A Study on Lipid Profile and Cardiovascular Manifestations in Type 2 Diabetes Mellitus Patients
- 1. International Journal of Medical Science and Innovative Research (IJMSIR)
Description
Background and objective: This study outlines a comprehensive approach for exploring the interplay between lipid profile and cardiovascular manifestations in type 2 diabetes mellitus patients, aiming to provide actionable insights and contribute to the broader scientific understandings of these relationships. This approach provides a comprehensive evaluation of therapeutic effectiveness and helps in identifying factors that could impact treatment outcomes.
Methodology: This is prospective comparative study conducted from June 2018 to December 2019 in the Department of Medicine and Cardiology at Paras HMRI hospital Patna, included 165 patients who fulfilled the WHO criteria of type 2 Diabetes Mellitus were taken of any age group on the basis of random sampling. The study collected demographic and medical history data using a pre-designed proforma. The statistical analysis of this study was done by ‘S PLUS’’ Statistical software.
Result: We compared the lipid profile abnormality of < 10 years and > 10 years duration group, there is absence of difference between two groups which shows that lipid profile abnormality does not varies much with time.
We also found no significant relation with respect to lipid profile between the group of glycosylated haemoglobin level HbA1C < 10 and HbA1c > 10 group, this shows that there no significant relationship exists between severity of diabetes and lipoprotein abnormality.
Left ventricular abnormalities in type 2 diabetes patients, shows that more the duration of the disease lesser is the E/A ratio, i.e., greater is the diastolic dysfunction. It is found that diastolic dysfunction was more common than systolic in type 2 diabetes mellitus.
Conclusion: No significant change in lipid profile is found between the study group on the basis of duration >10 years and <10 year and severity of type 2 diabetes mellitus i.e. HbA1c >10 and <10.
Diabetic patients have cardiovascular dysfunction and it depends on the duration of the disease, also diastolic dysfunction precedes systolic dysfunction and there is no difference between both sexes with respect to diastolic dysfunction.
Also, we found that the fasting and post prandial blood glucose level gradually increase with increase duration of type 2 diabetes mellitus.
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- 1. Gan D. ed. Diabetes Atlas 2017: the Rising Global Burden of Diabetes International Diabetes Federation, 2017: 9-13. 2. Barzilay JI, Kronmal RA, Bittner V et al. coronary artery disease and coronary artery bypass grafting in diabetic patients aged > 65 years Am.J. Cardiol 1994; 74: 334-9. 3. Haffner SM, Lehto S, Ronnemaa T, Pyolora K, Laakso M. Mortality from coronary heart disease in subjects with type-2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. NEngl J Med 1998; 339: 229-34. 4. Fisher BM, Gillen G, Lindop GBM, Dargie HJ, Frier B M. Cardiac function and coronary arteriography in asymptomatic type-1 (insulin-dependent) diabetic patients; evidence for a specific diabetic heart disease. Diabetologia 1986; 29: 706-12. 5. Pham I, Cosson E, Nguyen MT, et al. Evidence for a Specific Diabetic Cardiomyopathy: An Observational Retrospective Echocardiographic Study in 656 Asymptomatic Type 2 Diabetic Patients. Int J Endocrinol. 2015; 2015: 743503. 