Skip to main content
Top
Published in: Diabetes Therapy 1/2013

Open Access 01-06-2013 | Review

Management of Type 2 Diabetes in Older People

Authors: Ahmed H. Abdelhafiz, Alan J. Sinclair

Published in: Diabetes Therapy | Issue 1/2013

Login to get access

Abstract

The prevalence of diabetes is increasing due to aging of the population and increasing obesity. In the developed world, there is an epidemiologic shift from diabetes being a disease of middle age to being a disease of older people due to increased life expectancy. In old age, diabetes is associated with high comorbidity burden and increased prevalence of geriatric syndromes in addition to the traditional vascular complications. Therefore, comprehensive geriatric assessment should be performed on initial diagnosis of diabetes. Due to the heterogeneous nature of older people with diabetes and variations in their functional status, comorbidities, and life expectancy, therapeutic interventions, and glycemic targets should be individualized taking into consideration patients’ preferences and putting quality of life at the heart of their care plans.
Literature
1.
go back to reference Liu L. Changes in cardiovascular hospitalization and comorbidity of Heart failure in the United States: findings from the national hospital discharge surveys 1980–2006. Int J Cardiol. 2011;149:39–45.PubMedCrossRef Liu L. Changes in cardiovascular hospitalization and comorbidity of Heart failure in the United States: findings from the national hospital discharge surveys 1980–2006. Int J Cardiol. 2011;149:39–45.PubMedCrossRef
2.
go back to reference Valiyeva E, Russell LB, Miller JE, Safford MM. Lifestyle-related risk factors and risk of future nursing home admission. Arch Intern Med. 2006;166:985–90.PubMedCrossRef Valiyeva E, Russell LB, Miller JE, Safford MM. Lifestyle-related risk factors and risk of future nursing home admission. Arch Intern Med. 2006;166:985–90.PubMedCrossRef
3.
go back to reference Wild S, Roglic G, Green A, Sicree A, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27:1047–53.PubMedCrossRef Wild S, Roglic G, Green A, Sicree A, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27:1047–53.PubMedCrossRef
4.
go back to reference Ricci P, Blotière PO, Weill A, et al. Diabète traité en France: quelles évolutions entre 2000 et 2009? Bull Epidemiol Hebd. 2010;43:425–31. Ricci P, Blotière PO, Weill A, et al. Diabète traité en France: quelles évolutions entre 2000 et 2009? Bull Epidemiol Hebd. 2010;43:425–31.
5.
go back to reference Boyle JP, Thompson TJ, Gregg EW, Barker LE, Williamson DF. Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence. Popul Health Metr. 2010;8:29.PubMedCrossRef Boyle JP, Thompson TJ, Gregg EW, Barker LE, Williamson DF. Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence. Popul Health Metr. 2010;8:29.PubMedCrossRef
6.
go back to reference Cowie C, Rust KF, Ford ES, et al. Full accounting of diabetes and pre-diabetes in the US population in 1988–1994 and 2005–2006. Diabetes Care. 2009;32:287–94.PubMedCrossRef Cowie C, Rust KF, Ford ES, et al. Full accounting of diabetes and pre-diabetes in the US population in 1988–1994 and 2005–2006. Diabetes Care. 2009;32:287–94.PubMedCrossRef
7.
go back to reference Aspray TJ, Nesbit K, Cassidy TP, Farrow E, Hawthorne G. Diabetes in British nursing and residential homes: a pragmatic screening study. Diabetes Care. 2006;29:707–8.PubMedCrossRef Aspray TJ, Nesbit K, Cassidy TP, Farrow E, Hawthorne G. Diabetes in British nursing and residential homes: a pragmatic screening study. Diabetes Care. 2006;29:707–8.PubMedCrossRef
8.
go back to reference Resnick HE, Heineman J, Stone R, Shorr RI. Diabetes in US nursing homes, 2004. Diabetes Care. 2008;31:287–8. Resnick HE, Heineman J, Stone R, Shorr RI. Diabetes in US nursing homes, 2004. Diabetes Care. 2008;31:287–8.
