Increased frailty in older patients with type 2 diabetes and malnutrition.
(2014) Journées d’Automne - Société belge de gériatrie et gérontologie (SBGG) — Location: Liège, BE
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- Introduction Type 2 diabetes is a heterogeneous syndrome in the elderly, which may be associated with malnutrition. This study aimed at exploring features of older patients suffering from both diabetes and malnutrition. Methods Cross-sectional study among 172 older diabetic patients (83±4 years; sex ratio 1:1) admitted to medical or surgical wards of a Belgian teaching hospital (2012-2013). Four inclusion criteria were used: older age (≥75 years), type 2 diabetes mellitus, risk of functional decline (ISAR ≥2), and comprehensive geriatric assessment performed by the internal liaison team, including a short mini-nutritional assessment (MNA-SF, score range: 0-14). We compared the patients with malnutrition (MNA-SF ≤7/14) to those without malnutrition in terms of socio-demographic, diabetic and geriatric variables, as well as vital status (01/2014), using appropriate statistics (chi2 and t-tests). Results The 44 diabetic patients with malnutrition (MNA-SF 5.8±1.6), as compared to the 128 ones without malnutrition (MNA-SF 10.7±1.7), were of similar age and gender. No prevalence difference was found, according to the presence of the absence of malnutrition, as far as hypertension (78%), ischaemic disease (62%), grade IV-V renal failure (22%) or micro-angiopathic complications (17%) were concerned. No difference was observed either in common geriatric syndromes, e.g. multiple falls (49%), use of ≥ 10 medications daily (43%), chronic pain (34%), visual impairment (33%) or cognitive decline (32%). Diabetic patients with malnutrition more frequently presented with HbA1c <7% (62 vs. 46%, p=0.004), which was less frequently measured during the hospital stay (57 vs. 72%, p=0.01). They more frequently (p <0.05) had dependence in 3 or more basal ADL (54 vs. 34%), nursing home residency (36 vs. 10%) and high risk of functional decline as predicted by ISAR ≥ 4 (70 vs. 46%) or SHERPA ≥7 (64 vs. 43%). Their mortality rate, assessed in January 2014, was higher (34 vs. 19%, p=0.05). Conclusions Malnutrition was present in 1 in 4 older patients with diabetes mellitus. This subgroup of patients with diabetes and malnutrition deserves increased medical attention, as it shows higher prevalence of inappropriately low HbA1c, as well as higher risk of functional decline and mortality.
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Christiaens, A., Beeckmans, M., Hermans, M., & Boland, B. (2014). Increased frailty in older patients with type 2 diabetes and malnutrition. Geriatrie et Psychologie Neuropsychiatrie du Vieillissement, 12(Suppl. 3), 16. https://hdl.handle.net/2078.5/124913 (Original work published 2014)