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Science, Technology and Medicine open access publisher.Publish, read and share novel research. Age is an Important Risk Factor For Type 2 Diabetes Mellitus and Cardiovascular DiseasesKetut Suastika1, Pande Dwipayana1, Made Siswadi Semadi1 and RA Tuty Kuswardhani2[1] Division of Endocrinology and Metabolism, Internal Medicine, Faculty of Medicine, Udayana University, Sanglah Hospital, Denpasar, Indonesia[2] Division of Geriatrics; Department of Internal Medicine, Faculty of Medicine, Udayana University, Sanglah Hospital, Denpasar, Indonesia1. Akbaraly TN, Kivimaki M, Ancelin ML, Barberger-Gateau P, Mura T, Tzourio C, Touchon J, Ritchie K, Berr C.
Hayashi T, Kawashima S, Itoh H, Yamada N, Sone H, Watanabe H, Hattori Y, Ohrui T, Yokote K, Nomura H, Umegaki H, Iguchi A; Japan CDM Group. Holvoet P, Kritchevsky SB, Tracy RP, Mertens A, Rubin SM, Butler J, Goodpaster B, Harris TB. Kirwan JP, Khrisnan RK, Weaver JA, Del Aguila LF, Evans WJ.Human aging is associated with altered TNF-a production during hyperglycemia and hyperinsulinemia.
Minamino T, Orimo M, Shimizu I, Kunieda T, Yokoyama M, Ito T, Nojima A, Nabetani A, Oike Y, Matsubara H, Ishikawa F, Komuro I. Poehlman ET, Berke EM, MI Joseph JR, Gardner AW, Ades PA, Katzan-Rook SR, Goran MI.Influence of aerobic capacity, body composition, and thyroid hormone on age-related decline in resting metabolic rate. Increased mitochondrial activity leads to enhanced ROS production from the mitochondrial electron transfer chain. December 8, 2014 by arpan Leave a Comment Management of hyperglycaemia is still a challenge in patients with type 2 diabetes mellitus despite an increase in the pharmacological options. SGLT2 inhibitors are the new armour in the hands of the physicians for the treatment of type 2 diabetes. Most glucose filtered through the glomeruli is reabsorbed in the proximal renal tubule, mediated by SGLT-1 (10%) and SGLT-2 (90%).
There are only a few clinical trials comparing SGLT-2 inhibitors and DPP4 inhibitors available.The DPP-4 inhibitor that is used in all the trials is sitagliptin 100mg. Canagliflozin has showed non inferiority when compared with sitagliptin and subsequent analysis showed superiority with greater reductions in body weight, FPG, and blood pressure over the period of 52 weeks.
Empagliflozin also showed similar or greater reductions in HbA1C with clinically relevant reductions in weight and systolic blood pressure. Since the clinical trials comparing SGLT-2 inhibitors with DPP-4 inhibitors are for short term, conclusions about long term safety of the drugs are difficult to make.
Therefore, at present it is difficult to choose between the two classes of drugs for the control of hyperglycaemia considering the advantages and disadvantages of each drug. Similar or greater reductions in HbA1C with clinically relevant reductions in weight and systolic blood pressure.
Tufts OCW material is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported License. Right panel: Insulin resistance at the level of liver, muscle and adipose tissue is increased proportionally to both IH-TG and VF. Abstract Non-alcoholic fatty liver disease is marked by hepatic fat accumulation not due to alcohol abuse. This is an open access article distributed under the Creative Commons Attribution License (CC BY 3.0).
Write your meal or daily targets for each food choice in the section below.Plan your meals by choosing foods you like from this Food List for Diabetes.
4.When your meal is completed, simply wipe off the laminated Nutrition Place Mat with a Tissue! 5.Use the Nutrition Place Mat to help follow healthy nutrition guidelines and portion control. Frequency of metabolic syndrome (MS), impaired fasting glycemia (IFG), and diabetes mellitus (DM) in the younger-aged and elderly.