9.
go back to reference Zhang X, Decker FH, Luo H, et al. Trends in the prevalence and comorbidities of diabetes mellitus in nursing home residents in the United States: 1995–2004. J Am Geriatr Soc. 2010;58:724–30.PubMedCrossRef Zhang X, Decker FH, Luo H, et al. Trends in the prevalence and comorbidities of diabetes mellitus in nursing home residents in the United States: 1995–2004. J Am Geriatr Soc. 2010;58:724–30.PubMedCrossRef
10.
go back to reference Dybicz SB, Thompson S, Molotsky S, Stuart B. Prevalence of diabetes and the burden of comorbid conditions among elderly nursing home residents. Am J Geriatr Pharmacother. 2011;9:212–23.PubMedCrossRef Dybicz SB, Thompson S, Molotsky S, Stuart B. Prevalence of diabetes and the burden of comorbid conditions among elderly nursing home residents. Am J Geriatr Pharmacother. 2011;9:212–23.PubMedCrossRef
11.
go back to reference Nieto-Vazquez I, Fernandez-Veledo S, Kramer DK, Vila-Bedmar R, Garcia-Guerra L, Lorenzo M. Insulin resistance associated to obesity: the link TNF-alpha. Arch Physiol Biochem. 2008;114:183–94.PubMedCrossRef Nieto-Vazquez I, Fernandez-Veledo S, Kramer DK, Vila-Bedmar R, Garcia-Guerra L, Lorenzo M. Insulin resistance associated to obesity: the link TNF-alpha. Arch Physiol Biochem. 2008;114:183–94.PubMedCrossRef
12.
go back to reference Evans WJ. Skeletal muscle loss: cachexia, sarcopenia, and inactivity. Am J Clin Nutr. 2010;91:1123S–7S.PubMedCrossRef Evans WJ. Skeletal muscle loss: cachexia, sarcopenia, and inactivity. Am J Clin Nutr. 2010;91:1123S–7S.PubMedCrossRef
13.
go back to reference Szoke E, Shrayyef MZ, Messing S, et al. Effect of aging on glucose homeostasis: accelerated deterioration of β-cell function in individuals with impaired glucose tolerance. Diabetes Care. 2008;31:539–43.PubMedCrossRef Szoke E, Shrayyef MZ, Messing S, et al. Effect of aging on glucose homeostasis: accelerated deterioration of β-cell function in individuals with impaired glucose tolerance. Diabetes Care. 2008;31:539–43.PubMedCrossRef
14.
go back to reference Meneilly GS, Tessier D. Diabetes in the elderly. In: Morley JE, van den Berg L, eds. Contemporary endocrinology, endocrinology of aging. Totowa, NJ: Humana Press; 2000. p. 181–203. Meneilly GS, Tessier D. Diabetes in the elderly. In: Morley JE, van den Berg L, eds. Contemporary endocrinology, endocrinology of aging. Totowa, NJ: Humana Press; 2000. p. 181–203.
15.
go back to reference American Diabetes Association. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 2002;25(Suppl 1):S5–20. American Diabetes Association. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 2002;25(Suppl 1):S5–20.
16.
go back to reference Barzilay JI, Spiekerman CF, Wahl PW. Cardiovascular disease in older adults with glucose disorders: comparison of American Diabetes Association criteria for diabetes mellitus with WHO criteria. Lancet. 1999;354:622–5.PubMedCrossRef Barzilay JI, Spiekerman CF, Wahl PW. Cardiovascular disease in older adults with glucose disorders: comparison of American Diabetes Association criteria for diabetes mellitus with WHO criteria. Lancet. 1999;354:622–5.PubMedCrossRef
17.
go back to reference Sinclair AJ, Gadsby R, Penfold S, Croxson SC, Bayer AJ. Prevalence of diabetes in care home residents. Diabetes Care. 2001;24:1066–8.PubMedCrossRef Sinclair AJ, Gadsby R, Penfold S, Croxson SC, Bayer AJ. Prevalence of diabetes in care home residents. Diabetes Care. 2001;24:1066–8.PubMedCrossRef
18.