6. Ewing DJ, Neilson JM, Shapiro CM, et al.: Twenty four hour heart rate variability: Effects of posture, sleep, and time of day in healthy controls and comparison with bedside tests of autonomic function in diabetic patients. Br Heart J. 1991;65(5):239-44. 7. Lozano T, Ena J. Cardiovascular autonomic neuropathy in patients with diabetes mellitus. Neuropatia autonomica cardiovascular in pacientes con diabetes mellitus. Rev Clin Esp. 2017; 217(1): 46-54. 8. Liu Y, Liu SX, Zheng F, Cai Y, Xie KL, Zhang WL. Cardiovascular autonomic neuropathy in patients with type 2 diabetes. J Diabetes Investig. 2016; 7(4):615- 21. 9. Maser RE, Mitchell BD, Vinik AI, Freeman R. The association between cardiovascular autonomic neuropathy and mortality in individuals with diabetes: a meta-analysis. Diabetes Care. 2003; 26(6): 1895-1901. 10. Hirano T. Pathophysiology of Diabetic Dyslipidemia. J Atheroscler Thromb. 2018; 25(9): 771-82. 11. Mark L, Dani G. Diabeteses dyslipidaemia es atherosclerosis [Diabetic dyslipidaemia and the atherosclerosis]. Orv Hetil. 2016; 157(19): 746-52. 12. Welty FK. How do elevated triglycerides and low HDL-Cholesterol affect inflammation and atherothrombosis? Curr Cardiol Rep. 2013; 15(9): 400. 13. Ye X, Kong W, Zafar MI, Chen LL. Serum triglycerides as a risk factor for cardiovascular diseases in type 2 diabetes mellitus: a systematic review and meta-analysis of prospective studies. Cardiovasc Diabetol. 2019; 18(1): 48. 14. Steiner G. Dyslipoproteinemias in diabetes. Clin Invest Med. 1995;18(4):282-87. 15. Taskinen MR, Packard CI, Shepherd J. Effect of insulin therapy of metabolic fate of apolipoprotein B-containing lipoproteins in NIDDM Diabetes 1990; 39: 1017- 27. 16. Siegel RD, Cupples A, Schaefer EJ, Wilson PW. Lipoproteins, apolipoproteins, and low-density lipoprotein size among diabetics in the Framingham offspring study. Metabolism. 1996; 45 (10): 1267-72. 17. Yang Y, Yan B, Fu M, Xu Y, Tian Y. Relationship between plasma lipid concentrations and HDL subclasses. Clin Chim Acta. 2005; 354 (1-2): 49-58. 18. Tian L, Fu M. The relationship between high density lipoprotein subclass profile and plasma lipid concentrations. Lipids Health Dis. 2010; 9: 118. 19. Betteridge DJ. Diabetic dyslipidaemia Diabetes Obes Metab 2000; 2 (Suppl 1) S31-S36. 20. Bo S, Cavallo-Perin P, Gentile L, Repetti E, Pagano G. Low HDL cholesterol a component of the metabolic syndrome only in the presence of fasting hypertriglyceridemia in type 2 diabetic patients. Diabetes Metab 2001; 27: 31-5. 21. Wam BH, Kennel WB, D" Agostino. Search for an optimal atherogenic lipid risk profile: from the Framingham Study. Am J Cardiol. 2006; 97 (3): 372-75. 22. Lamarche B, Moorjani S, Cantin B et al. Associations of HDL2 and HDL3 subfractions with ischemic heart disease in men prospective result from the Quebec Cardiovascular Study Arterioscler Thromb Vasc Biol 1997; 17: 1098- 105 23. Alvin C. Power, Diabetes Mellitus, Harrison's Principle of Internal Medicine 20th Edition. 24. Ahmed AM. History of diabetes mellitus. Saudi Med J. 2002; 23 (4): 373-78. 25. Garcia MJ, McNamara PM, Gordon T et al: Morbidity and mortality in diabetes in the Framingham population. Sixteen years follow up study. Diabetes, 1974, 23: 105-11. 26. Rivellese AA, Riccardi G, Voccaro O. Cardiovascular risk in women with diabetes. Nutr Metab Cardiovasc Dis. 2010; 20 (6): 474-80. 27. Levitzky YS, Pencina MJ, D" Agostino RB, et al. Impact of impaired fasting glucose on cardiovascular disease: the Framingham Heart Study. J Am Coll Cardiol. 2008; 51 (3): 264-70 28. Setacci C, de Donato G, Setacci F, Chisci E. Diabetic patients: epidemiology and global impact. J cardiovasc Surg (Trrino) 2009; 50: 263-73. 