The Clinical Implications and Importance of Malnutrition in Elderly Diabetic Patients

Yıl 2022, Cilt: 44 Sayı: 3, 390 - 397, 14.03.2022

Saadet Koç Okudur , Pinar Soysal

https://doi.org/10.20515/otd.1016170

Öz

Diabetes mellitus and malnutrition are common health problems in older adults. Both are associated with numerous adverse health conditions. The aim of our study is to evaluate the relationship between comprehensivez geriatric assessment parameters and malnutrition in elderly diabetic patients. A cross-sectional study design was used. A total of 506 diabetic outpatients aged ≥ 65 years were included. Demographic data, comorbidities, number of drugs used, urinary incontinence, orthostatic hypotension and laboratory tests were recorded. All patients underwent comprehensive geriatric assessment. Mini mental state examination (MMSE) test was used for neurocognitive assessment, Geriatric Depression Scale (GDS) for mood assessment, Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL) scales for functionality assessment, Tinetti Balance and Gait Test and Time up and go test (TUG) for gait and balance assessment, Insomnia Severity Index (ISI) for sleep status assessment and hand grip strength for muscle strength assessment. Mini Nutritional Assessment (MNA) scores>23.5, 17-23.5, or <17 were categorized as normal nutritional status, malnutrition risk, and malnutrition, respectively. The mean age of the participants was 76.86 ± 6.97 years and 74.7% were women. Prevalence of normal nutritional status, malnutrition risk, and malnutrition were 60.8%, 30.43%, and 8.7%, respectively. Comprehensive geriatric assessment parameters were evaluated according to logistic regression analysis between the groups. BADL, IADL, Tinetti walking and balance scores, MMSE and hand grip strength test scores were significantly lower in the malnourished group, while GDS, ISI, and TUG scores were significantly higher (p<0.05). Malnutrition is a risk factor for functional decline, gait-balance disorders, cognition and mood disorders, decreased hand grip strength and sleep disorders in elderly diabetic patients. Nutritional assessment should be considered while evaluating elderly diabetic patients for diabetes treatment principles.

Anahtar Kelimeler

Diabetes mellitus, malnutrition, comprehensive geriatric assessment, older adults

Yaşlı Diyabetik Hastalarda Malnutrisyonun Klinik Sonuçları ve Önemi

Öz

Diabetes mellitus ve malnutrisyon, yaşlı hastalarda sık görülen sağlık problemleridir. Her ikisi de çok sayıda olumsuz sağlık durumlarıyla ilişkilidir. Çalışmamızın amacı, yaşlı diyabetik hastalarda malnutrisyon ile ayrıntılı geriatrik değerlendirme parametreleri arasındaki ilişkiyi değerlendirmektir. Kesitsel araştırma tasarımı kullanıldı. Çalışmaya geriatri polikliniğine başvuran ≥ 65 yaş, 506 diyabetik hasta dahil edildi. Hastaların demografik verileri, komorbiditeler, kullanılan ilaç sayısı, üriner inkontinans, ortostatik hipotansiyon varlığı ve laboratuar tetkikleri kaydedildi. Tüm hastalara ayrıntılı geriatrik değerlendirme yapıldı. Nörokognitif değerlendirme için Mini Mental Durum Değerlendirme testi (MMSE), duygu durum değerlendirmesi için Geriatrik Depresyon Skalası (GDS), fonksiyonellik değerlendirmesi için Temel Günlük Yaşam Aktiviteleri (TGYA) ve Enstrümantal Günlük Yaşam Aktiviteleri (EGYA) ölçekleri, yürüyüş ve denge fonksiyonları değerlendirmesi için Tinetti Denge ve Yürüme Testi ile Kalk ve Yürü testi (KYT), uyku durumu değerlendirmesi için Uykusuzluk Şiddet İndeksi (UŞİ) ve kas gücü için el kavrama gücü (EKG) testi dosya verileri kullanıldı. Çalışma grubu Mini Nutrisyonel Değerlendirme skorları>23,5, 17-23,5 ve <17 olması sırasıyla normal nutrisyon, malnutrisyon riski ve malnutrisyon olarak kategorize edildi. Katılımcıların yaş ortalaması 76,86 ± 6,97 yıl ve %74,7’si kadın idi. Normal nutrisyonel durum, malnutrisyon riski ve malnutrisyon prevalansı sırasıyla %60,8, %30,43’ü ve %8,7 idi. Ayrıntılı geriatrik değerlendirme parametreleri gruplar arasında lojistik regresyon analizine göre değerlendirildiğinde malnütrisyon olan grupta TGYA, EGYA, Tinetti yürüme ve denge skorları, MMSE ve EKG skorları anlamlı olarak düşük iken, GDS, UŞİ ve KYT skorları anlamlı olarak yüksek saptandı (p<0,05). Yaşlı diyabetik hastalarda malnütrisyon fonksiyonel gerileme, yürüme-denge bozuklukları, kognisyon ve duygu durum bozuklukları, el kavrama gücünde azalma ve uyku bozuklukları için bir risk faktörüdür. Yaşlı diyabetik hastalarda diyabet tedavi ilkeleri gözetilirken nutrisyonel değerlendirmenin de göz önünde bulundurulması gerekmektedir.

