TY - JOUR T1 - The hidden impact: frailty and malnutrition in patients with diabetic foot ulcers TT - Gizli etki: diyabetik ayak ülseri olan hastalarda kırılganlık ve yetersiz beslenme AU - Demir, Levent AU - Avcı, Mustafa AU - Kahraman, Murat AU - Kılıç, Selahattin PY - 2025 DA - March Y2 - 2025 DO - 10.32322/jhsm.1608035 JF - Journal of Health Sciences and Medicine JO - J Health Sci Med /JHSM /jhsm PB - MediHealth Academy Yayıncılık WT - DergiPark SN - 2636-8579 SP - 262 EP - 268 VL - 8 IS - 2 LA - en AB - Aims: Diabetic foot ulcers (DFUs) are a significant complication affecting over 30% of individuals with diabetes, leading to increased morbidity and mortality. This study investigates the relationships between frailty, nutritional status, and quality of life in patients aged 50 and older diagnosed with DFUs.Methods: A total of 100 participants with DFUs were prospectively included in the study, with assessments conducted using the Edmonton Frailty Scale and the Mini Nutritional Assessment Scale. Quality of life was evaluated using the EQ-5D-3L scale. Demographic data, concomitant diseases, medications, HbA1c levels, and participants’ height, weight, and circumferences of the upper arm, calf, and waist were recorded. The data analysis was performed using statistical software.Results: The findings revealed that 50% of patients exhibited varying degrees of frailty, and 85% were at risk of malnutrition. Both frailty and malnutrition were associated with a significant decline in quality of life. Notably, patients with normal nutritional status reported higher quality of life scores compared to those at risk of malnutrition or malnourishment.Conclusion: This study underscores the need for a holistic approach to managing DFUs that integrates frailty and nutritional status assessments. Targeted interventions addressing these factors are essential for improving health outcomes and enhancing the quality of life for individuals living with diabetes. The findings advocate a shift from a narrow focus on wound management to a broader, more comprehensive care strategy. KW - Diabetic foot ulcers KW - frailty KW - nutrition KW - quality of life N2 - Amaç: Diyabetik ayak ülserleri (DFU) diyabetli bireylerin %30'undan fazlasını etkileyen, morbidite ve mortalitenin artmasına yol açan önemli bir komplikasyondur. Bu çalışma, DFU tanısı alan 50 yaş ve üzeri hastalarda kırılganlık, beslenme durumu ve yaşam kalitesi arasındaki ilişkileri araştırmaktadır.Yöntemler: DFU'lu toplam 100 katılımcı prospektif olarak çalışmaya dahil edilmiş ve değerlendirmeler Edmonton Kırılganlık Ölçeği ve Mini Nutrisyonel Değerlendirme ölçeği kullanılarak yapılmıştır. Yaşam kalitesi EQ-5D-3L ölçeği kullanılarak değerlendirilmiştir. Demografik veriler, eşlik eden hastalıklar, ilaçlar, HbA1c düzeyleri ve katılımcıların boy, kilo ve üst kol, baldır ve bel çevreleri kaydedilmiştir. Veri analizi istatistiksel yazılım kullanılarak gerçekleştirilmiştir.Bulgular: Bulgular, hastaların %50'sinin çeşitli derecelerde kırılganlık sergilediğini ve %85'inin malnütrisyon riski altında olduğunu ortaya koymuştur. Hem kırılganlık hem de malnütrisyon yaşam kalitesinde önemli bir düşüşle ilişkilendirilmiştir. Özellikle, beslenme durumu normal olan hastalar, malnütrisyon veya malnütrisyon riski altında olanlara kıyasla daha yüksek yaşam kalitesi skorları bildirmiştir.Sonuç: Bu çalışma, kırılganlık ve beslenme durumu değerlendirmelerini