29. Thiruvoipati T, Kielhorn CE, Armstrong EJ. Peripheral artery disease in patients with diabetes: Epidemiology, mechanisms and outcomes. World J Diabetes, 2015; 6 (7): 961-69. 30. Mensah GA, Wei GS, Sorlie PD, et al. Decline in Cardiovascular Mortality : Possible Causes and Implications. Circ Res. 2017; 120 (2): 366-80. 31. Burchfiel CM, Reed DM, Marcus EB, Strong JP, Hayashi T. Association of diabetes mellitus with coronary atherosclerosis and myocardial lesions: an autopsy study from Honolulu Heart program. Am J Epidemiology 1993, 137: 1328- 40. 32. Hubbard BL, Gibbons RJ, Lapeyre AC III, Clements IP. Identification of severe coronary artery disease using simple clinical parameters. Arch Intern Med 1992, 152: 309-12. 33. Singh VP, Bali A, Singh N, Jaggi AS, Advanced glycation end products and diabetic complications. Korean J Physiol Pharmacol. 2014; 18 (1): 1-14 34. Reaven GM. the role on insulin resistance and hyperinsulinemia in coronary heart disease. Metabolism, 1992; 41 (5 Suppl 1): 16-19. 35. Pankow JS, Kwan DK, Duncan BB, et al. Cardiometabolic risk in impaired fasting glucose and impaired glucose tolerance: the Atherosclerosis Risk in Communities Study. Diabetes Care. 2007; 30 (2): 325-31. 36. Amini M, Horri N, Zare M, et al. People with impaired glucose tolerance and impaired fasting glucose are similarly susceptible to cardiovascular disease: a study in first degree relatives of type 2 diabetic patients. Ann Nutr Metab. 2010; 56 (4): 267-72. 37. Raynauld E, Perez-Martin A, Brun J, Aissa-Benhaddad, Fedou C, Mercier J. Relationship between fibrinogen and insulin resistance. Atherosclerosis. 2000; 150 (2): 365-70. 38. Yarmolinsky J, Bordin Barbieri N, Weinmann T, Ziegelmann PK, Duncan BB, Ines Schmidt M. Plasminogen activator inhibitor-1 and type 2 diabetes: a systematic review and metaanalysis of observational studies. Sci Rep. 2016; 6 : 17714. 39. Reaven GM. Syndrome x : a short history. Ochsner J. 2001; 3 (3) : 124-25. 40. Espinosa RA; Grupo FRICVE. El fibrnogeno: factor de riesgo cardiovascular[ Fibrinogen ; Cardiovascular risk factor] Invest Clin. 2003 Jun; 44 (2) : 165. 41. Gragnano F, Golia E, Natale F et al. Von Willebrand Factor and Cardiovascular Disease: From a Biochemical Marker to an Attractive Therapeutic Target. Curr Vasc Pharmacol. 2017; 15 (5) : 404-15. 42. Heller FR, Jamart J, Honore P et al. Serum Lipoprotein(a) in patients with diabetes mellitus. Diabetes Care 1993, 16 : 819-23. 43. Sulikowska B, Manitius J. Bialkomocz jako wskaznik ryzyka powiklan sercowoneczyniowych--nowe dane [ Proteinuria as a predictor of risk of cardiovascular disease: a new insight ]. Pol Arch Med Wewn. 2007; 117 (9) : 411-14. 44. Naidoo DP. The link between microalbumimuria , endothelial dysfunction and cardiovascular disease in diabetes. Cardiovasc I S Afr. 2002; 13 (4) : 194-99. 45. Aronson D. and Rayfield EJ : Diabetes and obesity. In Fuster V, Ross R. Ropol : Atheroscelerosis and coronary artery disease. Philadelphia, Lippin Cott-Raven 1996. 46. Stone PH, Muller JW, Hartwell T et al. The effect of diabetes mellitus on prognosis and serial left ventricular function after acute myocardial infarction, contribution of both CAD and diastolic left ventricular dysfunction to the adverse prognosis. J. Am. Coll. Cardiol. 1989, 14 : 49. 47. Nesto RW, Phillips RT, Kett KG et al. Angina and exertional myocardial ischaemia in diabetic and non-diabetic patients, assessment by exercise thallium scintigraphy. Ann Intern Med 1998, 108 : 170-5. 48. Scheidt-Nave C, Barret-Connor E, Wingard DL. Resting heart disease associated with NIDDM in a defined population. Circulation 1990, 81 : 899-906. 