|Year : 2014 | Volume
| Issue : 2 | Page : 104-107
Clinical and biochemical characteristics of type 2 diabetes mellitus in the elderly persons seen at a tertiary hospital in Benin City
Andrew E Edo1, EM Umuerri2, FM Akemokwe1, W Ordiah1
1 Department of Medicine, University of Benin Teaching Hospital, Benin, Edo, Nigeria
2 Department of Medicine, Delta State Teaching Hospital, Oghara, Delta, Nigeria
|Date of Web Publication||3-Oct-2014|
Andrew E Edo
Department of Medicine, University of Benin Teaching Hospital, PMB 1111, Benin City, Edo State
Source of Support: None, Conflict of Interest: None
Background: The population of elderly persons with diabetes mellitus is increasing worldwide. However, there is scarcity of data on this subgroup of diabetic subjects in our locale.
Objective: To study the clinical and biochemical characteristics of elderly diabetic subjects who developed DM at the age of 65 years and above.
Subjects and Methods: Hospital records of all persons with type 2 DM seen at a Diabetes Clinic in Benin City, Nigeria who were diagnosed at the age of 65 years and above were retrieved for the study. Data on patient's age, sex, duration of diabetes mellitus, body mass index, waist circumference, blood pressure, fasting plasma glucose, glycosylated hemoglobin A1c (HbA1c), and fasting lipid profile were extracted. Medical records of clinic patients with DM who were diagnosed before the age of 65 years served as controls.
Results: Sixty-three patients who developed DM at the age of 65 years and above were included as study subjects while 398 who developed DM before the age of 65 years served as controls. The study subjects consisted of 33 (52.4%) females and 30 (47.6%) males. The mean ± SEM age of study subjects was 73.40 ± 0.72 years (min-max, 66-92 years). Thirty-three (52.4%) of the study subjects had concurrent DM and hypertension. Hypertension and generalized obesity were found in 30 (47.6%) and 8 (12.7%) subjects, respectively. Abdominal obesity was found in 28 (44.4%) of female and in 12 (19%) of male study subjects. The mean body mass index (BMI) was significantly larger in the controls than in the study subjects (28.76 ± 0.45 vs. 26.64 ± 0.72; P = 0.016). The mean systolic and diastolic blood pressures and lipid profile were comparable in study subjects and the controls.
Conclusion: Hypertension and dyslipidemia were more common in our elderly study subjects but generalized obesity was less common.
Keywords: Dyslipidemia, elderly, hypertension, obesity, type 2 diabetes mellitus
|How to cite this article:|
Edo AE, Umuerri E M, Akemokwe F M, Ordiah W. Clinical and biochemical characteristics of type 2 diabetes mellitus in the elderly persons seen at a tertiary hospital in Benin City. Nig J Cardiol 2014;11:104-7
|How to cite this URL:|
Edo AE, Umuerri E M, Akemokwe F M, Ordiah W. Clinical and biochemical characteristics of type 2 diabetes mellitus in the elderly persons seen at a tertiary hospital in Benin City. Nig J Cardiol [serial online] 2014 [cited 2019 Dec 7];11:104-7. Available from: http://www.nigjcardiol.org/text.asp?2014/11/2/104/142094
| Introduction|| |
Diabetes mellitus (DM) is largely a disorder with its onset mainly in the middle age of life. With improvement in nutrition and healthcare services, the life expectancy has increased thus resulting in an increased proportion of the aged (65 years and above) in the population. The prevalence of DM in the elderly is, therefore, expected to increase. ,, The elderly adults are likely to have other co-morbidities such as hypertension, dyslipidemia, and coronary artery disease. Thus, their management will have to be tailored to meet their specific needs. It is thus imperative that the elderly persons with DM are studied systematically. The aim of this study was to determine the clinical and biochemical characteristics of the elderly persons with type 2 DM who were diagnosed at the age of 65 years and above and were receiving diabetes care in a tertiary care hospital in Benin City, Nigeria.
