The high prevalence of malnutrition in elderly diabetic patients: implications for anti‐diabetic drug treatments

Vischer, Ulrich M.; Perrenoud, Luz; Genet, Chantal; Ardigo, Sheila; Registe-Rameau, Yvette; Herrmann, Françoís

doi:10.1111/j.1464-5491.2010.03047.x

Cited by 70 publications

(58 citation statements)

References 27 publications

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“…18,[36][37][38] Also, low levels of glycaemia may not always be indicative of intentional good glycaemic control, but rather a proxy for poor nutritional status and general frailty, both of which have been associated with increased mortality risk. 39 The latter is supported by the existence of a J-shaped association between levels of glycaemia and mortality risk in non-diabetic populations, suggesting that non-glycaemic factors may partly explain the observed risk in the lower glycaemic range. 40 In terms of glycaemic variability, our results are in accordance with previous studies that have shown that higher variability in HbA1c is associated with an increased risk of mortality in patients with T2D.…”

Section: Discussionmentioning

confidence: 91%

Effect of diabetes duration on the relationship between glycaemic control and risk of death in older adults with type 2 diabetes

Ghouse

Isaksen

Skov

et al. 2019

Diabetes Obesity Metabolism

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Aim To investigate the effect of diabetes duration on glycaemic control, measured using mean glycated haemoglobin (HbA1c) level, and mortality risk within different age, sex and clinically relevant, comorbidity‐defined subgroups in an elderly population with type 2 diabetes (T2D). Methods We studied older (≥65 years) primary care patients with T2D, who had three successive annual measurements of HbA1c taken between 2005 and 2013. The primary exposure was the mean of all three HbA1c measurements. Follow‐up began on the date of the third measurement. Individual mean HbA1c levels were categorized into clinically relevant groups (<6.5% [<48 mmol/mol]; 6.5%‐6.9% [48‐52 mmol/mol]; 7%‐7.9% [53‐63 mmol/mol]; 8%‐8.9% [64‐74 mmol/mol]; and ≥9% [≥75 mmol/mol]). We used multiple Cox regression to study the effect of glycaemic control on the hazard of all‐cause mortality, adjusted for age, sex, use of concomitant medication, and age‐ and disease‐related comorbidities. Results A total of 9734 individuals were included. During a median (interquartile range) follow‐up of 7.3 (4.6‐8.7) years, 3320 individuals died. We found that the effect of mean HbA1c on all‐cause mortality depended on the duration of diabetes (P for interaction <.001). For individuals with short diabetes duration (<5 years), the risk of death increased with poorer glycaemic control (increasing HbA1c), whereas for individuals with longstanding diabetes (≥5 years), we found a J‐shaped association, where a mean HbA1c level between 6.5% and 7.9% [48 and 63 mmol/mol] was associated with the lowest risk of death. For individuals with longstanding diabetes, both low (<6.5% [<48 mmol/mol]; hazard ratio [HR] 1.21, 95% confidence interval [CI] 1.07‐1.37, P = .002) and high mean HbA1c levels (≥9.0% [≥75 mmol/mol]; HR 1.60, 95% CI 1.28‐1.99, P < .001) were associated with an increased risk of death. We also calculated 5‐year absolute risks of all‐cause mortality, separately for short and long diabetes duration, and found similar risk patterns across different age groups, sex and comorbidity strata. Conclusions In elderly individuals with T2D, the effect of glycaemic control (measured by HbA1c) on all‐cause mortality depended on the duration of diabetes. Of particular clinical importance, we found that strict glycaemic control was associated with an increased risk of death among individuals with long (≥ 5 years) diabetes duration. Conversely, for individuals with short diabetes duration, strict glycaemic control was associated with the lowest risk of death. These results indicate that tight glycemic control may be beneficial in people with short duration of diabetes, whereas a less stringent target may be warranted with longer diabetes exposure.

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Section: Discussionmentioning

confidence: 91%

Effect of diabetes duration on the relationship between glycaemic control and risk of death in older adults with type 2 diabetes

Ghouse

Isaksen

Skov

et al. 2019

Diabetes Obesity Metabolism

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“…30 g/L, occurrence of malnutrition was particularly frequent (53%) in patients with T2DM in a geriatric ward. 29 The high prevalence of malnutrition was not different between obese elderly patients and other older patients. In another geriatric ward study, 20 the mean serum albumin concentration of patients with T2DM was also particularly low (mean 32 g/L; standard deviation [SD] ± 5.0).…”

Section: Nutritional Issuesmentioning

confidence: 97%

Elderly Patients With Type 2 Diabetes Mellitus-the Need for High-Quality, Inpatient Diabetes Care

Bourdel-Marchasson

Sinclair

2013

Hospital Practice

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Elderly patients (aged > 70 years) with diabetes are at high risk of -hospitalization. We provide a detailed commentary about recent international clinical guidelines and a consensus statement devoted to elderly patients with type 2 diabetes mellitus in the context of hospitalization. In emergency departments, the 4 medication agents associated with the greatest number of patient adverse drug events are warfarin, oral glucose-lowering medications, insulin, and antiplatelet agents, all of which are commonly prescribed in older patients with diabetes. Comprehensive gerontological assessment, including review and, if indicated, discontinuation of all potentially unsafe or inappropriate patient medications should be done upstream to reduce the likelihood of adverse drugs events. Severe infections and ischemic heart disease are also frequent causes of acute admission into hospital in patients aged > 75 years. These patients are also likely to be malnourished and nutritional status should be monitored. Nutritional support, combined with specific products to avoid uncontrolled hyperglycemia must be implemented in patients at risk of malnutrition. Early exercise prescription may help patients maintain physical function and prevent the risk of falling. Clinical guidelines should be applied to achieve safe and effective patient target glucose levels. Insulin should be used earlier for its anabolic properties and patients closely monitored to reduce the risk of hypoglycemia and excessive hyperglycemia. The discharge plan needs to address full medical and social needs along with suitable follow-up to ensure a high level of patient safety.

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“…Malnutrition leads to poor health outcomes, sarcopenia, increased risk of falls, inflammation and frailty syndrome (Johansson et al, 2008;Cruz-Jentoft et al, 2010). Malnutrition might modify the pharmacokinetic and pharmacodynamics of drugs which has to be considered in the treatment of older adults (Vischer et al, 2010).…”

Section: Dehydration and Malnutritionmentioning

confidence: 99%

Towards better understanding of patient centric drug product development in an increasingly older patient population

Stegemann

2016

International Journal of Pharmaceutics

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The high prevalence of malnutrition in elderly diabetic patients: implications for anti‐diabetic drug treatments

Cited by 70 publications

References 27 publications

Effect of diabetes duration on the relationship between glycaemic control and risk of death in older adults with type 2 diabetes

Effect of diabetes duration on the relationship between glycaemic control and risk of death in older adults with type 2 diabetes

Elderly Patients With Type 2 Diabetes Mellitus-the Need for High-Quality, Inpatient Diabetes Care

Towards better understanding of patient centric drug product development in an increasingly older patient population

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