go back to reference Peter A, Fritsche A, Stefan N, Heni M, Häring HU, Schleicher E. Diagnostic value of hemoglobin A1c for type 2 diabetes mellitus in a population at risk. Exp Clin Endocrinol Diabetes. 2011;119:234–7.PubMedCrossRef Peter A, Fritsche A, Stefan N, Heni M, Häring HU, Schleicher E. Diagnostic value of hemoglobin A1c for type 2 diabetes mellitus in a population at risk. Exp Clin Endocrinol Diabetes. 2011;119:234–7.PubMedCrossRef
19.
go back to reference Maddigan SL, Feeny DH, Johnson JA. Health-related quality of life deficits associated with diabetes and comorbidities in a Canadian National Population Health Survey. Qual Life Res. 2005;14:1311–20.PubMedCrossRef Maddigan SL, Feeny DH, Johnson JA. Health-related quality of life deficits associated with diabetes and comorbidities in a Canadian National Population Health Survey. Qual Life Res. 2005;14:1311–20.PubMedCrossRef
20.
go back to reference Duffy RE, Mattson BJ, Zack M. Comorbidities among Ohio’s nursing home residents with diabetes. J Am Med Dir Assoc. 2005;6:383–9.PubMedCrossRef Duffy RE, Mattson BJ, Zack M. Comorbidities among Ohio’s nursing home residents with diabetes. J Am Med Dir Assoc. 2005;6:383–9.PubMedCrossRef
21.
go back to reference Gadsby R, Barker P, Sinclair A. People living with diabetes resident in nursing homes–assessing levels of disability and nursing needs. Diabet Med. 2011;28:778–80.PubMedCrossRef Gadsby R, Barker P, Sinclair A. People living with diabetes resident in nursing homes–assessing levels of disability and nursing needs. Diabet Med. 2011;28:778–80.PubMedCrossRef
22.
go back to reference Gadsby R, Barker P, Sinclair A. Death rate of residents with diabetes in nursing homes. Diabet Med. 2011;28:829–30.CrossRef Gadsby R, Barker P, Sinclair A. Death rate of residents with diabetes in nursing homes. Diabet Med. 2011;28:829–30.CrossRef
23.
go back to reference Tierney EF, Cadwell BL, Engelgau MM, et al. Declining mortality rate among people with diabetes in North Dakota, 1997–2002. Diabetes Care. 2004;27:2723–5.PubMedCrossRef Tierney EF, Cadwell BL, Engelgau MM, et al. Declining mortality rate among people with diabetes in North Dakota, 1997–2002. Diabetes Care. 2004;27:2723–5.PubMedCrossRef
24.
go back to reference Munshi M, Grande L, Hayes M, et al. Cognitive dysfunction is associated with poor diabetes control in older adults. Diabetes Care. 2006;29:1794–9.PubMedCrossRef Munshi M, Grande L, Hayes M, et al. Cognitive dysfunction is associated with poor diabetes control in older adults. Diabetes Care. 2006;29:1794–9.PubMedCrossRef
25.
go back to reference Gregg EW, Engelgau MM, Narayan V. Complications of diabetes in elderly people. BMJ. 2002;325:916–7.PubMedCrossRef Gregg EW, Engelgau MM, Narayan V. Complications of diabetes in elderly people. BMJ. 2002;325:916–7.PubMedCrossRef
26.
go back to reference Volpato S, Bianchi L, Lauretani F, et al. Role of muscle mass and muscle quality in the association between diabetes and gait speed. Diabetes Care. 2012;35:1672–9.PubMedCrossRef Volpato S, Bianchi L, Lauretani F, et al. Role of muscle mass and muscle quality in the association between diabetes and gait speed. Diabetes Care. 2012;35:1672–9.PubMedCrossRef
27.
go back to reference Morley JE, Perry HM, Miller DK. Something about frailty. J Gerontol A Biol Sci Med Sci. 2002;57:M698–704.PubMedCrossRef Morley JE, Perry HM, Miller DK. Something about frailty. J Gerontol A Biol Sci Med Sci. 2002;57:M698–704.PubMedCrossRef
28.