49. Weiner DA, Ryan TJ, Parsons L et al. Significance of silent myocardial ischaemia during exercise testing in patients with diabetes mellitus : a report from CASS registry. Am. J. Cardiol 1991, 68 : 729-34. 50. Yudkin J, Hendra TJ, Vascular events and diabetes : Acute myocardial infarction and stroke. In, Alberti KGMM, Keen HA, De Franzo RA, eds. International text book of diabetes. Chichester, John Wiley and Sons Ltd. 1992 : 1185-212. 51. Einarson TR, Acs A, Ludwig C, Phanton UH. Prevalence of cardiovascular disease in type 2 diabetes: a systematic literature review of scientific evidence from across the world in 2007-2017. Cardiovasc Diabetol. 2018; 17 (1) : 83. 52. Dhingra R, Vasan RS, Diabetes and the risk of heart failure. Heart Fail Clin. 2012; 8 (1) : 125-33. 53. Aronson D, Edelman ER. Coronary artery disease and diabetes mellitus. Cardiol Clin. 2014; 32 (3) : 439-55. 54. Haffner SM. Coronary heart disease in patients with diabetes. N Eng J Med. 2002; 342 (14) : 1040-42. 55. Kawano Y, Takemoto M, Mito T, et al. Silent myocardial ischemia in asymptomatic patients with type 2 diabetes mellitus without previous histories of cardiovascular disease. Int J Cardiol. 2016; 216 : 151-55. 56. Cornelia Junghans, Neha Sekhri, M. Justin Zaman, Harry Hemingway, Gene S. Feder, Adam Timmis, Atypical chest pain in diabetic patients with suspected stable angina : Impact on diagnosis and coronary outcomes, European Heart Journal-Quality of care & clinical outcomes, Volume 1, Issue 1, 2015; 37-43. 57. Hamby RI, Zoneriach S, Sherman L. Diabetic cardiomyopathy JAMA 1974; 229 (13) : 1749-54. 58. Paolillo S, Marsico F, Prastaro M, et al. Diabetic Cardiomyopathy: Definition, Diagnosis and Therapeutic Implications. Heart Fail Clin. 2019; 15 (3): 341-47. 59. Law B, Fowlkes, Goldsmith JG, Carver W, Goldsmith EC. Diabetes-induced alterations in the extracellular matrix and their impact on myocardial function. Microsc Microanal. 2012; 18(1): 22-34. 60. Berridge BR, Mowat V, Nagai H et al. Non-proliferative and Proliferative Lesions of the Cardiovascular System of the Rat and Mouse. J Toxicol Pathol. 2016; 29 ( 3 Suppl) : 1S-47S. 61. Shapiro LM. A prospective study of heart disease in diabetes mellitus. Q J Med. 1984; 53 (209): 55-68. 62. Paillole C, Dahan M, Paycha F, Cohen A, Gourgon R. Prevalence and significance of left ventricular filling abnormalities determined by Doppler echocardiography in young type 1 diabetic patients. Am J. Cardiol, 1990,64: 1010-16. 63. Cosson S, Kevorkian JP. Left ventricular diastolic dysfunction : an early sign of diabetic cardiomyopathy? . Diabetes Metab. 2003; 29(5) : 455-66. 64. Mishra TK, Rath PK, Mohanty NK, Mishra SK. Left ventricular systolic and diastolic dysfunction and their relationship with microvascular complications in normotensive, asymptomatic patients with type 2 diabetes mellitus. India Hear J. 2008; 60 (6): 548-53. 65. Schannwell CM, Schneppenheim M, Perings S, Plehn G, Strauer BE. Left ventricular diastolic dysfunction as an early manifestation of diabetic cardiomyopathy. Cardiology. 2002; 29 (5): 455-66. 66. Redfield MM, Jacobsen SJ, Burnett JC Jr, Mahoney DW, Bailey KR, Rodeheffer RJ. Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA. 2003; 289 (2) : 194- 202. 67. Poirier P, Bogaty P, Garneau C, Marois L, Dumesnil JG. Diastolic dysfunction in normotensive men with well-controlled type 2 diabetes : importance of maneuvers in echocardiographic screening for preclinical diabetic cardiomyopathy. Diabetes Care. 2001; 24 (1) : 5-10. 