Editorial
The meaning of words in diabetes. Language matters
El significado de las palabras en la diabetes. El lenguaje importa
J. Carretero-Gómez
, J.C. Arévalo-Lorido
Corresponding author
Servicio de Medicina Interna, Hospital Universitario de Badajoz, Badajoz, Spain
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Language matters" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "502" "paginaFinal" => "503" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J. Carretero-Gómez, J.C. Arévalo-Lorido" "autores" => array:2 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Carretero-Gómez" "email" => array:1 [ 0 => "juanicarretero@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "J.C." "apellidos" => "Arévalo-Lorido" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario de Badajoz, Badajoz, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El significado de las palabras en la diabetes. El lenguaje importa" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">According to the Di@bet.es study, 13.8% of the population in Spain has type 2 diabetes mellitus (DM2), including 16.7% of those between 65 and 74 years and 19.3% of those older than 75 years.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In 2020, the incidence was 11.6 new cases for every 1,000 person-years. These data in and of themselves represent a serious public health problem, but this tsunami is even greater if we analyze individuals in the 61-to-75-year age range, where it increases to 17 cases per 1,000 person-years in women and 22 in men. Even more surprisingly, it is as high as 25 new cases per 1,000 person-years in those older than 76 years with no differences according to sex.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">These alarming figures have a multifactorial origin that includes increased life expectancy; improvements in hygiene, dietary, and healthcare conditions; population aging; and—a no less important factor—increased knowledge of the big geriatric syndromes that has allowed for changing the discourse regarding older adults.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Language is very important. And even more so in medicine. We do not refer to diabetic patients, but rather individuals who live with diabetes; we do not refer to obese patients, but rather individuals who live with obesity. Likewise, we do not speak of older adults to refer to all people older than 65 years of age. Now, we shine the spotlight on their functional capacity in order to more correctly speak of individuals with or without frailty.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Frailty is a state frequently (but not exclusively) associated with aging that is characterized by decline in physiological reserves associated with a loss of strength, an increase in the risk of disability, and greater morbidity and mortality. The main physiological systems associated with the development of frailty are the cardiovascular, neuroendocrine, metabolic, nervous, and immune systems. But, most of all, it is a dynamic and reversible process and thus, once again, its detection is key.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The prevalence of frailty in individuals older than 70 years who live with diabetes can be as high as 19.3%, compared to 11.9% in individuals without diabetes. Diabetes leads to a 1.47 times greater risk of developing frailty.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> In fact, frailty is considered the “third comorbidity” together with the known micro- and macrovascular comorbidities.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">We have already discussed the alarming increase in the incidence of diabetes among those older than 70 years. Aging tips the blood glucose equilibrium toward hyperglycemia. With age, subcutaneous fat decreases and visceral fat increases. Muscle mass, one of the main peripheral metabolizers of glucose, decreases at a rate greater than 3% in those older than 60 years.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> All of this contributes to reducing insulin sensitivity.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">On the other hand, insulin secretion is also compromised, decreasing by 0.7% annually due to beta cell dysfunction and apoptosis. What’s more, aging entails changes in both the secretion and function of gastrointestinal hormones such as glucagon-like peptide (GLP-1) or gastric inhibitor peptide (GIP). Both participate in postprandial blood glucose control as well as the growth, maintenance, and proliferation of beta cells.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Diabetes is associated with an accelerated aging process that promotes frailty. In addition, the comorbidities associated with diabetes, such as hypertension or chronic kidney disease, increase the risk of frailty. In this issue, Gómez-Peralta et al.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> publish a treatment protocol for type 2 diabetes in older adult or frail individuals. This protocol is an update of the one published in 2018 regarding the treatment of type 2 diabetes in older adult patients. And, once again, we see that language is very important.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Referring to an older adult patient, in general, implies the bias of considering all people over 65 years of age as older adults, regardless of their physical or functional condition. Rightly so, Gómez-Peralta et al., in line with the recommendations of other groups,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> focus on differentiating older adult patients from frail patients. The reference age for the target population is 75 years and the protocol recommends the detection of frailty or sarcopenia according to the FRAIL or SARC-F scale, respectively. The presence of these entities, not chronological age, will be what guides us when starting, intensifying, or deintensifying glucose-lowering treatment.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Although this population is permanently excluded from clinical trials, the benefits of new treatment families, such as GLP-1 receptor agonists (GLP-1ra) or sodium/glucose cotransporter inhibitors, are to be expected and are applicable to individuals older than 75 years without frailty. Both treatment families improve cardiovascular and renal prognosis and, in addition, could have other potential effects, such as the role of GLP-1ra on the development of dementia or Alzheimer’s disease.</p><p id="par0055" class="elsevierStylePara elsevierViewall">In the age of precision medicine, in order to provide our patients with equitable, proportional, and personalized treatment, knowledge and early detection of frailty, malnutrition, or sarcopenia are obligatory. As Cervantes said, “No science, as far as science is concerned, deceives; deception is in those who do not know it.” Therefore, it is essential that clinicians incorporate useful tools that help us detect these conditions into our daily clinical practice.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npa10035">Please cite this article as: Carretero-Gómez J, Arévalo-Lorido JC. El significado de las palabras en la diabetes. El lenguaje importa. Rev Clin Esp. 2022;222:502–503.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of diabetes mellitus and impaired glucose regulation in Spain: the Di@bet.es Study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Soriguer" 1 => "A. Goday" 2 => "A. Bosch-Comas" 3 => "E. Bordiú" 4 => "A. Calle-Pascual" 5 => "R. Carmena" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00125-011-2336-9" "Revista" => array:6 [ "tituloSerie" => "Diabetologia." 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| 2023 March | 2 | 0 | 2 |
| 2022 October | 2 | 0 | 2 |