| Subjects and methods|| |
Hospital records of all elderly patients with type 2 DM (who developed DM at the age of 65 years and above) seen at the Diabetes Clinic of the University of Benin Teaching Hospital, Benin City over a 36-month period were retrieved for this retrospective study. Data documented included the patient's age, gender, history of hypertension, blood pressure, anthropometric indices: Weight, height, body mass index (BMI), and waist circumference (WC). Results of laboratory investigations requested for at presentation to hospital were also extracted. These included fasting serum lipid profile, glycosylated hemoglobin A1c (HbA1c), and FBS. Medical records of our clinic patients with type 2 DM who developed DM before the age of 65 years served as controls.
Statistical analysis was carried out using the Statistical Package for Social Sciences version 16.0 (SPSS, Chicago, IL, USA). Data are expressed as mean ± SEM. Comparison of means was done using Student's t-test for continuous data and Chi-square test for categorical data. Level of statistical significance was set at P < 0.05.
Definition of terms
Diabetes mellitus was defined using the 1999 World Health Organization criteria. 
Elderly type 2 DM subjects were those who were 65 years  and above, while young type 2 DM subjects were those who were less than 65 years old.
For the purpose of this study, the study subjects were those subjects whose diagnosis of type 2 DM were made at the age of 65 years and above, while the controls were those subjects whose diagnosis were made before the age of 65 years even if they were now 65 years and above.
Using World Health Organization criteria,  abdominal obesity was defined as WC > 88 cm in women and WC > 102 cm in men while generalized obesity was BMI > 30 kg/m -2 in both genders. Dyslipidemia was defined using the National Cholesterol Education Program (Adult Treatment Panel III) criteria  as total cholesterol level greater than 200 mg/dl, low density lipoprotein cholesterol greater than 100 mg/dl, triglyceride level greater than 150 mg/dl and high density lipoprotein cholesterol level less than 50 mg/dl in females and less than 40 mg/dl in males.
| Results|| |
One hundred and twenty subjects were 65 years and older. The study population however, consisted of only 63 subjects with type 2 DM who developed DM at 65 years and above, while 398 who developed DM before the age of 65 years served as controls. Among the study subjects, 33 (52.4%) were females and 30 (47.6%) were males giving a female to male of 1.1:1. The mean ± SEM age of study subjects was 73.40 ± 0.72 years (min-max, 66-92 years). Twenty-eight (44.4%) study subjects had type 2 DM only, and 33 (52.4%) had concurrent DM and hypertension. Their mean ± SEM duration of DM was 2.79 ± 0 . 37 years. Hypertension and generalized obesity were found in 30 (47.6%) and 8 (12.7%) subjects, respectively. Abdominal obesity was found in 28 (44.4%) of female and in 12 (19%) of male study subjects. A family history of type 2 DM was documented in 12 (19%) of the study subjects. The characteristics of the study subjects and controls are summarized in [Table 1]. BMI was significantly larger in the controls than in the study subjects (28.76 ± 0.45 vs. 26.64 ± 0.72; P = 0.016). Systolic blood pressure, total cholesterol (TC), high-density lipoprotein (HDL), and LDL were comparable in both study subjects and controls. The characteristics of the male diabetic and female study subjects were comparable and are shown in [Table 2]. The baseline characteristics were similar in both male and female study subjects. The common types and frequency of dyslipidemia in the study subjects and controls are summarized in [Figure 1]. No significant difference was seen in the frequency of the different types of DL in the study subjects compared to the controls.
|Figure 1: Types and frequency of dyslipidaemia among elderly diabetics and controls|
Click here to view
| Discussion|| |
The study showed that over 50% of our patients who developed diabetes mellitus after the age of 65 years had concurrent type 2 DM and hypertension. The prevalence of hypertension in these subjects (47.6%) was similar to the 41.6% reported by Ikem et al.  but lower than the 60.9% found in a multicenter study in Nigeria by Chinenye et al.  The difference in prevalence rate of hypertension could be partly because the study population in these other Nigerian studies included all age groups and not solely the elderly. The mean ages of the study population in these Nigerian studies were less than 60 years. Hypertension is more prevalent in persons with DM of longer duration and those with complications, especially renal impairment. Hypertension worsens prognosis in DM subjects by accelerating development of cardiovascular events and renal impairment. Controlling blood pressure within the desirable target blood pressure of 130/80 mmHg is therefore imperative.