68. Bertoni AG, Tsai A, Kasper EK, Brancati FL. Diabetes and idiopathic cardiomyopathy: a nationwise case-control study. Diabetes Care. 2003; 26 (10): 2791-95. 69. Galderisi M, Anderson KM, Wilson PW, Levy D. Echocardiographic evidence for the existence of a distinct diabetic cardiomyopathy ( the Framingham Heart Study). Am J Cardiol. 1991; 68(1) : 85-89. 70. Struthers AD, Morris AD. Screening for and treating left-ventricular abnormalities in diabetes mellitus: a new way of reducing cardiac deaths. Lancet. 2002; 359 ( 9315) : 1430-32. 71. Fishman SL, Sonmez H, Basman C, Singh V, Poretsky L. The role of advanced glycation end-products in the development of coronary artery disease in patients with and without diabetes mellitus: a review. Mol Med. 2018; 24 (1) : 59 72. Ziegelhöffer A, Ravingerová T, Styk J, et al. Mechanisms that may be involved in calcium tolerance of the diabetic heart. Mol Cell Biochem. 1997;176(1- 2):191‐98. 73. Das Evcimen N, King GL. The role of protein kinase C activation and the vascular complications of diabetes. Pharmacol Res. 2007;55(6):498‐510. 74. Henning RJ, Bourgeois M, Harbison RD. Poly(ADP-ribose) Polymerase (PARP) and PARP Inhibitors: Mechanisms of Action and Role in Cardiovascular Disorders. Cardiovasc Toxicol. 2018;18(6):493‐506. 75. Young ME, McNulty P, Taegtmeyer H. Adaptation and maladaptation of the heart in diabetes: Part II: potential mechanisms. Circulation. 2002;105(15):1861‐70. 76. Liu JE, Robbins DC, Palmieri V, et al. Association of albuminuria with systolic and diastolic left ventricular dysfunction in type 2 diabetes: the Strong Heart Study. J Am Coll Cardiol. 2003;41(11):2022‐28. 77. Arnold JM, Yusuf S, Young J, et al. Prevention of Heart Failure in Patients in the Heart Outcomes Prevention Evaluation (HOPE) Study. Circulation. 2003;107(9):1284‐90. 78. Klein LW, Nathan S. Coronary artery disease in young adults. J Am Coll Cardiol. 2003;41(4):529‐31. 79. Ferrario CM. Cardiac remodelling and RAS inhibition. Ther Adv Cardiovasc Dis. 2016;10(3):162‐71. 80. Serhiyenko VA, Serhiyenko AA. Cardiac autonomic neuropathy: Risk factors, diagnosis and treatment. World J Diabetes. 2018;9(1):1‐24. 81. Balcıoğlu AS, Müderrisoğlu H. Diabetes and cardiac autonomic neuropathy: Clinical manifestations, cardiovascular consequences, diagnosis and treatment. World J Diabetes. 2015;6(1):80‐91. 82. Ewing DJ, Campbell IW, Cherke BF : The natural history of diabetic autonomic neuropathy. Quarterly Journal of Medicine, 1990, 35 : 193. 83. Neubauer B, Christensen NJ. Norepinephrine, epinephrine, and dopamine contents of the cardiovascular system in long-term diabetics. Diabetes. 1976;25(1):6‐10. 84. Ganguly PK, Dhalla KS, Innes IR, Beamish RE, Dhalla NS. Altered norepinephrine turnover and metabolism in diabetic cardiomyopathy. Circ Res. 1986;59(6):684‐93. 85. O"Brien T, Nguyen TT, Zimmerman BR. Hyperlipidemia and diabetes mellitus. Mayo Clin Proc 1998; 73 : 969-76. 86. Laitinen T, Vauhkonen IK, Niskanen LK, et al. Power spectral analysis of heart rate variability during hyperinsulinemia in nondiabetic offspring of type 2 diabetic patients: evidence for possible early autonomic dysfunction in insulinresistant subjects. Diabetes. 1999;48(6):1295‐99. 87. Wheelock KM, Jaiswal M, Martin CL, et al. Cardiovascular autonomic neuropathy associates with nephropathy lesions in American Indians with type 2 diabetes. J Diabetes Complications. 2016;30(5):873‐79. 88. Beijers HJ, Ferreira I, Bravenboer B, et al. Microalbuminuria and cardiovascular autonomic dysfunction are independently associated with cardiovascular mortality: evidence for distinct pathways: the Hoorn Study. Diabetes Care. 2009;32(9):1698‐1703. 