Anahtar Kelimeler

Diyabetes mellitus, malnutrisyon, ayrıntılı geriatrik değerlendirme, yaşlı

Kaynakça

• Zheng Y, Ley S, Hu F. Global aetiology and epidemiology of type 2 diabetes mellitus and its complications. Nat Rev Endocrinol. 2018;14, 88–98.
• Kirkman MS, Briscoe VJ, Clark N, et al. Consensus Development Conference on Diabetes and Older Adults. Diabetes in older adults: a consensus report. J Am Geriatr Soc. 2012;60(12):2342-56.
• Resnick B, Boltz M. Optimizing Function and Physical Activity in Hospitalized Older Adults to Prevent Functional Decline and Falls. Clin Geriatr Med. 2019;35(2):237-251.
• Abada S, Clark LE, Sinha AK, et al. Medication Regimen Complexity and Low Adherence in Older Community-Dwelling Adults With Substantiated Self-Neglect. J Appl Gerontol. 2019 Jun;38(6):866-883. doi: 10.1177/0733464817714565. Epub 2017 Jun 23. PMID: 28645225.
• Sircar M, Bhatia A, Munshi M. Review of Hypoglycemia in the Older Adult: Clinical Implications and Management. Can J Diabetes. 2016;40(1):66-72.
• Corish CA, Bardon LA. Malnutrition in older adults: screening and determinants. Proc Nutr Soc. 2019;78(3):372-379.
• Dent E, Hoogendijk EO, Visvanathan R, et al. Malnutrition Screening and Assessment in Hospitalised Older People: a Review. J Nutr Health Aging. 2019;23(5):431-441.
• Ülger Z, Halil M, Kalan I, et al. Comprehensive assessment of malnutrition risk and related factors in a large group of community-dwelling older adults. Clinical Nutrition. 2010;29(4), 507-511.
• Di Francesco V, Pellizzari L, Corrà L, et al. The anorexia of aging: impact on health and quality of life. Geriatric Care. 2018;4(2).
• Rizvi AA. Nutritional challenges in the elderly with diabetes. Int J Diabetes Mellit. 2009; 1: 26–31.
• Unutmaz GD, Soysal P, Tuven B, et al. Costs of medication in older patients: before and after comprehensive geriatric assessment. Clin interv aging. 2018;13, 607.
• Durmaz B, Soysal P, Ellidokuz H, et al. Validity and reliability of geriatric depression scale-15 (short form) in Turkish older adults. North clin Istanb. 2018;5(3), 216.
• Morin CM, Belleville G, Bélanger L, et al. The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep, 2011;34(5), 601-608.
• Ates Bulut E, Soysal P, Dokuzlar O, et al. Validation of population-based cutoffs for low muscle mass and strength in a population of Turkish elderly adults. Aging Clin Exp Res. 2020;32(9):1749–55.
• Dutoglu E, Soysal P, Smith L, et al. Nocturia and its clinical implications in older women. Arch Gerontol Geriatr. 2019 Jul;85:103917.
• Lanier JB, Mote MB, Clay EC. Evaluation and management of orthostatic hypotension. Am Fam Physician. 2011;84(5):527–536.
• Soysal P, Smith L, Dokuzlar O, et al. Relationship between nutritional status and insomnia severity in older adults. J Am Med Dir Assoc. 2019; 20(12), 1593-1598.
• Bozoglu E, Isik AT, Doruk H, et al. The effects of early vitamin B12 replacement therapy on the cognitive and functional status of elderly subjects. Klin Psikofarmakol Bul. 2010;20(2):120-124.
• Soysal P, Smith L, Capar E, et al. Vitamin B12 and folate deficiencies are not associated with nutritional or weight status in older adults. Exp Gerontol. 2019;116, 1-6.
• Dawson-Hughes B, Mithal A, Bonjour JP, et al. IOF position statement: vitamin D recommendations for older adults. Osteoporos Int, 2010;21(7), 1151-1154.