go back to reference Kahn AJ. Central and peripheral mechanisms of aging and frailty: a report on the 8th Longevity Consortium Symposium, Santa Fe, New Mexico, May 16–18, 2007. J Gerontol A Biol Sci Med Sci. 2007;62:1357–60.PubMedCrossRef Kahn AJ. Central and peripheral mechanisms of aging and frailty: a report on the 8th Longevity Consortium Symposium, Santa Fe, New Mexico, May 16–18, 2007. J Gerontol A Biol Sci Med Sci. 2007;62:1357–60.PubMedCrossRef
29.
go back to reference Egede LE. Effect of comorbid chronic diseases on prevalence and odds of depression in adults with diabetes. Psychosom Med. 2005;67:46–51.PubMedCrossRef Egede LE. Effect of comorbid chronic diseases on prevalence and odds of depression in adults with diabetes. Psychosom Med. 2005;67:46–51.PubMedCrossRef
30.
go back to reference Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-years follow-up of intensive glucose control in Type 2 diabetes. N Engl J Med. 2008;359:1577–89.PubMedCrossRef Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-years follow-up of intensive glucose control in Type 2 diabetes. N Engl J Med. 2008;359:1577–89.PubMedCrossRef
31.
go back to reference Action to Control Cardiovascular Risk in Diabetes Study Group; Gerstein HC, Miller ME, Byington RP, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358:2545–59. Action to Control Cardiovascular Risk in Diabetes Study Group; Gerstein HC, Miller ME, Byington RP, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358:2545–59.
32.
go back to reference ADVANCE Collaborative Group; Patel A, MacMahon S, Chalmers J, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358:2560–72. ADVANCE Collaborative Group; Patel A, MacMahon S, Chalmers J, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358:2560–72.
33.
go back to reference Duckworth W, Abraira C, Mortiz T, et al. VADT Investigators. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2009;360:129–39. Duckworth W, Abraira C, Mortiz T, et al. VADT Investigators. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2009;360:129–39.
34.
go back to reference Launer LJ, Miller ME, Williamson JD, et al. ACCORD MIND investigators. Effects of intensive glucose lowering on brain structure and function in people with type 2 diabetes (ACCORD MIND): a randomised open-label substudy. Lancet Neurol. 2011;10:969–77. Launer LJ, Miller ME, Williamson JD, et al. ACCORD MIND investigators. Effects of intensive glucose lowering on brain structure and function in people with type 2 diabetes (ACCORD MIND): a randomised open-label substudy. Lancet Neurol. 2011;10:969–77.
35.
go back to reference Pham M, Pinganaud G, Richard-Harston S, Decamps A, Bourdel-Marchasson I. Prospective audit of diabetes care and outcomes in a group of geriatric French care homes. Diabetes Metab. 2003;29:251–8.PubMedCrossRef Pham M, Pinganaud G, Richard-Harston S, Decamps A, Bourdel-Marchasson I. Prospective audit of diabetes care and outcomes in a group of geriatric French care homes. Diabetes Metab. 2003;29:251–8.PubMedCrossRef
36.
go back to reference Nelson JM, Dufraux K, Cook PF. The relationship between glycaemic control and falls in older adults. J Am Geriatr Soc. 2007;55:2041–4.PubMedCrossRef Nelson JM, Dufraux K, Cook PF. The relationship between glycaemic control and falls in older adults. J Am Geriatr Soc. 2007;55:2041–4.PubMedCrossRef
37.
go back to reference Huang ES, Zhang Q, Gandra N, Chin MH, Meltzer DO. The effect of comorbid illness and functional status on the expected benefits of intensive glucose control in older patients with type 2 diabetes: A decision analysis. Ann Intern Med. 2008;149:11–9.PubMedCrossRef Huang ES, Zhang Q, Gandra N, Chin MH, Meltzer DO. The effect of comorbid illness and functional status on the expected benefits of intensive glucose control in older patients with type 2 diabetes: A decision analysis. Ann Intern Med. 2008;149:11–9.PubMedCrossRef
38.