IntroductionA field study by World Health Organization (WHO), World Bank and Harvard University in 1990 found a changing pattern of diseases caused by unhealthy lifestyle changes that may eventually lead to metabolic syndrome, type 2 diabetes mellitus, coronary arterial diseases, depression, and traffic accidents (Kinsella and Phillips, 2005). Low HDL cholesterol is associated with the risk of stroke in elderly diabetic individuals: changes in the risk for atherosclerotic diseases at various ages. The metabolic syndrome, circulating oxidized LDL, and risk of myocardial infarction in well-functioning elderly people in the health, aging, and body composition cohort. High liporotein (a) level promotes both coronary atherosclerosis and myocardial infarction: a path analysis using a large number of autosy cases.
In healthy states, a hormetic response (shown by dotted green lines) ensues, whereby increased ROS generation upregulates the production of ROS-neutralizing enzymes, such as SOD2 and glutathione peroxidase, as well as the transcription factors PGC-1α and NRF-1, which promote mitochondrial biogenesis.
Although metformin is the first drug to be started for the treatment of type 2 diabetes mellitus, some patients may not tolerate it and the many patients do not get adequate control with metformin alone and an additional drug will become necessary. Although DPP4 inhibitors have lesser risk of hypoglycaemia and weight gain, they are expensive. Two SGLT2 inhibitors dapagliflozin and canagliflizon are already available in the market and the third one empagliflozin is expected to commercialise in the near future. The glycosuria induced by glomeruli has been linked with various metabolic responses in type 2 diabetes mellitus patients including increased total glucose removal, improved beta cell function, and shift in glucose utilisation from glucose to lipid. The adverse effects reported were slightly increased incidence of genital infections and benign urinary infections. And also there is not much data available on the durability of glycaemic control with SGLT-2 inhibitors. More prospective, long term, randomized control trials may help us to choose between the two drugs in the future. Insulin resistance is associated with an increase of free fatty acids (FFAs) flux that contributes to increased TG production that, in turn, stimulate assembly and secretion of VLDL in hepatocytes.
Several studies have demonstrated that NAFLD is associated with insulin resistance leading to a resistance in the antilipolytic effect of insulin in the adipose tissue with an increase of free fatty acids (FFAs). Non-Alcoholic Fatty Liver Disease (NAFLD) and Its Connection with Insulin Resistance, Dyslipidemia, Atherosclerosis and Coronary Heart Disease.
Develop and individualized meal plan with your Registered Dietitian, Nurse, Physician or Health Educator. Improves satisfaction and adherence: Overall Type 2 diabetes patients using insulin pump therapy are happier with the treatment than those on injections which leads to better adherence [16]. Learn about diabetes before pregnancy and the impact diabetes can have on conception and pregnancy. The study also predicted that cerebrovascular diseases would become the most prevalent disease, whereas human HIV infection would sharply increase in the year 2020 (Kinsella and Phillips, 2005). These transcription factors are also induced as a consequence of muscle fiber contraction and the subsequent influx of calcium ions and consumption of ATP. In most of the patients with type 2 diabetes on oral antidiabetic drugs (OADs), the disease progresses and Insulin becomes necessary for the treatment. SGLT-2 belongs to the family of sodium glucose co-transporters which are located in various tissues including kidney, brain, liver, heart, thyroid and muscle. However, liraglutide is associated with greater weight loss in patients with higher baseline BMI. Type 2 Diabetes Food Snacks Food For Recipes Sugar Diabetics Free in patients with diabetes mellitus and loss of protective sensation these deformities may cause ulcers and eventually deep sinus tracts (see diabetes mellitus type 1 nursing management insulin injections canine Figure 1 Figure 2 Figure 3a Figure 3b Figure 4a and Figure 4b .