• Lorenzo-Lopez L, Maseda A, de Labra C, et al. Nutritional determinants of frailty in older adults: a systematic review. BMC Geriatr. 2017;17(1):108. doi:10.1186/s12877-017-0515-3.
• Soysal P, Veronese N, Arik F, et al. Mini Nutritional Assessment Scale-Short Form can be useful for frailty screening in older adults. Clin Interv Aging, 2019;14, 693.
• American Diabetes Association. Executive summary: standards of medical care in diabetes – 2008. Diabetes Care, 2008; 31: S5– S11.
• Wakimoto P, Block G. Dietary intake, dietary patterns and changes with age: an epidemiological perspective. J Gerontol A Biol Sci Med Sci. 2001; 56: 65–80.
• Turnbull PJ, Sinclair AJ. Evaluation of nutritional status and its relationship with functional status in older citizens with diabetes mellitus using the mini nutritional assessment (MNA) tool—a preliminary investigation. J Nutr Health Aging. 2002; 6: 185–189.
• Vischer UM, Perrenoud L, Genet C, et al. The high prevalence of malnutrition in elderly diabetic patients: implications for anti‐diabetic drug treatments. Diabetic Medicine, 2010;27(8), 918-924.
• Bonin-Guillaume S, Herrmann FR, Boillat D, et al. Insulinemia and leptinemia in geriatric patients: markers of the metabolic syndrome or of undernutrition?. Diabetes Metab. 2006; 32: 236–243.
• Pflipsen MC, Oh RC, Saguil A, et al. The prevalence of vitamin B12 deficiency in patients with type 2 diabetes: a cross-sectional study. J Am Board Fam Med, 2019; 22(5):528–534.
• Kaidar-Person O, Person B, Szomstein S, et al. Nutritional deficiencies in morbidly obese patients: a new form of malnutrition? Part A: vitamins. Obesity Surgery, 2008;18(7):870–876.
• Efendioğlu EM, Göl M, Tarakçıoğlu MS, et al. Determination of Vitamin D, Vitamin B12 and Folic Acid Deficiency Prevalence Among Geriatric Palliative Care Patients. Eur J Geriatr Gerontol. 2020;2(1):9-12.
• Işık AT, Soysal P. Sendrom, Geriatri ve Geriatrik Sendrom. Soysal P, Işık AT, edt, In: Geriatri Pratiğinde Geriatrik Sendromlar 1. baskı, İzmir, US Akademi, 2018. p. 7–50.
• Heybeli C, Soysal P, Oktan MA, et al. Associations between nutritional factors and excessive daytime sleepiness in older patients with chronic kidney disease. Aging Clin Exp Res, 2021;1-9.
• Liu GX, Chen Y, Yang YX, et al. Pilot study of the Mini Nutritional Assessment on predicting outcomes in older adults with type 2 diabetes. Geriatr Gerontol Int, 2017;17(12), 2485-2492.
• Velázquez‐Alva MC, Irigoyen‐Camacho ME, Zepeda‐Zepeda MA, et al. Sarcopenia, nutritional status and type 2 diabetes mellitus: A cross‐sectional study in a group of Mexican women residing in a nursing home. Nutr Diet, 2020;77(5), 515-522.
• Jang HC. Sarcopenia, frailty, and diabetes in older adults. Diabetes Metab J. 2016; 40: 182–9.
• Biessels GJ, Despa F. Cognitive decline and dementia in diabetes mellitus: mechanisms and clinical implications. Nat Rev Endocrinol. 2018;14(10):591–604.
• Mantzorou M, Vadikolias K, Pavlidou E, et al. Nutritional status is associated with the degree of cognitive impairment and depressive symptoms in a Greek elderly population. Nutr Neurosci, 2020;23(3), 201-209.
• Keckeis M, Lattova Z, Maurovich-Horvat E, et al. Impaired glucose tolerance in sleep disorders. PLoS One 2010;5:e9444.