go back to reference American Diabetes Association. Executive summary: standards of medical care in diabetes-2010. Diabetes Care. 2010;33:S4–10.CrossRef American Diabetes Association. Executive summary: standards of medical care in diabetes-2010. Diabetes Care. 2010;33:S4–10.CrossRef
39.
go back to reference Abdelhafiz AH, Sinclair AJ. Tailor treatment in the older patient with type 2 diabetes. Practitioner. 2013;257:21–5.PubMed Abdelhafiz AH, Sinclair AJ. Tailor treatment in the older patient with type 2 diabetes. Practitioner. 2013;257:21–5.PubMed
40.
go back to reference Kronmal RA, Barzilay JI, Smith NL, et al. Mortality in pharmacologically treated older adults with diabetes: the Cardiovascular Health Study, 1989–2001. PLoS Med. 2006;3:e400.PubMedCrossRef Kronmal RA, Barzilay JI, Smith NL, et al. Mortality in pharmacologically treated older adults with diabetes: the Cardiovascular Health Study, 1989–2001. PLoS Med. 2006;3:e400.PubMedCrossRef
41.
go back to reference Blaum CS, Volpato S, Cappola AR, et al. Diabetes, hyperglycaemia and mortality in disabled older women: the Women’s Health and Ageing Study I. Diabet Med. 2005;22:543–50.PubMedCrossRef Blaum CS, Volpato S, Cappola AR, et al. Diabetes, hyperglycaemia and mortality in disabled older women: the Women’s Health and Ageing Study I. Diabet Med. 2005;22:543–50.PubMedCrossRef
42.
go back to reference Schwartz AV, Vittinghoff E, Sellmeyer DE, et al; Health, Aging, and Body Composition Study. Diabetes-related complications, glycaemic control, and falls in older adults. Diabetes Care. 2008;31:391–6. Schwartz AV, Vittinghoff E, Sellmeyer DE, et al; Health, Aging, and Body Composition Study. Diabetes-related complications, glycaemic control, and falls in older adults. Diabetes Care. 2008;31:391–6.
43.
go back to reference Huang ES, Liu JY, Moffet HH, John PM, Karter AJ. Glycemic control, complications, and death in older diabetic patients: the diabetes and aging study. Diabetes Care. 2011;34:1329–36.PubMedCrossRef Huang ES, Liu JY, Moffet HH, John PM, Karter AJ. Glycemic control, complications, and death in older diabetic patients: the diabetes and aging study. Diabetes Care. 2011;34:1329–36.PubMedCrossRef
44.
go back to reference Cox DJ, Kovatchev BP, Gonder-Frederick LA, et al. Relationships between hyperglycemia and cognitive performance among adults with type 1 and type 2 diabetes. Diabetes Care. 2005;28:71–7.PubMedCrossRef Cox DJ, Kovatchev BP, Gonder-Frederick LA, et al. Relationships between hyperglycemia and cognitive performance among adults with type 1 and type 2 diabetes. Diabetes Care. 2005;28:71–7.PubMedCrossRef
45.
go back to reference Lee SJ, Eng C. Goals of glycemic control in frail older patients with diabetes. JAMA. 2011;305:1350–1.PubMedCrossRef Lee SJ, Eng C. Goals of glycemic control in frail older patients with diabetes. JAMA. 2011;305:1350–1.PubMedCrossRef
46.
go back to reference Cheng G, Huang C, Deng H, Wang H. Diabetes as a risk factor for dementia and mild cognitive impairment: a meta-analysis of longitudinal studies. Intern Med J. 2012;42:484–91.PubMedCrossRef Cheng G, Huang C, Deng H, Wang H. Diabetes as a risk factor for dementia and mild cognitive impairment: a meta-analysis of longitudinal studies. Intern Med J. 2012;42:484–91.PubMedCrossRef
47.
go back to reference Middleton LE, Yaffe K. Promising strategies for the prevention of dementia. Arch Neurol. 2009;66:1210–5.PubMedCrossRef Middleton LE, Yaffe K. Promising strategies for the prevention of dementia. Arch Neurol. 2009;66:1210–5.PubMedCrossRef
48.