Because type 2 diabetes develops when diabetes care club brentwood tn plans diabetic for 2 type diet the pancreas cannot make enough insulin to overcome insulin We don’t sell anything we just want to help. The lifestyle-related and degenerative diseases are significant problems in the old aged population group.The number of elderly population has increased worldwide, and recently it has been increasing sharply in the developing countries.
Elliott, Metabolic alterations in middle-aged and elderly obese patients with type 2 diabetes. As a consequence of these changes, cells deal more efficiently with the influx of fatty acids through oxidative phosphorylation, which reduces the amount of lipid metabolism intermediates produced (such as ceramides, DAG and acyl carnitine) and decreases the release of ROS.
Selective inhibition of SGLT2 is important because inhibition of SGLT-1 transporter can lead to glucose malabsorption and diarrhea.
No interaction between baseline BMI and weight reduction has been observed for dapagliflozin.

Furthermore NAFLD subjects have increased secretion of inflammatory markers, plasma glucose and a decrease in HDL concentration.
Moreover, in subjects with NAFLD, ectopic fat also accumulates as cardiac and pancreatic fat. It is known that long-term antibiotic treatments poor dietary habits increased stress a low immunity diabetes and sexual intercourse may favor the occurrence of male yeast infection. The projection of the number of elderly population in Indonesia by the year 2010 is 23,992.
Suastika, Age and homocystein were risk factor for peripheral arterial disease in elderly with type 2 diabetes mellitus. However, when matched per IH-TG (~13%), subjects with low and high VF had comparable indexes of insulin resistance (reproduced with permission from [12]).
The consequence of this physiological dysfunction is increased risk for the development of diabetes and atherosclerosis and increased risk for coronary artery disease.
In this review we analyzed the mechanisms that relate NAFLD with metabolic syndrome and dyslipidemia and its association with the development and progression of cardiovascular disease. Typically Type 2 Diabetes Food Snacks Food For Recipes Sugar Diabetics Free diabetics should aim to eat 30 to 60 grams of carbohydrates per meal and 15 to 30 grams Type 2 Diabetes Food Snacks Food For Recipes Sugar Diabetics Free per snack so that they spread their carb intake Fresh and rich this homemade sweet treat can be served simply in a bowl for a summer BBQ or dressed up in martini glasses for a more sophisticated affair. These Bayer Blood Glucose Test Strips feature the Contour system which needs only a very small drop of blood (0. The Indonesian Central Bureau for Statistics (Badan Pusat Statistik) has reported that Indonesia is the world’s fourth in the number of elderly population after China, India, and USA (Komala et al., 2005). US Bureau of Census predicted that from 1990 to 2020, the Indonesian elderly population would increase to 41.4%. These responses involve, at least in part, the release of NRF-2 from its inhibitor Keap1, allowing NRF-2 to enter the nucleus and promote the transcription of genes involved in antioxidant and general cell defenses, such as those coding for SOD or glutathione peroxidase. The predicted increased number of elderly was ascribed to the success of health promotion and improvement of social and economic status (Kinsella and Taeuber, 1993). Metabolic disorders including type 2 diabetes mellitus (T2DM) and cardiovascular diseases are closely related with the aging process.
Nemeth, Histochemical and enzymatic comparison of the gastrocnemius muscle of young and elderly men and women.J. Central obesity and insulin resistance as the initial preconditions and its consequences related to metabolic diseases and cardiovascular diseases are frequently found among the elderly.
Donath, Aging correlates with decreased ?-cell proliferative capacity and enhanced sensitivity to apoptosis.
