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			<h3 class="s-property-title">Full Text Contents</h4>
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					<li><a href="#articleinfo">Article Info</a></li>
					<li><a href="#abstract">Abstract</a></li>
					<li><a href="#intro">Introduction</a></li>
<li><a href="#objective">Objective</a></li>
<li><a href="#result">Results</a></li>
<li><a href="#cause">Causes of Hospitalization</a>
<li><a href="#discussion">Discussion</a>
<li><a href="#conclusion">Conclusion</a>
					<li><a href="#references">References</a></li>			
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			<li class="active"><a href="#articleinfo">Article Info</a></li>
			<li><a href="#abstract">Abstract</a></li>
			<li><a href="#intro">Introduction</a></li>
<li><a href="#objective">Objective</a></li>
<li><a href="#result">Results</a></li>
<li><a href="#cause">Causes of Hospitalization</a>
<li><a href="#discussion">Discussion</a>
<li><a href="#conclusion">Conclusion</a>
			<li><a href="#references">References</a></li>							
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                    <p class="art-type" id="articleinfo">Research Article</p>
		    <p class="art-title">Diabetes in the Elderly Adults: Characteristics in Black African Diabetic Patients in Cotonou - Benin</p>
		    <p class="art-author"><?php $authors="Fran&ccedil;ois Djrolo<sup>*</sup>, Jules Gninkoun and Adebayo Alassani"; echo (stristr($authors,$coauthor))?str_replace($coauthor,"<a href='".$extpath."authors/".$courl."' target='_blank'>".$coauthor."</a>",$authors):$authors; ?></p>
<p class="art-affl">Faculty of Health Sciences, Department of Internal Medicine - Endocrinology, Metabolism and Nutrition Unit, Cotonou, B&eacute;nin
</p>
		    <p class="art-aff"><b>*Corresponding author: <?php $corresponding_author="Fran&ccedil;ois Djrolo"; echo ($coauthor!="" && $coauthor==$corresponding_author)?"<a href='".$extpath."authors/".$courl."' target='_blank'>".$coauthor."</a>":$corresponding_author;?></b>,
Faculty of Health Sciences,
Department of Internal Medicine -
Endocrinology, Metabolism and Nutrition
Unit,
Cotonou, B&eacute;nin
E-mail: <a href="mailto:fdjrolofss@yahoo.fr">fdjrolofss@yahoo.fr</a></p>
<p class="art-aff"><b>Received:</b>  July 28, 2015
<b>Accepted:</b>  August 14, 2015
<b>Published:</b> August 19, 2015</p>
<p class="art-aff"><b>Citation:</b> Djrolo F, Gninkoun J, Alassani A. Diabetes in the Elderly Adults: Characteristics in Black African Diabetic Patients in Cotonou - Benin. <i>Madridge J Diabetes</i>. 2015; 1(1): 1-4. doi: <a href="https://doi.org/10.18689/mjd-1000101">10.18689/mjd-1000101</a></p>
<p class="art-aff"><b>Copyright:</b> &copy;  2015 The Author(s). This work is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</p>
<p><a href="<?php echo $extpath;?><?php echo $jres['journal_link'];?>/mjd-1000101.pdf" class="btn btn-danger pull-right" target="_blank">Download PDF</a></p>
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<div class="articlecontent">
<p class="art-subhead" id="abstract">Abstract</p>
<p class="art-para"><b>Background:</b> According to literature data, 23% of diabetic subjects are more than 65 years old and high prevalence of microvascular and macrovascular complications are responsible for a high rate of morbidity and mortality in elderly diabetic patients.</p>
<p class="art-para"><b>Objective:</b> To evaluate the frequency of elderly diabetic patients and to identify factors associated with high morbidity and mortality rate.</p>
<p class="art-para"><b>Patients and Method:</b> It is a cross- sectional study including diabetic patients hospitalized from 2010, January 1st to 2012, December 31st. Were considered elderly diabetic patients, patients who were 65 years or more old. Statistical analysis was performed using Chi <a href="#2" id="ref2">[2]</a> test and Student test. Difference was considered significant for p<0.05.</p>
<p class="art-para"><b>Results:</b> A total of 478 patients were hospitalized during the study period and 135 were 65
years or older making a prevalence rate of elderly diabetic patients of 28.20%. Mean age of
elderly diabetic patients was 71.83&plusmn;6.32 years with extremes of 65 and 94 years. The main
complications observed were significantly more frequent in elderly diabetic patients than
in others: diabetic foot, 46.70% versus 17.0% (p<10<sup>-4</sup>); poor control of diabetes, 28.10%
versus 35.10% ( p<0.07); Hyperglycaemic hyperosmolar syndrome, 20.0% versus 10.0%
(p=0.002); Neuropathy, 54.90% versus 17.70% (p<10<sup>-4</sup>); Leg arteriopathy, 48.90% versus
10.80% (p<10<sup>-4</sup>) and diabetic nephropathy, 37.80% versus 3.0% (p<10<sup>-4</sup>). The same figure
was observed with high blood pressure, 87.89% versus 63.94% (p=0.03). The evolution
during hospitalization was marked by a high mortality rate of 34.10%. All chronic
complications of diabetes (arteriopathy, retinopathy, nephropathy, neuropathy and
diabetic foot) were significantly more frequent in elderly diabetic patients than in nonolder and were significantly associated with mortality with p value <10<sup>-4</sup>.</p>
<p class="art-para"><b>Conclusion:</b>  Elderly adult diabetes become more and more prevalent even in developing
countries and is responsible for a high rate of morbidity and mortality. The main cause
of hospitalization was diabetic foot. Education for diabetic foot prevention would allow
to reduce hospitalization rate and mortality rate in elderly diabetic patients.</p>
<p class="art-para"><b>Keywords:</b> Diabetes; Elderly subjects; Complications; Mortality.</p>