go back to reference Biessels GJ, Staekenborg S, Brunner E, Brayne C, Scheltens P. Risk of dementia in diabetes mellitus: a systematic review. Lancet Neurol. 2006;5:64–74.PubMedCrossRef Biessels GJ, Staekenborg S, Brunner E, Brayne C, Scheltens P. Risk of dementia in diabetes mellitus: a systematic review. Lancet Neurol. 2006;5:64–74.PubMedCrossRef
49.
go back to reference Feil DG, Zhu CW, Sultzer DL. The relationship between cognitive impairment and diabetes self-management in a population-based community sample of older adults with Type 2 diabetes. J Behav Med. 2012;35:190–9.PubMedCrossRef Feil DG, Zhu CW, Sultzer DL. The relationship between cognitive impairment and diabetes self-management in a population-based community sample of older adults with Type 2 diabetes. J Behav Med. 2012;35:190–9.PubMedCrossRef
50.
go back to reference Bruce DG, Davis WA, Casey GP, et al. Severe hypoglycaemia and cognitive impairment in older patients with diabetes: the Fremantle Diabetes Study. Diabetologia. 2009;52:1808–15.PubMedCrossRef Bruce DG, Davis WA, Casey GP, et al. Severe hypoglycaemia and cognitive impairment in older patients with diabetes: the Fremantle Diabetes Study. Diabetologia. 2009;52:1808–15.PubMedCrossRef
51.
go back to reference Sinclair A, Armes DG, Randhawa G, Bayer AJ. Caring for older adults with diabetes mellitus: characteristics of carers and their prime roles and responsibilities. Diabet Med. 2010;27:1055–9.PubMedCrossRef Sinclair A, Armes DG, Randhawa G, Bayer AJ. Caring for older adults with diabetes mellitus: characteristics of carers and their prime roles and responsibilities. Diabet Med. 2010;27:1055–9.PubMedCrossRef
52.
go back to reference Rosentock J, Daily G, Massi-Benedetti M, Fritsche A, Lin Z, Salzman A. Reduced hypoglycaemia risk with insulin glargine: a meta-analysis comparing insulin glargine with human NPH insulin in type 2 diabetes. Diabetes Care. 2005;28:950–6.CrossRef Rosentock J, Daily G, Massi-Benedetti M, Fritsche A, Lin Z, Salzman A. Reduced hypoglycaemia risk with insulin glargine: a meta-analysis comparing insulin glargine with human NPH insulin in type 2 diabetes. Diabetes Care. 2005;28:950–6.CrossRef
53.
go back to reference Abdelhafiz AH, Sinclair AJ. Hypoglycemia in residential care homes. Br J Gen Pract. 2009;59:49–50.PubMedCrossRef Abdelhafiz AH, Sinclair AJ. Hypoglycemia in residential care homes. Br J Gen Pract. 2009;59:49–50.PubMedCrossRef
54.
go back to reference Bramlage P, Gitt AK, Binz C, Krekler M, Deeg E, Tschöpe D. Oral antidiabetic treatment in type-2 diabetes in the elderly: balancing the need for glucose control and the risk of hypoglycaemia. Cardiovasc Diabetol. 2012;11:122.PubMedCrossRef Bramlage P, Gitt AK, Binz C, Krekler M, Deeg E, Tschöpe D. Oral antidiabetic treatment in type-2 diabetes in the elderly: balancing the need for glucose control and the risk of hypoglycaemia. Cardiovasc Diabetol. 2012;11:122.PubMedCrossRef
Metadata
Title
Management of Type 2 Diabetes in Older People
Authors
Ahmed H. Abdelhafiz
Alan J. Sinclair
Publication date
01-06-2013
Publisher
Springer Healthcare
Published in
Diabetes Therapy / Issue 1/2013
Print ISSN: 1869-6953
Electronic ISSN: 1869-6961
DOI
https://doi.org/10.1007/s13300-013-0020-4

Other articles of this Issue 1/2013

Diabetes Therapy 1/2013 Go to the issue