entegre eden DFU'ların yönetimine yönelik bütüncül bir yaklaşıma duyulan ihtiyacın altını çizmektedir. Bu faktörleri ele alan hedefe yönelik müdahaleler, diyabetle yaşayan bireylerin sağlık sonuçlarını iyileştirmek ve yaşam kalitesini artırmak için gereklidir. Bulgular, yara yönetimine dar bir odaklanmadan daha geniş, daha kapsamlı bir bakım stratejisine geçişi savunmaktadır.Anahtar Kelimeler: diyabetik ayak ülseri, kırılganlık, beslenme, yaşam kalitesi CR - Sinclair A, Saeedi P, Kaundal A, Karuranga S, Malanda B, Williams R. Diabetes and global ageing among 65-99-year-old adults: findings from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract. 2020;162:108078. doi:10.1016/j.diabres.2020. 108078 CR - Yüceler Kaçmaz H, Kahraman H, Akın S, Sözüer E. The effects of frailty on quality of recovery and complications in older adults undergoing major abdominal surgery: a prospective cohort study. J Health Sci Med. 2023;6(5):1133-1141. doi:10.32322/jhsm.1350264 CR - Bôas NCRV, Salomé GM, Ferreira LM. Frailty syndrome and functional disability among older adults with and without diabetes and foot ulcers. J Wound Care. 2018;27(7):409-416. doi:10.12968/jowc.2018.27.7.409 CR - Aydemir A, Yıldırım Gürkan D, Kapukaya EE, Korkmaz M. The investigation of frailty level and factors affecting frailty in older adults with osteoarthritis; a cross-sectional study on Turkish population. J Health Sci Med. 2024;7(4):387-394. doi:10.32322/jhsm.1453110 CR - Sinclair AJ, Abdelhafiz AH. Unravelling the frailty syndrome in diabetes. Lancet Healthy Longev. 2021;2(11):e683-e684. doi:10.1016/S2666-7568 (21)00256-7 CR - Fernando ME, Blanchette V, Mishra R, et al. Frailty in people with chronic limb threatening ischemia and diabetes-related foot ulcers: a systematic review. Ann Vasc Surg. 2023;89:322-337. doi:10.1016/j.avsg. 2022.09.057 CR - Walsh JW, Hoffstad OJ, Sullivan MO, Margolis DJ. Association of diabetic foot ulcer and death in a population-based cohort from the United Kingdom. Diabet Med. 2016;33(11):1493-1498. doi:10.1111/dme. 13054 CR - Maltese G, Basile G, Meehan H, et al. Frailty is associated with impaired diabetic foot ulcer healing and all-cause re-hospitalization. J Nutr Health Aging. 2022;26(2):169-173. doi:10.1007/s12603-022-1726-7 CR - Tamura Y, Omura T, Toyoshima K, Araki A. Nutrition management in older adults with diabetes: a review on the importance of shifting prevention strategies from metabolic syndrome to frailty. Nutrients. 2020;12(11):3367. doi:10.3390/nu12113367 CR - Ni Lochlainn M, Cox NJ, Wilson T, et al. Nutrition and frailty: opportunities for prevention and treatment. Nutrients. 2021;13(7):2349. doi:10.3390/nu13072349 CR - Da Porto A, Miranda C, Brosolo G, Zanette G, Michelli A, Ros RD. Nutritional supplementation on wound healing in diabetic foot: what is known and what is new? World J Diabetes. 2022;13(11):940-948. doi:10. 4239/wjd.v13.i11.940 CR - Brookes JDL, Jaya JS, Tran H, et al. Broad-ranging nutritional deficiencies predict amputation in diabetic foot ulcers. Int J Low Extrem Wounds. 2020;19(1):27-33. doi:10.1177/1534734619876779 CR - Hong J, Huang QQ, Liu WY, et al. Three nutritional indices are effective predictors of mortality in patients with type 2 diabetes and foot ulcers. Front Nutr. 2022;9:851274. doi:10.3389/fnut.2022.851274 CR - Arshad MA, Arshad S, Arshad S, Arshad S, Abbas H. The quality of life in patients with diabetic foot ulcers. J Diab Metab. 