<p class="art-subhead" id="intro">Introduction</p>
<p class="art-para">All recent estimation studies on diabetes mellitus report a worrying increase in the
prevalence of the disease worldwide and particularly in the developing countries <a href="#1" id="ref1">[1</a>,<a href="#2" id="ref2">2]</a>. In
subsaharan Africa, the number of subjects with diabetes was estimated to 19.8 million in
2013 realizing a prevalence rate of 4.8% and was thought to grow to 41.5 million in 2035
with a prevalence rate of 5.3% <a href="#3" id="ref3">[3]</a>. In Benin, the same trend was observed in the evolution
of the disease with a prevalence rate of 1.1% in 2001, growing to 2.6% in 2008 <a href="#4" id="ref4">[4</a>,<a href="#5" id="ref5">5]</a>. This
increase of the prevalence of diabetes mellitus is often related to life style modifications
with development and urbanization but can also be explained by the improvement of life conditions and especially in developing countries, by the
reduction of transmissible and nutritional diseases and
consequently the increase of life expectancy. All
epidemiological studies of diabetes have underlined the
increase of the prevalence with age <a href="#4" id="ref4">[4</a>,<a href="#6" id="ref6">6</a>,<a href="#7" id="ref7">7]</a>. People living older,
diabetes in the older age is becoming a public health concern
problem even in developing countries. A high prevalence of
microvascular and macrovascular complications was reported
to be responsible for a high rate of hospitalization and death
in elderly diabetic patients <a href="#8" id="ref8">[8]</a>. In subsaharan Africa very few
studies have been devoted to diabetes in the elderly adults.</p>

<p class="art-subhead" id="objective">Objective</p>
<p class="art-para">The objective of the present study was to determine the
frequency of elderly subjects among diabetic patients
hospitalized in the endocrine and metabolism unit of the
teaching hospital in Cotonou and to identify factors associated
with morbidity and mortality in these patients.</p>

<p class="art-subhead" id="method">Patients and Method</p>
<p class="art-para">The study was a retrospective and transversal study
interesting diabetic patients of both sexes hospitalized in the
unit from 2010 January the 1<sup>st</sup> to 2012 December the 31<sup>st</sup>.
Patients of 65 years or more were defined as elderly adult
patients <a href="#9" id="ref9">[9]</a>. Diabetes mellitus was defined according to the
American Diabetes Association criteria <a href="#10" id="ref10">[10]</a>. The medical
report of every patient was screened. Parameters investigated
were age of patients, the control of the diabetes, the presence
of long term complications and the final evolution of the
patient. About long term complications, ischemic heart
disease was defined as the presence of characteristic
electrocardiographic signs of ischemia. Leg arteriopathy was
defined with the disappearance of distal pulses and/or the
objectivation of characteristic lesions at arterial Doppler
ultrasonographic examination. Systolic index pressure were
not measured. Retinopathy was defined with the presence of
characteristic lesions at eye fundoscopy. Diabetic nephropathy
was defined with the presence of significant microalbuminuria
(&#8805;30 mg/24h) or proteinuria coexisting with retinopathy in
the absence of other cause of proteinuria.</p>
<p class="art-para">The control of the diabetes was evaluated with glycated
haemoglobin level and was considered optimal with glycated
haemoglobin level less than 7%. Glycated haemoglobin level
between 7% and 8% defined a poor control of diabetes and
glycated haemoglobin level higher than 8% defined a bad
control. Chi <a href="#2" id="ref2">[2]</a> test was used for statistical analysis and
difference observed was considered significant with p<0.05.</p>

<p class="art-subhead" id="result">Results</p>
<p class="art-para"><b>Characteristics of Patients</b><br/>
During the study period, a total of 478 patients were
hospitalized in the service. Of them, 135 were 65 years or
older representing a frequency of 28.20%. The mean age of
elderly diabetic patients was 71.83%&plusmn;83 years. Concerning
gender, Women represented 52.60% of patients. As shown in figure 1, frequency of elderly diabetic patients grown with
years from 23.10% in 2010 to 40.70% in 2012.</p>
<div class="art-img">
<img src="<?php echo $imgpath;?>images/mjd-101-f001.gif" class="img-responsive center-block"/></div>

