Background and Objectives: Type 2 diabetes is one of the common chronic diseases in the elderly. It is thought that long-term complications of type 2 diabetes will negatively affect the quality of life in elderly individuals. It is possible that geriatric syndromes, especially frailty syndrome, are associated with diabetic complications, too. In this study, we aimed to evaluate the effect of macrovascular and microvascular complications of type 2 diabetes on frailty and other geriatric syndromes. In addition, the effect of these complications on quality of life was also reviewed. Materials and Methods: We conducted a cross-sectional study for four months. Comprehensive geriatric assessment tests were done on all patients. The Fried frailty index (FFI) was used for the evaluation of frailty syndrome. We assessed malnutrition by mini nutritional assessment short-form (MNA-SF), and Global Leadership Initiative on Malnutrition criteria (GLIM). The EWGSOP 2 criteria were used for the diagnosis of sarcopenia. Quality of life (QoL) was evaluated using the short form-36 (SF-36) questionnaire. Data analysis was done by SPSS version 22. Results: 237 females and 142 males with a mean age of 71.7 ± 6.1 years were included in the study. The frequency of macrovascular and microvascular complications was 41.4% and 68.1%, respectively. Frailty was found to be associated with macrovascular complications (p = 0.003). Handgrip strength, skeletal muscle mass index, and gait speed were decreased in the presence of macrovascular complications (p = 0.043, p < 0.001, p < 0.001). QoL was also decreased in patients with macrovascular complications (p = 0.003). Nutritional status and handgrip strength were negatively affected in patients with diabetic neuropathy (p = 0.019, p = 0.014). Polypharmacy was also found to be associated with macrovascular complications (p < 0.001, p < 0.001). Macrovascular complications were 2.5 times more common in malnourished patients according to GLIM and 3.2 times more common in patients with decreased gait speed. Conclusion: In this study, we observed that both macrovascular and microvascular complications of diabetes increase susceptibility to geriatric syndromes in elderly individuals. It could be useful to conduct prospective studies in which we can compare the effectiveness of treatment methods on this subject.
Hypersecretion of PTHrP is a relatively common cause of malignancy-related hypercalcemia. However, there is only one case report of letrozole induced hypercalcemia. A 52-year-old female patient was referred to our clinic because of the recent discovery of hypercalcemia (11.0 mg/dL). The patient had a history of left breast carcinoma. She had started a course of letrozole (aromatase inhibitor; 2.5 mg dose/day) ten months earlier. Patient's parathyroid hormone-related protein levels were normal and a bone scintigram revealed no evidence of skeletal metastasis. Other potential causes of high calcium levels were ruled out. We recognized that, when letrozole was taken at one dose daily (2.5 mg), she had recurrent hypercalcemia. Our experience suggests that letrozole may precipitate hypercalcemia in a patient with breast cancer.
Purpose: Polypharmacy is a very important geriatric syndrome related to critical health conditions. The purpose of this study is to research the association of polypharmacy with comprehensive geriatric assessment’s (CGA) various parameters which are indicators of health and life quality in older individuals. Material and Methods: 515 older adults admitted to a university hospital were included in this cross-sectional study. Along with CGA, European Quality of Life (EQ-5D) was performed on the participants. Geriatric Depression Scale (GDS) was used to evaluate depressive symptoms. Daily living activities were assessed by using Lawton & Brody index of Instrumental Activities of Daily Living (IADL) and Katz Index of Activities of Daily Living (ADL). The Full Mini-Nutritional Assessment (MNA) questionnaire was performed to evaluate nutritional status. Results: The participants’ mean age was 72.2±6.3 years and 58.6% of them were female. 242 participants using 5 or more drugs were included in the polypharmacy group. The polypharmacy group had lower IADL, MNA, EQ-5D, HGS, and gait speed scores and higher GDS scores compared to those without polypharmacy. According to the correlation analysis results, the number of the medications had a moderate positive correlation with GDS scores and a moderate negative correlation with EQ-5D and MNA. Conclusion: As the number of medications increases; patients tend to have depression, malnutrition, and a decline in functional status. Polypharmacy also impairs the quality of life. It will be wise to address polypharmacy as a crucial health problem, optimize the number of medications and thereby make the health condition better.
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