89. Maqbool M, Cooper ME, Jandeleit-Dahm KAM. Cardiovascular Disease and Diabetic Kidney Disease. Semin Nephrol. 2018;38(3):217‐32. 90. Bissinger, A. (2017). Cardiac Autonomic Neuropathy: Why Should Cardiologists Care about That? Journal of Diabetes Research, 2017, 1–9. 91. Vinik AI, Erbas T, Casellini CM. Diabetic cardiac autonomic neuropathy, inflammation and cardiovascular disease. J Diabetes Investig. 2013;4(1):4‐18. 92. Lopaschuk G. Regulation of carbohydrate metabolism in ischemia and reperfusion. Am Heart J. 2000;139(2 Pt 3):S115‐S119. 93. Feingold KR, Grunfeld C. Diabetes and Dyslipidemia. In: Feingold KR, Anawalt B, Boyce A, et al., eds. Endotext. South Dartmouth (MA): MDText.com, Inc.; 2000. 94. Rizzo M, Berneis K. Lipid triad or atherogenic lipoprotein phenotype: a role in cardiovascular prevention?. J Atheroscler Thromb. 2005;12(5):237‐39. 95. McGarry JD. Banting lecture 2001: dysregulation of fatty acid metabolism in the etiology of type 2 diabetes. Diabetes. 2002;51(1):7‐18. 96. Coppack SW, Jensen MD, Miles JM. In vivo regulation of lipolysis in humans. J Lipid Res. 1994;35(2):177‐93. 97. Ginsberg HN. Diabetic dyslipidemia: basic mechanisms underlying the common hypertriglyceridemia and low HDL cholesterol levels. Diabetes. 1996;45 Suppl 3:S27‐S30. 98. Durrington PN, Mackness B, Mackness MI. Paraoxonase and atherosclerosis. Arterioscler Thromb Vasc Biol. 2001;21(4):473‐80. 99. Sniderman AD, Scantlebury T, Cianflone K. Hypertriglyceridemic hyperapob: the unappreciated atherogenic dyslipoproteinemia in type 2 diabetes mellitus. Ann Intern Med. 2001;135(6):447‐59. 100. Proctor SD, Pabla CK, Mamo JC. Arterial intimal retention of pro-atherogenic lipoproteins in insulin deficient rabbits and rats. Atherosclerosis. 2000;149(2):315‐22. 101. Mahley RW, Huang Y, Rall SC Jr. Pathogenesis of type III hyperlipoproteinemia (dysbetalipoproteinemia). Questions, quandaries, and paradoxes. J Lipid Res. 1999;40(11):1933-49. 102. Roche HM, Gibney MJ. The impact of postprandial lipemia in accelerating atherothrombosis. J Cardiovasc Risk. 2000;7(5):317‐24. 103. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001;285(19):2486‐97. 104. Mandal M,Kumari R,Mukherjee A.Prevalence of dyslipidemia in patients with type 2 diabetes mellitus patients:a hospital based study in kishanganj,India.Int J Res Med Sci 2015;3:3691-7 105. Shapiro LM, Leatherdale BA, Coyne ME, Fletcher RF, Mackinnon J. Prospective study of heart disease in untreated maturity onset diabetics. Br Heart J. 1980;44(3):342-48. 106. Rubler S, Dlugas h J, Yuceoglu YZ, Kumral T, Branwood AW, Grishman A. New type of cardiomyopathy associated with diabetic glomerulosclerosis. Am J Cardiol. 1972;30(6):595-602. 107. Russo C, Jin Z, Homma S, et al. Effect of diabetes and hypertension on left ventricular diastolic function in a high-risk population without evidence of heart disease. Eur J Heart Fail. 2010;12(5):454-61. 108. Patel TM, Mathur VS, Dave SH, Kothari SS, Patel TK. Noninvasive assessment of left ventricular function in asymptomatic diabetics and its relation to metabolic control and microangiopathy. Panminerva Med. 1991;33(1):6-10. 109. Stout RW. Glucose tolerance and ageing. J R Soc Med. 1994;87(10):608-9. 110. Muller DC, Elahi D, Tobin JD, Andres R. The effect of age on insulin resistance and secretion: a review. Semin Nephrol. 1996;16(4):289-98. 111. Meneilly GS, Elliott T, Tessier D, Hards L, Tildesley H. NIDDM in the elderly. Diabetes Care. 1996;19(12):1320-25