Max E. Otiniano

The effect of diabetes combined with stroke on disability, self-rated health, and mortality in older Mexican Americans: results from the Hispanic EPESE

OBJECTIVE To examine how diabetes in combination with stroke affects functional activities of daily living (ADLs) and instrumental activities of daily living (IADLs), self-rated health, and 5-year mortality in elderly Mexican Americans with or without other comorbid conditions. DESIGN Longitudinal study. SETTING Five southwestern states. PARTICIPANTS A total of 3050 subjects of age 65 years or older, of whom 23% had diabetes and 6% had a stroke. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES ADL and IADL disabilities, self-rated health, and 5-year mortality. RESULTS Subjects with both diabetes and stroke but without other comorbid conditions had almost 18 times higher risk of having any ADL disability (odds ratio [OR]=18.8; 95% confidence interval [CI], 3.3-105.2) and 10 times higher risk of having any IADL disability (OR=10.6; 95% CI, 1.1-101.5), compared with subjects without either of the 2 conditions. The risk of disability was further increased if the subject had a comorbid condition (hypertension, heart attack, cancer, hip fracture, arthritis). The risk of fair or poor self-rated health was 3.5 (95% CI, 1.4-8.6) and the hazard ratio for 5-year mortality was 2.4 (95% CI, 1.7-3.4) in people with both diseases. CONCLUSIONS Diabetes and stroke in combination is strongly associated with a higher risk of disabilities, poor self-rated health, and 5-year mortality in elderly Mexican Americans. The effect on outcomes appears to follow an additive model. Information on disability risk and morbidity and mortality should be useful to rehabilitation professionals in discharge planning and allocation of therapy resources.

Clinical Experience with Human Immunodeficiency Virus–Infected Older Patients in the Era of Effective Antiretroviral Therapy

New therapies for human immunodeficiency virus (HIV)-infected patients suggest the need to examine whether these therapies are as effective in older patients as in younger patients. Fifty-two patients aged >/=50 years were compared with 52 patients aged <50 years for changes in CD4(+) counts, viral loads, opportunistic disease, hospitalizations, drug side effects, and death. No differences were found, except for higher rates of candidiasis in younger patients. Antiretroviral therapy seems to be equally effective in older and younger patients.

Factors associated with insulin discontinuation in subjects with ketosis-prone diabetes but preserved β-cell function

Aim  To evaluate factors predictive of insulin discontinuation in subjects with ketosis‐prone Type 2 diabetes.

Lower extremity amputations in diabetic Mexican American elders: Incidence, prevalence and correlates

This study was designed to determine the incidence and prevalence of amputations in diabetic Mexican American elders and to identify correlates of lower extremity amputations. Data for this study came from baseline and two follow-up interviews of the Hispanic Established Population for the Epidemiological Study of the Elderly (EPESE) conducted in five southwestern states (Texas, California, New Mexico, Colorado and Arizona) in 1993-1994. Of the 3050 subjects aged 65 and older, 690 reported diabetes, and from these, 60 (8%) reported having at least one lower extremity amputation. Losing a leg was the most common type of amputation (53%). Twelve percent of respondents reported a new amputation and 40% of amputees reported a second amputation during follow-up. Mortality among amputees was 46% during a 5-year follow-up. Multiple logistic regression analysis showed that being male and having eye problems, hip fracture and diabetes for 10 or more years were significantly associated with lower extremity amputations at baseline, whereas obesity, stroke and 10 or more years with diabetes were significantly associated with new amputations at 5-year follow-up. Gender and disease history were associated with lower extremity amputations at baseline and follow-up. These variables may be useful in developing patient education and intervention programs.

Self-reported diabetic complications and 7-year mortality in Mexican American elders: Findings from a community-based study of five Southwestern states

PURPOSE This study was designed to examine the relationship between self-reported diabetic complications and 7-year mortality in Mexican American elders. METHODS We studied 3050 Mexican Americans aged 65 and older from the Hispanic Established Population for the Epidemiological Studies of the Elderly (EPESE), conducted in five Southwestern states of the United States, for whom data were available from the baseline interview in 1993-1994 and three follow-up interviews in 1995-1996, 1998-1999, and 2000-2001. A total of 690 respondents in the baseline interview reported a physicians diagnosis of diabetes. RESULTS Of 690 patients with diabetes, 412 (59.7%) subjects had self-reported complications of eye, kidney, circulation problems, amputations, and 276 (40%) died within the 7-year follow-up. Compared to patients without any diabetic complications, subjects with only one complication were not statistically significantly different in terms of the 7-year mortality (hazard ratio with 95% CI: 1.30, 0.96-1.76), after adjusting for age, sex, living arrangements, smoking, drinking, past medical history of stroke, heart attack, hypertension, cancer, and hip fracture. However, those with two or three complications were nearly twice as likely to die within 7 years than those without complications (1.75, 1.26-2.43 and 1.80, 1.17-2.79, respectively), whereas patients with four complications were nearly three times more likely to die (2.86, 1.47-5.58). CONCLUSION The risk of 7-year mortality increased with the number of diabetic complications among Mexican American older adults. Detection of and early treatment/control for diabetic complications may lead to increase survival in this population.

Predictors of glycaemic control in indigent patients presenting with diabetic ketoacidosis

Aim:  To derive predictors of good glycaemic control in patients presenting with diabetic ketoacidosis (DKA) followed prospectively in a specialized clinic.

Self-reported heart attack in Mexican-American elders: examination of incidence, prevalence, and 7-year mortality.

OBJECTIVES: To examine the prevalence, incidence, and mortality of self‐reported heart attack in older Mexican Americans and to identify significant factors associated with heart attack.