The prevalence rate of generalized obesity (12.7%) in this study was much lower than the 32.9% rate of generalized obesity documented among type 2 DM patients seen in a secondary healthcare center in Benin City.  Possible reason for the lower prevalence rate of obesity in this study when compared with other studies (where the mean ages of participants were usually less than 60 years) may be that our study subjects were elderly persons. Longitudinal evidence suggests that body weight starts declining during older age. , This decline is primarily due to a loss of lean tissue, including muscle mass and bone. Prevalence of obesity of 8 (12.7%) in this study is much lower than the 42.5% obesity rate found among type 2 DM patients in Sokoto.  Obesity was more prevalent in females than in males in our study as also documented in previous Nigerian studies. ,,,,, Abdominal obesity rate of 44.4% in females was also lower than the 76.2% in female type 2 DM patients in the study by Edo and Edo.  Obesity is a common feature in persons with type 2 diabetes mellitus (DM) and is believed to be the driving force behind the increasing prevalence of type 2 DM worldwide.  Obesity is an independent risk factor for cardiovascular disease. , Obesity has the potential of hindering the attainment of good glycemic control and accelerating progression of DM complications. In the management of the elderly diabetic, the choice of glucose lowering medications is very important. Weight-neutral medications such as dipeptidyl peptidase-4 (DPP-4) inhibitors will be useful first-line medications in the elderly patients. Long-acting sulphonyl ureas such as glibenclamide should be avoided in the elderly because of the increased risk of hypoglycemia.
The pattern of DL in the elderly was similar to those in the younger subjects. The most common dyslipidemia in the elderly was high LDL-C dyslipidemia and low HDL cholesterol dyslipidemia. The pattern of DL in this study was similar to other studies , on lipid profile in diabetic patients with low high-density lipoprotein cholesterol (HDLC) being the commonest DL. However, the prevalence of individual DLs in this study was comparable to those in oil workers with DM reported by Edo and Adediran  but lower than those reported by Jisieike-Onuigbo et al.  The mean levels of the lipid fractions (TC; triglyceride, TG; HDLC; low-density lipoprotein cholesterol, LDLC) were not significantly different between the elderly and the younger patients. This is similar to finding by Mann et al.  The prevalence of total hypercholesterolemia (17.5%) is less than the 64% reported in elderly diabetic patients in India and the hypertriglyceridemia of 7.9% is less than the 42% among elderly Indians with diabetes mellitus. 
In conclusion, our study showed that about 50% of elderly subjects with type 2 DM had hypertension. Dyslipidemia was also common among elderly persons with DM seen at our Diabetes Clinic. Obesity was less frequent. The combination dyslipidemia, obesity, and hypertension in our subjects put them at increased risk of cardiovascular events. Therefore, appropriate measures must be put in place to address these co-morbidities beyond glycemic control.