2020;11(2):1-2. doi:10.35248/2155-6156.20.11.e101 CR - Pedras S, Carvalho R, Pereira MG. Quality of life in Portuguese patients with diabetic foot ulcer before and after an amputation surgery. Int J Behav Med. 2016;23(6):714-721. doi:10.1007/s12529-016-9567-6 CR - Argyriou C, Dimitriadou I, Saridi M, Toska A, Lavdaniti M, Fradelos EC. Assessment of the relation between depression, frailty, nutrition and quality of life among older adults: findings from a cross-sectional study in Greece. Psychogeriatrics. 2024;24(5):1065-1074. doi:10.1111/psyg.13160 CR - Rolfson DB, Majumdar SR, Tsuyuki RT, Tahir A, Rockwood K. Validity and reliability of the Edmonton Frail Scale. Age Ageing. 2006;35(5):526-529. doi:10.1093/ageing/afl041 CR - Aygör HE, Fadıloğlu Ç, Şahin S, Aykar FŞ, Akçiçek F. Validation of Edmonton Frail Scale into elderly Turkish population. Arch Gerontol Geriatr. 2018;76:133-137. doi:10.1016/j.archger.2018.02.003 CR - Navarro-Flores E, de Bengoa Vallejo RB, Losa-Iglesias ME, et al. The reliability, validity, and sensitivity of the Edmonton Frail Scale (EFS) in older adults with foot disorders. Aging (Albany NY). 2020;12(24):24623-24632. doi:10.18632/aging.202140 CR - Cereda E. Mini nutritional assessment. Curr Opin Clin Nutr Metab Care. 2012;15(1):29-41. doi:10.1097/MCO.0b013e32834d7647 CR - EuroQol Group. EuroQol-a new facility for the measurement of health-related quality of life. Health Policy. 1990;16(3):199-208. doi:10.1016/ 0168-8510(90)90421-9 CR - Byrnes J, Ward L, Jensen S, et al. Health-related quality of life in people with different diabetes-related foot ulcer health states: a cross-sectional study of healed, non-infected, infected, hospitalised and amputated ulcer states. Diabetes Res Clin Pract. 2024;207:111061. doi:10.1016/j.diabres.2023.111061 CR - Maity S, Leton N, Nayak N, et al. A systematic review of diabetic foot infections: pathogenesis, diagnosis, and management strategies. Front Clin Diabetes Healthc. 2024;5:1393309. doi:10.3389/fcdhc.2024.1393309 CR - Wang A, Lv G, Cheng X, et al. Guidelines on multidisciplinary approaches for the prevention and management of diabetic foot disease (2020 edition). Burns Trauma. 2020;8:tkaa017. doi:10.1093/burnst/tkaa017 CR - Sinclair A, Bellary S, Dhatariya KK. Diabetes in older adults-time to include frailty as a care indicator. Diabet Med. 2021;38(5):e14560. doi:10. 1111/dme.14560 CR - Alshanberi AM. Frailty in the Kingdom of Saudi Arabia-prevalence and management, where are we? Healthcare. 2023;11(12):1715. doi:10.3390/healthcare11121715 CR - Lauwers P, Dirinck E, Van Bouwel S, et al. Malnutrition and its relation with diabetic foot ulcer severity and outcome: a review. Acta Clin Belg. 2022;77(1):79-85. doi:10.1080/17843286.2020.1800315 CR - Kurian SJ, Baral T, Unnikrishnan MK, et al. The association between micronutrient levels and diabetic foot ulcer: a systematic review with meta-analysis. Front Endocrinol (Lausanne). 2023;14:1152854. doi:10. 3389/fendo.2023.1152854 CR - Basiri R, Spicer MT, Ledermann T, Arjmandi BH. Effects of nutrition intervention on blood glucose, body composition, and phase angle in obese and overweight patients with diabetic foot ulcers. Nutrients. 2022; 14(17):3564. doi:10.3390/nu14173564 CR - Deng L, Du C, Song P, et al. The role of oxidative stress and antioxidants in diabetic wound healing. Oxid Med Cell Longev. 