Diabetes mellitus is a chronic condition that occurs when the body cannot produce enough or effectively use of insulin. Compared with individuals without diabetes, patients with type 2 diabetes mellitus have a considerably higher risk of cardiovascular morbidity and mortality, and are disproportionately affected by cardiovascular disease. Most of this excess risk is it associated with an augmented prevalence of well-known risk factors such as hypertension, dyslipidaemia and obesity in these patients. However the improved cardiovascular disease in type 2 diabetes mellitus patients can not be attributed solely to the higher prevalence of traditional risk factors. Therefore other non-traditional risk factors may be important in people with type 2 diabetes mellitus. Cardiovascular disease is increased in type 2 diabetes mellitus subjects due to a complex combination of various traditional and non-traditional risk factors that have an important role to play in the beginning and the evolution of atherosclerosis over its long natural history from endothelial function to clinical events. Many of these risk factors could be common history for both diabetes mellitus and cardiovascular disease, reinforcing the postulate that both disorders come independently from “common soil”. The objective of this review is to highlight the weight of traditional and non-traditional risk factors for cardiovascular disease in the setting of type 2 diabetes mellitus and discuss their position in the pathogenesis of the excess cardiovascular disease mortality and morbidity in these patients.

Type 2 diabetes and cardiovascular disease: Have all risk factors the same strength?

Diabetes mellitus is seen to be prevalent among the different epidemics. The prevalence rate of the diabetes mellitus is seen to be increasing in different regions of the world. Type 2 diabetes mellitus is the most common form of the disease that causes the defect in the production of insulin. It is associated with the disruption in the metabolism of fat, proteins and carbohydrates. Different complications that are associated with T2DM includes the retinopathy, neuropathy, nephropathy and weakness and other issues. Due to the loss of the function of the insulin, the metabolism is disturbed. . It is needed to consider the effects of inflammation aging and the oxidative stress on the diabetes mellitus. Therefore this review has dealt with this particular issue in great detail. The predominant aim of this review was to evaluate the effects of inflammation aging and oxidative stress on the T2DM. It was achieved through correlating and comparing the studies of different researchers. This review article has reviewed this topic in great detail considering the different researches related to the inflammation aging, oxidative stress and their impact on the diabetes mellitus.

The effects of inflammation, aging and oxidative stress on the pathogenesis of diabetes mellitus (type 2 diabetes)

Diabetes in the elderly is a growing public health burden. Persons with diabetes are living longer and are vulnerable to the traditional microvascular and macrovascular complications of diabetes but also at increased risk for geriatric syndromes. Peripheral vascular disease, heart disease, and stroke all have a high prevalence among older adults with diabetes. Traditional microvascular complications such as retinopathy, nephropathy, and neuropathy also frequently occur. Unique to this older population is the effect of diabetes on functional status. Older adults with diabetes are also more likely to experience geriatric syndromes such as falls, dementia, depression, and incontinence. Further studies are needed to better characterize those elderly individuals who may be at the highest risk of adverse complications from diabetes.

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Epidemiology of Diabetes and Diabetes Complications in the Elderly: An Emerging Public Health Burden

Clinical frailty scale and mortality in COVID-19: A systematic review and dose-response meta-analysis.

© 2012 Suastika et al., licensee InTech. This is an open access chapter distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Age is an Important Risk Factor for Type 2 Diabetes Mellitus and Cardiovascular Diseases

/pdf/age-is-an-important-risk-factor-for-type-2-diabetes-mellitus-3rflgs4y2p.pdf

Age is an Important Risk Factor for Type 2 Diabetes Mellitus and Cardiovascular Diseases

Background and aims The ongoing COVID-19 pandemic is disproportionately affecting patients with comorbidities. Therefore, thorough comorbidities assessment can help establish risk stratification of patients with COVID-19, upon hospital admission. Charlson Comorbidity Index (CCI) is a validated, simple, and readily applicable method of estimating the risk of death from comorbid disease and has been widely used as a predictor of long-term prognosis and survival. Methods We performed a systematic review and meta-analysis of CCI score and a composite of poor outcomes through several databases. Results Compared to a CCI score of 0, a CCI score of 1–2 and CCI score of ≥3 was prognostically associated with mortality and associated with a composite of poor outcomes. Per point increase of CCI score also increased mortality risk by 16%. Moreover, a higher mean CCI score also significantly associated with mortality and disease severity. Conclusion CCI score should be utilized for risk stratifications of hospitalized COVID-19 patients.

