se anziana e fragile

Anziano Fragile Disabile Non autosufficiente

ASST

ASST

glibenclamide

Chhetri JK et Al. The prevalence and incidence of frailty in pre-diabetic and diabetic community-dwelling older population. BMC Geriatr 17: 47, 2017 no frail 80% 20% diabetic older population

Chhetri JK et Al. The prevalence and incidence of frailty in pre-diabetic and diabetic community-dwelling older population. BMC Geriatr 17: 47, 2017 frail 20% frailty phenotypes diabetic older population

Phenotypes of frailty. Presence of 0– 1 phenotype = not frail, two phenotypes = pre-frail, ≥three phenotypes = frail

CHE COSA SAPPIAMO DEL TERMINE “ANZIANO FRAGILE”? • Perdita autonomia • Isolamento • Rallentamento del cammino • Debolezza muscolare • Polifarmacoterapia • Perdita di peso (involontaria)

Sinclair AJ et Al, J Diab Compl 31: 1465; 2017

Chhetri JK et Al. The prevalence and incidence of frailty in pre-diabetic and diabetic community-dwelling older population. BMC Geriatr 17: 47, 2017 no frail 80% 20% diabetic older population

Consumo attuale di farmaci che aumentano il rischio ipoglicemico e di complicanze CV 40%

no frail 80% 20% 40% farmaci killer diabetic population

ASST

Il Paziente anziano Il Paziente fragile

Recuperare subito almeno il 30% di quota dai farmaci tossici alle nuove terapie che proteggono dall’ipoglicemia e dal rischio CV e riducono l’iperglicemia.

Contrastare l’ipoglicemia iperglicemia Un insegnamento dalla battaglia di Waterloo

J Gerontol A Biol Sci Med Sci. 2016 Sep; 71(9): 1223 -9. GLUCOSE LEVELS AND RISK OF FRAILTY. Zaslavsky O, Walker RL, Crane PK, Gray S, Larson EB. Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle. ozasl@uw. edu. BACKGROUND: The association between glucose levels and incident frailty in older persons remains unclear. We examined the extent to which higher glucose levels in older adults with and without diabetes are related to risk of frailty. METHODS: The data are from the Adult Changes in Thought study. We identified 1, 848 individuals aged 65+ without dementia for whom glucose levels from laboratory measurements of glucose and glycated hemoglobin were available. Physical frailty using modified Fried's criteria was determined from biennial assessments. Frailty hazard was modeled as a function of time-varying measures of diabetes and average glucose levels using Cox regression. RESULTS: A total of 578 incident frailty cases (94 with diabetes, 484 without) occurred during a median follow-up of 4. 8 years. The adjusted hazard ratio for frailty comparing those with and without diabetes was 1. 52 (95% confidence interval = 1. 19 -1. 94). In participants without diabetes, modeling suggested elevated frailty risk with greater average glucose levels (p =. 019); for example, a glucose level of 110 mg/d. L compared with 100 mg/d. L yielded a hazard ratio of 1. 32 (95% confidence interval = 1. 09 -1. 59). In participants with diabetes, glucose levels less than 160 mg/d. L and greater than 180 mg/d. L were related to increased risk of frailty (p =. 001). CONCLUSION: Higher glucose levels may be a risk factor frailty in older adults without diabetes. The apparent Ushape association between glucose levels and frailty in people with diabetes is consistent with the literature on glycemia and mortality and deserves further examination.

SPPB 4 MGS Short Physical Performance Battery (n>10) Sarc. F 4 Meter Gait Speed (n<6 sec) Sarcopenic Risk (n> 10) Sinclair AJ et Al, J Diab Compl 31: 1465; 2017

Rockwood Frailty Index Rockwood K et Al. Gonzalez-Colaco HM et Al. A global clinical measure of fitness and frailty in elderly people. CMAJ 173: 489, 2005 Comparing the predictive value of three definitions of frailty: results fromthe three-city study. Arch Gerontol Geriatr 72: 153, 2017

Rockwood Frailty Index

Perez-Tasigchana RF et Al. METABOLIC SYNDROME AND INSULIN RESISTANCE ARE ASSOCIATED WITH FRAILTY IN OLDER ADULTS: A PROSPECTIVE COHORT STUDY. Ageing September 46: 807, 2017

J. B. Halter et Al. Diabetes. 2014 Aug; 63(8): 2578– 2589. Heterogeneity in health status among patients with diabetes, based on data from the Health and Retirement Study of people over age 50. People with known diabetes were assigned to one of four mutually exclusive categories. A Very Healthy group with no comorbidities; A Healthy Intermediate group with comorbidities constrained to osteoarthritis and hypertension, and with no functional impairments; A group for whom intensive diabetes management would be Difficult to Implement and/or any one of the following: mild cognitive impairment, poor vision, two or more minor functional due to multiple comorbidities impairments; and a group with Uncertain Benefit from intensive diabetes management due to having the poorest health status, with one or more of the following: moderate-to-severe cognitive impairment, two or more major functional dependencies, and/or residence in a long-term nursing facility. As the Health and Retirement Study is a U. S. population-based survey, the y-axis estimates the total number of people in the U. S. over age 50 with diabetes in each category.

il Paziente anziano diabetes pre-fragile il Paziente disabile non autosufficiente

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