2021;2021:8852759. doi:10.1155/2021/8852759 CR - Basiri R, Spicer M, Levenson C, Ledermann T, Akhavan N, Arjmandi B. Improving dietary intake of essential nutrients can ameliorate inflammation in patients with diabetic foot ulcers. Nutrients. 2022; 14(12):2393. doi:10.3390/nu14122393 CR - Basiri R, Spicer MT, Levenson CW, Ormsbee MJ, Ledermann T, Arjmandi BH. Nutritional supplementation concurrent with nutrition education accelerates the wound healing process in patients with diabetic foot ulcers. Biomedicines. 2020;8(8):263. doi:10.3390/biomedicines8080263 CR - Armstrong DG, Mills JL, Molina M, Molnar JA. Nutrition interventions in adults with diabetic foot ulcers. Guideline Central. 2021. Accessed February 23, 2022. http://eguideline.guidelinecentral.com/i/1428995-nutrition-in-dfu-guidelines-advisory-pocket-guide/0? CR - Luo R, Ji Y, Liu YH, Sun H, Tang S, Li X. Relationships among social support, coping style, self-stigma, and quality of life in patients with diabetic foot ulcer: a multicentre, cross-sectional study. Int Wound J. 2023;20(3):716-724. doi:10.1111/iwj.13914 CR - Hanlon P, Fauré I, Corcoran N, et al. Frailty measurement, prevalence, incidence, and clinical implications in people with diabetes: a systematic review and study-level meta-analysis. Lancet Healthy Longev. 2020;1(3): e106-e116. doi:10.1016/S2666-7568(20)30014-3 CR - Chao CT, Wang J, Chien KL; COhort of GEriatric Nephrology in NTUH (COGENT) study group. Both pre-frailty and frailty increase healthcare utilization and adverse health outcomes in patients with type 2 diabetes mellitus. Cardiovasc Diabetol. 2018;17(1):130. doi:10.1186/s12933-018-0772-2 CR - Chittrakul J, Siviroj P, Sungkarat S, Sapbamrer R. Multi-system physical exercise intervention for fall prevention and quality of life in pre-frail older adults: a randomized controlled trial. Int J Environ Res Public Health. 2020;17(9):3102. doi:10.3390/ijerph17093102 CR - Nakazeko T, Shobako N, Shioya N, et al. Frailty-preventing effect of an intervention program using a novel complete nutritional “COMB-FP meal”: a pilot randomized control trial. Nutrients. 2023;15(20):4317. doi:10.3390/nu15204317 CR - Peng LN, Cheng YC, Yu PC, Lee WJ, Lin MH, Chen LK. Oral nutritional supplement with β-hydroxy-β-methylbutyrate (HMB) improves nutrition, physical performance and ameliorates intramuscular adiposity in pre-frail older adults: a randomized controlled trial. J Nutr Health Aging. 2021;25(6):767-773. doi:10.1007/s12603-021-1621-7 CR - Zhang T, Qin J, Guo J, et al. Prevalence and influencing factors of malnutrition in diabetic patients: a systematic review and meta-analysis. J Diabetes. 2024;16(10):e13610. doi:10.1111/1753-0407.13610 CR - Wang YC, Liang CK, Chou MH, et al. The effectiveness of frailty intervention for older patients with frailty during hospitalization. J Nutr Health Aging. 2023;27(6):413-420. doi:10.1007/s12603-023-1924-y CR - Kim J, Nomkhondorj O, An CY, Choi YC, Cho J. Management of diabetic foot ulcers: a narrative review. J Yeungnam Med Sci. 2023;40(4):335-342. doi:10.12701/jyms.2023.00682 CR - Hansen CA, Hjelmgaard CMH, Kristensen MØ, Berthelsen C. Patient involvement in diabetes-related foot ulcers: what do patients need and prefer when undergoing treatment at multidisciplinary outpatient foot centres? A phenomenological hermeneutic study. Int Wound J. 2024; 21(12):e70128. doi:10.1111/iwj.70128 UR - https://doi.org/10.32322/jhsm.1608035 L1 - https://dergipark.org.tr/en/download/article-file/4470268 ER -