Charlson comorbidity index and a composite of poor outcomes in COVID-19 patients: A systematic review and meta-analysis.

Objective: Delirium is a common neuropsychiatric syndrome in the elderly characterized by concurrent impairments in cognition and behavior. Infection is one of the most important risk factors for delirium. The objective of this study is to elaborate the factors related to the severity of delirium in the elderly patients with infection. Method: An observational study on the relationship of several clinical parameters and the severity of delirium in elderly patients (more than 60 years) with infection was conducted at Geriatric Inpatient Ward, Sanglah Hospital. Delirium was defined by the Memorial Delirium Assessment Scale (MDAS). Charlson Age Comorbidity Index (CACI) scores were calculated as proposed by Charlson et al. Infection was confirmed by clinical, laboratory, and radiographic findings. Results: During 3 months, there were 60 elderly patients (35 men and 25 women) who were hospitalized with infection and delirium. In all, 33 (55.0%), 16 (26.7%), and 11 (18.3%) patients had pneumonia, urinary tract infection, and other infections, respectively, and 44 out of 60 (73.3%) patients had sepsis. There was no significant difference found in MDAS score between male and female patients and among different types of infection, but patients with sepsis had higher MDAS score significantly compared with patients without sepsis (19.48 ± 3.72 vs. 15.88 ± 2.82; p < .001). This study revealed that of several clinical parameters, only CACI (R = .533; p < .001), blood urea nitrogen (BUN; R = .230; p = .040), and interleukin 6 (IL-6) levels (R = .499; p < .001) were correlated with MDAS score significantly. By multiple linear regression test, CACI, IL-6, and sepsis have significant role, meanwhile, BUN has no role, on the severity of delirium. Conclusions: The CACI score, IL-6 levels, and sepsis have strong relationship with the severity of delirium, but BUN only has weak role in the severity of delirium in the elderly patients with infection.

https://journals.sagepub.com/doi/pdf/10.1177/2333721417739188

Factors Related to the Severity of Delirium in the Elderly Patients With Infection.

The more increasing of life expectancy is more complex disease in elderly. One of cause disease in elderly is hypertension The isolated systolic hypertension (ISH) the most risk factor in stroke, coronary failure, and coronary heart disease, their role is predicted more their in the youth. The definition of hypertension is not change in the age : systolic blood pressure (SBP) 140 mmHg, and or diastolic blood pressure (DBP) 90 mmHg. The Joint National Committee on Prevention, Detection, Evaluation and Treatment of high blood pressure (JNC VI) and WHO or International society of hypertension guidelines sub committees agree that SBP and DBP, both are used to classify the hypertension. Patophysiology of blood pressure is not clear. The most effect of the mortal aging in the cardio vascular system includes the changing of compliance aorta and systemic vessels. The thickening of aorta wall are major vessels are increasing while the elasticity of vessel is decreasing in aging. This changing brings the compliance of aorta is decreasing and the major vessel, it causes the increasing of peripheral vascular resistance. Baroreceptor sensitivity is also changing in aging. The changing in the metabolism of baroreceptor reflex possibly can explain the existence the variability pressure. The changing of vasodilatation adrenergic and vasoconstriction of adrenergic a in balance will tend vasoconstriction are will bring the increasing of peripheral vessel resistance and blood pressure. The management of hypertension in the elderly includes behavior, exercise, and pharmacology therapy.

RA Tuty Kuswardhani

Papers

Charlson comorbidity index and a composite of poor outcomes in COVID-19 patients: A systematic review and meta-analysis.

Clinical frailty scale and mortality in COVID-19: A systematic review and dose-response meta-analysis.

Age is an Important Risk Factor for Type 2 Diabetes Mellitus and Cardiovascular Diseases

Factors Related to the Severity of Delirium in the Elderly Patients With Infection.

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