Decline in lean body mass and increase in body fat, particularly visceral adiposity that often accompanies aging, may contribute to the development of insulin resistance. Bolli, Demonstration of a critical role for free fatty acids in mediating counter regulatory stimulation of gluconeogenesis and suppression of glucoseutilization in humans. As for the mechanism of T2DM, it is known that aging induces a decrease of insulin sensitivity and alteration or insufficient compensation of beta cell functional mass in the face of increasing insulin resistance (Meneilly and Elliot, 1999). Ducimetiere, The metabolic syndrome and the carotid artery structure in non-institutionalized elderly subjects. Related to beta cell functions, aging correlates with a decrease of beta cell proliferation capacity and enhances sensitivity to apoptosis (Maedler et al., 2006). Young, Effect of age on energy expenditure and substrate oxidation during experimental overfeeding in healthy men. It has recently been proposed that an age-associated decline in mitochondrial function contributes to insulin resistance in the elderly (Petersen et al., 2003). Lima, Age-related left ventricular remodeling and associated risk for cardiovascular outcomes. Gerich, Effect of aging on glucose homeostasis: Accelerated deterioration of ?-cell function in individuals with impaired glucose tolerance. Lamb, The ageing male heart: myocardial triglyceride content as independent predictor of diastolic function.
Age, mitochondrial dysfunction and inflammationMitochondria, a membrane-enclosed organelle found in most eukaryotic cells, generate most of the cell's supply of adenosine triphosphate (ATP), are used as a source of chemical energy, and are involved in a range of other processes such as signaling, cellular differentiation, cell death, as well as the control of the cell cycle and cell growth. Mitochondria have been implicated in several human diseases, including mitochondrial disorders, aging process and cardiac dysfunction. Mitochondrial dysfunction is central to the theories of aging because age-related changes of mitochondria are likely to impair a host of cellular physiological functions in parallel and thus contribute to the development of all the common age-related diseases (Dai et al., 2012).
Rising cellular oxidative stress due to any cause induces mtDNA and mitochondria damage and culminates in a mitochondria function crisis, cell death and aging. Otherwise, aging itself causes abnormal mitochondrial morphology and cell death or apoptosis (Seo et al., 2010).
How old age can be a major risk factor for CVD via mitochondrial dysfunction has been completely reviewed by Dai et al.
The role of NF-?B in bridging the explanation of how aging is associated with inflammation and endothelial dysfunction is reviewed well by Csiszar et al. Another study has shown that depletion of cellular (GSH) during aging plays an important role in regulating the hepatic response to IL-1? (Rutkute et al., 2007). At rest, skeletal muscles of elderly people showed a lower number of macrophages, higher gene expression of several cytokines, and activation of stress signaling proteins, compared with skeletal muscles of young people (Peake et al., 2010).
Human aging is associated with the development of insulin resistance, ?-cell dysfunction and glucose intolerance. The level of suppression of the TNF-? production was observed and found to be significantly correlated with insulin action.
Reduced suppression of TNF-? production in the elderly may in part contribute to the decline in insulin sensitivity (Kirwan et al., 2001).
Age and lipid metabolismAging and age are often associated with lipid metabolism disorders. After the age of 20 years, low-density lipoprotein cholesterol (LDL-C) increases significantly in both men and women.
LDL-C does not increase or is in a flat state between the age of 50-60 years (male) and 60-70 years (female) (Gobal and Mehta, 2010). On the other hand, high–density lipoprotein cholesterol (HDL-C) levels decrease during puberty to young adulthood (in males).
Throughout their lives women have lower total cholesterol compared to men, but the levels will rise sharply after menopause and will be higher in the age >60 years as compared to men.
Concentrations of triglyceride (TG) increase sharply in males, reaching a peak at the age 40-50 years and decline gradually thereafter. TG levels increase in women throughout their lives, especially in women taking estrogen replacement therapy (Gobal and Mehta, 2010).
With the increase of age the composition of body fat also increases, which especially accumulates in the abdomen triggering the incidence of central obesity. TG composition in the muscle and liver are higher in older age compared with younger age groups (Cree et al., 2004). Increased body fat composition is associated with reduced fat oxidation both at rest and in activity (Nagy et al., 1996).