| References|| |
|1.||Kim KS, Kim SK, Sung KM, Cho YW, Park SW. Management of type 2 diabetes mellitus in older adults. Diabetes Metab J 2012;36:336-44. |
|2.||Alix M. Diabetes in the elderly patient. Presse Med 2000;29:2150-5. |
|3.||Singh NP, Pugazhendki V, Das AK, Prakash A, Agarwal SK. Clinical and laboratory profile of diabetes in elderly. J Indian Med Assoc 1999;97:124-8. |
|4.||World Health Organization. Report of a WHO Consultation: Definition, diagnosis and classification of diabetes mellitus and its complication: Part 1. Diagnosis and classification of diabetes mellitus. Department of Noncommunicable Disease Surveillance. Geneva: WHO; 1999. |
|5.||Centers for Disease Control and Prevention. National Diabetes Fact Sheet: General Information and National Estimates on Diabetes in the United States. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. 2011; p. 2011. |
|6.||Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterolin Adults. Executive Summary of the Third Report of the National Cholesterol Education program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285:2486-97. |
|7.||Ikem RT, Akinola NO, Balogun MO, Ohwovoriole AE, Akinsola A. What does the presence of hypertension portend in the Nigerian with non insulin dependent diabetes mellitus? West Afr J Med 2001;20:127-30. |
|8.||Chinenye S, Uloko AE, Ogbera AO, Ofoegbu EN, Fasanmade OA, Fasanmade AA, et al. Profile of Nigerians with diabetes mellitus- Diabcare Nigeria Study group (2008): Results of a multicenter study. Indian J Endocrinol Metab 2012;16:558-64. |
|9.||Edo AE, Edo GO. Prevalence of obesity in Nigerians with type 2 diabetes mellitus seen in a secondary medical center. Ann Biomed Sci 2012;11:44-50. |
|10.||Evans WJ. Exercise, nutrition and aging. Clin Geriatr Med 1995;11:725-34. |
|11.||Steen B. Body composition and aging. Nutr Rev 1988;46:45-51. |
|12.||Isezuo SA, Ezunu E. Demographic and clinical correlates of metabolic syndrome in Native African type 2 diabetic patients. J Natl Med Assoc 2005;97:557-63. |
|13.||Fasanmade OA, Okubadejo NU. Magnitude and gender distribution of obesity and abdominal adiposity in Nigerians with type 2 diabetes mellitus. Niger J Clin Pract 2007;10:52-7. |
|14.||Fadupin GT, Joseph EU, Keshinro OO. Prevalence of obesity among type 2 diabetics in Nigeria a case study of patients in Ibadan, Oyo State, Nigeria. Afr J Med Med Sci 2004;33:381-4. |
|15.||Okafor CI, Fasanmade OA, Oke DA. Pattern of dyslipidaemia among Nigerians with type 2 diabetes mellitus. Niger J Clin Pract 2008;11:25-31. |
|16.||Bakari AG, Onyemelukwe C, Sani BG, Aliyu S, Hassan SS, Aliyu TM. Relationship between casual blood sugar and body mass index in a suburban northern Nigerian population: A short communication. Niger J Med 2007;16:77-8. |
|17.||Jisieike-Onuigbo NN, Unuigbe EI, Oguejiofor CO. Dyslipidaemia in type 2 diabetes mellitus patients in Nnewi South-East Nigeria. Ann Afr Med 2011;10:285-9. |
|18.||Alebiosu CO, Odusan BO. Metabolic syndrome in subjects with type 2 diabetes mellitus. J Natl Med Assoc 2004;96:817-21. |
|19.||Rosenbloom AL, Joe JR, Young RS, Winter WE. Emerging epidemic of type 2 diabetes in youth. Diabetes Care 1999;22:345-54. |
|20.||Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. Lancet 2005;365:1415-28. |
|21.||Hubert HB, Feinleib M, McNamara PM, Castelli WP. Obesity as an independent risk factor for cardiovascular disease: A 26-year follow-up of participants in the Framingham Heart Study. Circulation 1983;67:968-77. |
|22.||Edo A, Adediran OS. Dyslipidaemia among Nigerian oil workers with type 2 diabetes mellitus West Afr J Med 2011;30:206-9. |
|23.||Mann E, Vonbank A, Drexel H, Saely CH. Diabetes care among older adults in primary care in Austria- a cross-sectional study. Swiss Med Wkly 2012;142:w13646. |
[Table 1], [Table 2]
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|[Pubmed] | [DOI]|