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The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 55:M257-M259 (2000)
© 2000 The Gerontological Society of America

Epidemiology of Hyperglycemia in Elderly Persons

Shih-Wei Laia, Chee-Keong Tana and Kim-Choy Ngb

a Department of Community Medicine, China Medical College Hospital, Taichung, Taiwan
b Department of Emergency, China Medical College Hospital, Taichung, Taiwan

Shih-Wei Lai, Department of Community Medicine, China Medical College Hospital, No. 2, Yuh-Der Road, Taichung, 404, Taiwan E-mail: shihweil{at}ms2.hinet.net.

Decision Editor: John E. Morley, MB, BCh


   Abstract
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 Abstract
Methods
 Results
 Discussion
 References
 
Background. Our study used data collected in the Chung-Shing-Shin-Tseun community of Taiwan in May 1998 to evaluate the distribution of fasting glucose and the relation between hyperglycemia and the cardiovascular risk factors and sociodemographic factors in elderly persons.

Methods. Individuals aged 65 and over were recruited as study subjects. A total of 1,093 persons, out of 1,774 registered residents, were contacted in face-to-face interviews. The response rate was 61.6%. However, only 586 respondents took blood tests and completed questionnaires. Analysis in this study was based on these 586 subjects. The t test, chi-square analysis, and multivariate logistic regression were used to study the significant correlates of hyperglycemia.

Results. Of the individuals in our study, 66.0% were men and 34.0% were women. The mean age was 73.1 ± 5.3 years. The mean values of fasting glucose were 5.5 ± 1.6 mmol/L in elderly men and 5.7 ± 2.1 mmol/L in elderly women. The hyperglycemic rates determined by modified World Health Organization criteria (>=6.05 mmol/L) were 20.2% in elderly men and 20.7% in elderly women. Multivariate logistic regression analysis was used, after controlling the other covariates, to show that the significant related factors in hyperglycemia were obesity (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.02–4.5), high systolic pressure (OR 2.1, 95% CI 1.1–4.0), and hypertriglyceridemia (OR 2.1, 95% CI 1.03–4.4). No significant association was found between hyperglycemia and gender, age, high diastolic pressure, abnormal glutamic pyruvic transaminase, hypercholesterolemia, hyperuricemia, renal function impairment, education level, retirement status, or marital status.

Conclusions. The prevalence of hyperglycemia is high in elderly persons. Hyperglycemia is significantly associated with obesity, high systolic pressure, and hypertriglyceridemia in elderly persons. It is important to examine other cardiovascular risk factors if one cardiovascular risk factor is observed.

DIABETES mellitus has been identified as one risk factor for cardiovascular disease (1). In Aronow's report, diabetes mellitus correlated with cardiovascular disease in elderly men and women (2). In Taiwan, cardiovascular disease is the third leading cause of death after neoplasm and cerebrovascular disease, and diabetes mellitus is the fifth leading cause of death (3). In Chen and Yu's report, serum fasting glucose values were 5.68 ± 2.17 mmol/L in men and 5.47 ± 2.06 mmol/L in women ( p < .05). The hyperglycemic rates (>=7.70 mmol/L) were 8.2% in men and 5.9% in women (p < .05) (4). In the Framingham study, blood sugar correlated with cardiovascular disease in elderly men and women (5). The population of Taiwan is larger than 21 million, and the population aged 65 and over has exceeded 7.0% since 1994 (6). There is little information about the distribution of fasting glucose or the associations between hyperglycemia and the cardiovascular and sociodemographic risk factors in Taiwanese elderly persons. As a result, health promotion and disease prevention recommendations for elderly persons remain uncertain. Thus, it is time to pay attention to the health status of elderly people and its determinants in this country.

The distribution of fasting glucose in elderly persons living in the Chung-Shing-Shin-Tseun community in Taiwan was determined. The relation between hyperglycemia and the cardiovascular and sociodemographic risk factors was also investigated.


   Methods
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 Abstract
 Methods
Results
 Discussion
 References
 
In May 1998, a cross-sectional study was conducted in the Chung-Shing-Shin-Tseun community in Taiwan. All individuals aged 65 and over were candidates for the study, for a total of 1,774 subjects according to the official household registration records. A total of 1,093 persons, out of the possible 1,774 subjects, participated in the study. The response rate was 61.6%. However, only 586 respondents took blood tests and completed questionnaires. Analysis in this study was based on these 586 subjects. Information about the subjects' socioeconomic status, family structure, and educational level was collected by well-trained interviewers in face-to-face interviews.

The subjects' educational levels were identified as junior high school or less, senior high school, professional training college, and undergraduate or graduate. If the subject had retired from work, that status was identified. If the subject still lived with a spouse, marital status was defined as living together. If not, marital status was defined as living alone.

The subjects' blood pressure was measured using a mercury sphygmomanometer, with the subject seated. Weight and height were measured. Blood samples were obtained in the morning after a 12-hour overnight fast. A number of biochemical markers, such as glutamic pyruvic transaminase (GPT), cholesterol, triglyceride, fasting glucose, creatinine, and uric acid, were analyzed with a biochemical autoanalyser (Chem1+, Technicon, USA) at the Department of Clinical Laboratory of Chung-Shing Hospital within 4 hours of collection.