Aging (age) affects the release of fatty acids (FFA),from fat tissue (adipose), and the capacity of peripheral tissues such as muscles, to oxidize fat. These are some of the changes in lipid metabolism influenced by age and aging, which decreases lipolysis response and capacity of fat oxidation.Lipolysis is modulated by various hormones such as catecholamines, glucagon, adrenocorticotropic hormone, growth hormone, prostaglandin, and thyroid hormone (Toth and Tchernof, 2000).
Decreased ability of catecholamines to stimulate lipolysis in the elderly is caused by decreased fat tissue response to adrenergic stimulation (Dillon et al., 1984).
This response involves reduced role of protein kinase A, G-protein complex adenylil cyclase, or the stages in the cyclic AMP signaling cascade (Toth and Tchernof, 2000). Effects of insulin on plasma FFA was different between in the elderly compared with in younger subjects.
Insulin infusions showed that plasma FFA, turnover and oxidation, and total lipid oxidation were higher significantly in the elderly than in the younger group (Bonadonna et al., 1994).

Aging is also associated with decreased sensitivity to antilipolysis effects of insulin (Toth and Tchernof, 2000). In principle, the capacity of metabolically active tissues such as the muscles to oxidize fat represents a combination of the tissue mass and oxidative capacity of the tissue.
Fat free mass decreases with age (Poehlman et al., 1992) and in resting condition fat oxidation tends to be influenced by the size of fat free mass itself. Changes in lipid metabolism in the aging process are associated with dysfunction of endothelial cells pseudocapillarization of the liver sinusoid.
This change causes decreased endocytosis, increased leukocyte adhesion, decreased hepatic perfusion and will potentially reduce the passage of chylomicron remnants into hepatocytes (Denke and Grundy, 1990).
After activity or after meal, fat oxidation rate is more influenced by the oxidative capacity of muscle tissue. Disposal of non-oxidative free fatty acids into the liver will increase the formation of triglyceride-rich very low-density lipoprotein (VLDL) that plays a role in the formation of atherogenic dyslipidemia. Increased levels of TG and decrease HDL-C are features of atherogenic dyslipidemia in people with central obesity, hypertension and insulin resistance (Linblad et al, 2001). Lower HDL cholesterol is an important risk factor for not only ischemic heart disease but also for cerebrovascular disease, especially in diabetic elderly individuals (Hayashi et al., 2009). Age, insulin resistance and metabolic syndrome Metabolic syndrome is a group of metabolic abnormalities of which central obesity and insulin resistance are believed to be the primary backgrounds.
The diagnostic criteria for metabolic syndrome have been proposed by several organizations and associations, all of which are based on five parameters i.e. The pathogenesis of how central obesity causes insulin resistance and metabolic syndrome has been explained in many publications. Decreased insulin sensitivity, reduced muscle mass, and increased body fat mass, especially visceral fat that accompanies aging contribute to insulin resistance in the elderly. Aging process is also associated with reduced compensatory beta cell mass function of the pancreas and to insulin resistance (Maneilly and Elliott, 1999) as well as with decreased mitochondrial function that contributes to insulin resistance (Petersen et al., 2003). Insulin resistance as risk factor for cardiovascular disease (CVD) is associated with increase of acute phase protein response and inflammatory markers.
The association of metabolic syndrome and increased frequency of carotid plaque and thickening of the carotid artery intima media in elderly subjects (aged 65-85 years) was noted in a study by Empana et al.
Metabolic syndrome in the elderly was associated with two-times increase of CRP levels (3.1 vs. Sports activities >2 hours per week would be effective in lowering the risk of metabolic syndrome. Age and type 2 diabetes mellitus Similar to metabolic syndrome, the prevalence of impaired fasting glycemia (IFG) and T2DM increase with rising age.
In the United States, the estimated percentage of people aged 20 years or older having diagnosed or undiagnosed diabetes in 2005-2008 was increasing with age. Similar feature was also observed n England, where the prevalence of diabetes was increasing with age.