<p class="art-subhead" id="cause">Causes of Hospitalization</p>
<p class="art-para">Causes of hospitalization were recapitulated in table 1
and we can see that the more frequent causes in the elderly
patients were foot ulcer and hyperglycemic hyperosmolar
syndrome.</p>
<div class="art-img">
<img src="<?php echo $imgpath;?>images/mjd-101-t001.gif" class="img-responsive center-block"/></div>
<p class="art-para">As shown in table 2, all degenerative complications were
significantly higher in the elderly diabetic patients than the
other. The more frequent complications were successively
retinopathy, neuropathy and ischemic heart disease.</p>
<div class="art-img">
<img src="<?php echo $imgpath;?>images/mjd-101-t002.gif" class="img-responsive center-block"/></div>

<p class="art-para"><b>Diabetes Control and Evolution</b><br/>
Looking at glycated haemoglobin level, only 9.30% of
patients shared an optimal control of the diabetes at
admission. A poor control was observed in 11.30% of patients
and in the majority (79.40%), diabetes control was bad. In the
elderly diabetic patients, 66.40% of patients were treated with
insulin and oral hypoglycemic agents were used in 33.60% of
them when 43.70% of the other patients were treated with
insulin and 54.70% with oral hypoglycemic agents. The
difference was significant with p<10-4. Regarding the evolution during the hospitalization, 34.10% of death were observed in
elderly diabetic patients versus 5.80% in the others (p<10-4).
The main conditions associated with elevated mortality in
elderly diabetic patients were the presence of degenerative
complications (Table 3).</p>
<div class="art-img">
<img src="<?php echo $imgpath;?>images/mjd-101-t003.gif" class="img-responsive center-block"/></div>

<p class="art-subhead" id="discussion">Discussion</p>
<p class="art-para">In the present study, the frequency of 28.20% found for
elderly subjects diabetes was not far from the number of 23%
reported in USA in 2002 <a href="#11" id="ref11">[11]</a>. On the other hand, Charles, et al.
<a href="#12" id="ref12">[12]</a> have reported a higher prevalence rate of 44.08% in
Senegal in 1987. This higher prevalence can be explained by
the definition used for elder subject, which definition was
based on the age of 60 years when our cut off was 65 years.
The growing population of elderly diabetic patients in black
Africa can be explained by many factors among witch the
increase of the prevalence of diabetes, the better treatment of
the disease resulting in longer life expectancy, the large
campaigns of sensitization and screening.</p>

<p class="art-para">The most frequent cause of hospitalization of elderly
diabetic patients in our study was foot wound. This result is
concordant with the report of Mitty, et al. <a href="#13" id="ref13">[13]</a> who reported
in 2009 that the main cause of hospitalization of elderly
diabetic patients in USA was foot lesions in 75% of cases. This
high rate of foot wound can be explained by the high rate of
arteriopathy and neuropathy, the main etiopathogenic factors
of diabetic foot <a href="#14" id="ref14">[14</a>,<a href="#15" id="ref15">15]</a>. Not surprisingly frequency of
ketoacidosis was significantly lower in elder patients because
type 1 diabetes which is the ketone prone diabetes is well
known as a pathology of younger people.</p>
<p class="art-para">Microvascular complications were dominated by
retinopathy and neuropathy with a respective rate of 71.40%
and 54.90%. Lower rate of retinopathy (38%) was reported by
Otiniano, et al. in a multicentric study <a href="#11" id="ref11">[11]</a> and in literature
data, prevalence rate of retinopathy was situated about 34%.
<a href="#16" id="ref16">[16</a>,<a href="#17" id="ref17">17]</a> The high rate observed in our study is probably related
to the fact that the study was focused on hospitalized patients
so patients with complications and in this condition, prevalence
rate can be overestimated.</p>
<p class="art-para">Regarding leg arteriopathy, our finding was closed to the
rate of 42% reported by Mendelson <a href="#18" id="ref18">[18]</a> but a lower rate
(32.4%) has been reported in the elderly diabetic patients by
Guerchet in Brazzaville in 2012 <a href="#19" id="ref19">[19]</a>. In our study, the evolution
of the disease in hospitalized elderly diabetic patients resulted
in a high rate of mortality of 34.10% when Bertoni in a two
years running study has reported a lower mortality rate of 14.8% in USA <a href="#20" id="ref20">[20]</a>. However, like us, Bertoni in his study
underlined diabetic foot as the main cause of morbidity and
mortality. The high mortality rate in our study can be explained
by many factors among which can be listed delay in
consultation, the poor level of the therapeutic set and the
absence of health care insurance.</p>
<p class="art-subhead" id="conclusion">Conclusion</p>
<p class="art-para">Diabetes in elderly adult subjects becomes more and
more prevalent inducing high rate of morbidity and mortality.
Diabetic foot with its vascular component appeared as the
main cause of hospitalization in elderly diabetic patients. In
our context of practice with poor therapeutic set and absence
of revascularization possibility, education for diabetic foot
prevention would be the best way to reduce hospitalization
and mortality rate in elderly diabetic patients.</p>
<p class="art-para"><b>Conflicts of Interest:</b> The authors declare no conflicts of
interest.</p>
<p class="art-para"><b>Consent:</b> Patient has provided written consent for publication
of this study.</p>

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