Body mass index (BMI) was measured as weight (kg) ÷ height (m)2. BMI >= 28 was defined as obesity, 25 to <28 as overweight, 20 to <25 as normal, and <20 as underweight (7). Abnormal serum transaminase activities were defined as GPT >30 units/L (8). Hypercholesterolemia was defined as total cholesterol >=5.18 mmol/L, and hypertriglyceridemia was defined as triglyceride >=2.26 mmol/L (9). Hyperglycemia was defined as a fasting glucose >=6.05 mmol/L (10). Subjects were considered to have high blood pressure if the average of three readings exceeded 140 mmHg systolically and/or 90 mmHg diastolically (11). Hyperuricemia was defined as serum uric acid >=416.5 µmol/L in men and >=386.8 µmol/L in women (12). Renal function impairment was defined as a creatinine >=132.6 µmol/L (13).

The statistical analyses were performed with the aid of an SAS package (version 6.12, SAS Institute Inc., Cary, NC). The methods of statistical analysis applied in this study were t test, chi-square analysis, and multivariate logistic regression. A p value <.05 was considered statistically significant.


   Results
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 Abstract
 Methods
 Results
Discussion
 References
 
Among the 1,093 subjects, 65.7% were men and 34.3% were women. The mean age was 73.5 ± 5.6 years. Our study disclosed that of the 586 subjects from whom we took blood samples, 66.0% were men and 34.0% were women. The mean age was 73.1 ± 5.3 years. We performed t test and chi-square analysis to examine the gender and age distributions between these two samples. No significant differences were observed. Therefore, the potential non-response bias could be minimized. In our report, the mean values of fasting glucose were 5.5 ± 1.6 mmol/L in elderly men and 5.7 ± 2.1 mmol/L in elderly women ( p > .05). The hyperglycemic rates were 20.2% in elderly men and 20.7% in elderly women ( p > .05). The fasting glucose values did not change with age in elderly men or elderly women (Table 1 ).


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  		Table 1. Fasting Glucose Values (mmol/L) in Elderly Persons by Age and Gender

 
The results of chi-square analysis for hyperglycemia are shown in Table 2 . The significant correlates of hyperglycemia were high systolic pressure, abnormal GPT, and hypertriglyceridemia. No significant association was found between fasting hyperglycemia and gender, obesity, high diastolic pressure, hypercholesterolemia, hyperuricemia, renal function impairment, educational level, retirement status, or marital status.


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  		Table 2. Correlates of Hyperglycemia in Chi-Square Analysis in Elderly Persons

 
The results of multivariate logistic regression for hyperglycemia are shown in Table 3 . After controlling the other covariates, the significant related factors for hyperglycemia were obesity (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.02–4.5), high systolic pressure (OR 2.1, 95% CI 1.1–4.0), and hypertriglyceridemia (OR 2.1, 95% CI 1.03–4.4). That is, obese people were more likely to have hyperglycemia than were people with normal body weight. Persons with high systolic pressure were more likely to have hyperglycemia than were those with normal blood pressure. Persons with hypertriglyceridemia were more likely to have hyperglycemia than were those with normal triglycerides. No significant association was found between hyperglycemia and gender, age, high diastolic pressure, abnormal GPT, hypercholesterolemia, hyperuricemia, renal function impairment, education level, retirement status, or marital status.


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  		Table 3. Multivariate Logistic Regression of Hyperglycemia in Elderly Persons

 

   Discussion
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 Abstract
 Methods
 Results
 Discussion
References
 
Most of the people living in the Chung-Shing-Shin-Tseun community had moved to Taiwan from mainland China after the civil war, during their military service. Most were men, so the proportion of men to women in this sample was high.

In the report by Chou and colleagues, the prevalence of diabetes among the population including both established and newly diagnosed cases was 12.4%. Possible risk factors associated with diabetes were family history of diabetes, obesity, and age (14). In the report by Huang and colleagues, hyperglycemic rates (>7.70 mmol/L) were 7.3% in elderly men and 12.5% in elderly women (15). In our report, the hyperglycemic rates were 20.2% in elderly men and 20.7% in elderly women. Although the rate of hyperglycemia seems to vary between reports, this difference may be due to different diagnostic methods and criteria. However, hyperglycemia was commonly found in elderly persons. Therefore, it is important to examine fasting glucose periodically in elderly persons so that early detection of hyperglycemia and early intervention can be performed.

In previous reports, hyperglycemia was also a cardiovascular risk factor in the elderly (16)(17). Because hyperglycemia was often associated with obesity, hypertension, hyperlipidemia, and hyperuricemia (4)(12)(17)(18)(19), this association suggested the same pathogenesis for hyperglycemia, hyperlipidemia, and hyperuricemia (4)(12)(18)(19). In Chen and Yu's report, hyperglycemia was significantly correlated with hypercholesterolemia and hyperuricemia (4). In our report, hyperglycemia was significantly correlated with obesity, high systolic pressure, and hypertriglyceridemia. These findings further indicate that cardiovascular risk factors often cluster within the same individual. Thus, it is important to examine other cardiovascular risk factors if one cardiovascular risk factor is observed.

In conclusion, the prevalence of hyperglycemia was high in elderly persons in Taiwan. Hyperglycemia is significantly associated with obesity, high systolic pressure, and hypertriglyceridemia in elderly persons. It is important to examine other cardiovascular risk factors if one cardiovascular risk factor is observed.


   Acknowledgments
 
This study was supported by grants from the Department of Health, Taiwan Province, Republic of China. We thank Mei-Yen Li and Hsing-Yi Chan for statistical assistance in preparing the manuscript and the personnel of Chung-Shing Hospital for their full cooperation.

Received December 27, 1999

Accepted January 7, 2000


   References
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 Abstract
 Methods
 Results
 Discussion
 References
 

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