There was a tendency of increasing frequency of IFG and T2DM with increasing age (Table 2). Hypertension, overt proteinuria, IFG and high total cholesterol were independent risk factors for new onset diabetes (Peng et al., 2006). The main factors are that aging induces decrease insulin sensitivity and alteration or insufficient compensation of beta cell functional in the face of increasing insulin resistance (Chang and Halter, 2003).
Decrease in beta cell proliferation capacity and enhanced sensitivity to apoptosis are the states related with aging (Maedler et al., 2006).
But aging per se has no effect on insulin sensitivity independent of change in body composition.
Decline in lean body mass and the increase in body fat particularly visceral adipocytes (“central obesity”) that accompanies aging may contribute to insulin resistance.
It has recently been proposed that an age-associated decline in mitochondrial function contributes to insulin resistance in elderly. Mitochondrial oxidative and phosphorylation function was reduced about 40% in association with increased intramyocellular and intrahepatocellular lipid content and decreased insulin-stimulated glucose uptake (Petersen et al., 2003). The pathophysiological basis of sarcopenia (loss of muscle mass with age) has a relationship with oxidative stress, reduced neuronal stimulation, subclinical inflammatory and insulin resistant state. Those conditions contribute to the development of glucose intolerance and type 2 diabetes (Khamseh et al., 2011). They also proposed that adipose tissue p53 tumor suppressor mediated the lipid abnormalities and cardiovascular morbidity associated with obesity. The study found that excessive calorie intake caused accumulation of oxidative stress in the adipose tissue of mice with type 2 diabetes–like disease and promoted senescence-like changes, such as increased activity of senescence-associated ?-galactosidase, increased expression of p53 and increased production of proinflammatory cytokines.
Inhibition of p53 activity in adipose tissue decreased the expression of proinflammatory cytokines and improved insulin resistance.
Age and cardiovascular diseases Cardiovascular disease remains to be the most important cause of death in all countries over the world. Although certain reports from some developed countries indicate the incidence tends to decrease, from many countries there are reports mentioning that its incidence tends to increase. Cardiovascular disease is a complex disease; too many risk factors are involved in its pathogenesis. In general, risk factors for CVD can be divided into two main groups, namely traditional and non-traditional risk factors. Age itself may be an independent risk factor or may have other risk factors related to aging or exposure to risk factors during their lifetime.
In the United States, CVD was the leading cause of death for persons 65 years of age and over in 2007, which accounted for 28% of deaths in this age group (National Center for Health Statistics, 2011).
Age in the group with CHD (old myocardial infarction and myocardial ischemia) was significantly higher than those without CHD (65.0 vs. This increase includes luminal enlargement with wall thickening and a reduction of elastic properties at the level of large elastic arteries.
Long standing arterial pulsation in the central artery has a direct effect on the structural matrix proteins, collagen and elastin in the arterial wall, disrupting muscular attachments and causing elastin fibers to fatigue and fracture.
Increased vascular calcification and endothelial dysfunction is also characteristic of arterial aging. These changes lead to increased pulse wave velocity, especially along central elastic arteries, and increase in systolic blood pressure and pulse pressure (Lee and Oh, 2010).
Aging cardiovascular tissues are exemplified by pathological alterations including hypertrophy, altered left ventricular (LV) diastolic function, and diminished LV systolic reverse capacity, increased arterial stiffness, and impaired endothelial function. This pattern of ventricular remodeling confers significant cardiovascular risk, particularly when present earlier in life. Peripheral artery disease (PAD), a marker of systemic atherosclerosis, is frequently related with age. A study by Kuswardhani and Suastika (2010) on elderly patients who visited the Geriatric Outpatient Clinic, Sanglah Hospital showed that diabetic patients with PAD had higher age (70.7 vs. By multivariate analysis (logistic regression), it was found that only age played a role in PAD event.
ConclusionThe number of elderly population has increased worldwide, and recently it has been increasing sharply in the developing countries. Prolong survival in the elderly creates an impact on the appearance of metabolic diseases and CVD.

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  1. Dj_SkypeGirl

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