Relationship between nutrition status and diabetes treatment in elderly diabetic outpatients

Objectives: To measure the malnutrition prevalence in elderly outpatients with diabetes and to determine the relationship between nutritional status and duration of diabetes and treatment therapy.

RELATIONSHIP BETWEEN NUTRITION STATUS AND

DIABETES TREATMENT IN ELDERLY DIABETIC OUTPATIENTS

Nguyen Xuan Thanh*; Nguyen Ngoc Tam**

Vu Xuan Nghia***; Vu Thi Thanh Huyen*

SUMMARY

Objectives: To measure the malnutrition prevalence in elderly outpatients with diabetes and

to determine the relationship between nutritional status and duration of diabetes and treatment therapy Methods: 158 elderly outpatients with diabetes were included in a descriptive cross-sectional study The designed questionnaire was used to obtain information Malnutrition was assessed with the Mini Nutritional Assessment (MNA) tool Results: The age ranged from 60 to

92 with the mean of 69.52 ± 6.76 The female/male ratio was 1.63 29.1% of elderly outpatient diabetes had risk of malnutrition, and 1.9% of them had malnutrition No correlation between nutritional status and duration of diabetes and treatment therapy was found Consclusion: The results of the study provided the high prevalence of risks of malnutrition among elderly outpatients with diabetes, no correlation between nutritional status and duration of diabetes and treatment therapy was found MNA-SF is useful to screen risk of malnutrition

* Key words: D iabetes; N utrition; E lderly; Treatment

INTRODUCTION

Diabetes is becoming a huge and

growing problem worldwide and impacts

on different groups of age, especially the

older people The epidemic of diabetes

continues to increase at an alarming rate

throughout the world Globally, 387 million

people have diabetes; by 2035, this will

have risen to 592 million [1] Malnutrition

is more common and increasing in the

older population In the US, about 16% of

those over 65 years and 2% of those over

85 years living in the community are

undernourished [2] These figures are

predicted to rise dramatically in the next

30 years Malnutrition is associated with a

decline in functional status, impaired

muscle function, decreased bone mass,

immune dysfunction, anemia, reduced cognitive function, poor wound healing, delayed recovering from surgery, higher hospital and readmission rate, and mortality [3] Several investigations demonstrated that diabetes in the elderly increases the risk of suboptimal nutrition The association between under nutrition, length of stay and treatment therapy was found in some researches [4]

In Vietnam, few researches on malnutrition status in diabetic patients addressed to elderly subjects Therefore, we conducted this study to measure the malnutrition prevalence in elderly outpatients with diabetes and to determine the correlation between nutritional status, duration of diabetes and treatment therapy

* Hanoi Medical University

* National Institute of Gerontology

*** Military Medical University

Corresponding author: Vu Thi Thanh Huyen (vuthanhuyen11@yahoo.com)

PATIENTS AND METHODS

1 Patients

The outpatients included into this study

were at the age of 60 years or older,

diagnosed with diabetes according to IDF’s

criteria 2013 [6], treated as out-patient

from August 7 to November 1, 2015 at

National Geriatric Hospital, Hanoi Patients

who could not complete the questionnaire or

refused to participate into the study were

excluded

2 Methods

Data were collected by face-to-face

interview using the designed questionnaire

The collected data included age, gender,

duration of diabetes, treatment therapy

The Mini-Nutritional Assessment short-form

(MNA-SF) was used to assess nutritional

status of the participants It contained 6

items about food intake, weight loss, mobility,

psychological stress or acute disease,

neuropsychological problems and BMI

Patients were scored according to the

tool’s guideline The score ranged from 0

to 14 The results were assigned into 3

groups: malnourished (0 - 7 points), at risk

of malnutrition (8 - 11 points) and normal

nutritional status (12 - 14 points) Height and

weight were measured for BMI calculating,

using the same type of mechanical height

and weight scale in the National Geriatric

Hospital Participants removed shoes,

heavy outer clothing, hats, and barrettes

before the measurement Height results

were recorded to the nearest centimeter

and weight was recorded to the nearest

0.1 kg BMI was calculated using the formula:

BMI = weight (kg)/height2 (m2)

3 Statistical analysis

This is a descriptive cross-sectional study Data was analyzed using Statistical Package for Social Sciences (SPSS) version 21.0 computer software Means and standard deviations (SDs) were reported for continuos variables and proportions for categorical variables Inferential statistics were done

to perform comparisons between nutritional status and other factors, using χ2 test Difference was considered to be significant

if the p-value was below 0.05

RESULTS AND DISCUSSION

During the period from August 7th to November 1st 2015, 158 patients who met the criteria were included in the study

Of 158 participants, female patients accounted for 62%, which was significantly higher than males The female/male ratio was 1.63 The result was similar to the other researches conducted at National Geriatric Hospital with the corresponding proportions of male and female of 40% and 60% The reason is that both researches were conducted in the same setting

Figure 2: Age distribution (n = 158)

The figure 2 showed that a group of 60

to 69 years old accounted for the highest

proportion (53.2%), followed by the age of

70 to 79 years old (38.6%) and participants

aged 80 and older (8.2%) Age of participants

ranged from 60 to 92, mean age was

69.52 ± 6.76, which was lower than the

study by Julia et al with participants aged

75 and older [7]

Half of participants (51.9%) were diagnosed

with diabetes more than 10 years Only

4.4% of them had diabetes less than 1

year A study in 2011 showed that 63% of

diabetic patients were diagnosed between

the ages of 40 and 64 years [8] In addition, the study population in this study is elderly diabetes, who had experienced diabetes for a long time

The elderly in our study had experienced diabetes for a long time, but oral medications were the most popular treatment (50%) Combination of pills and insulin was used

by 33.5% of patients

The pie chart illustrated nutritional status distribution of elderly diabetic patients

Of those, people who had normal nutritional status accounted for the largest proportion (69%, 109 patients) The rate of malnutrition and risk of malnutrition were 1.9% and

29.1%, respectively Our study showed a

higher proportion of malnourished patients

than the finding by Valeria Maria et al [9]

and Julia Bollwein et al [7], in which no

malnourished elderly were found The

difference might be due to in the tools,

since we used MNA Short Form, but others

used the full MNA Compared to the

research in Sweden [10], the malnourished

proportion in our study was lower (1.9%

vs 36%) They assessed nutritional status

of all individuas in assisted accommodation,

such as service flats, old people’s homes,

group living for the demented, and nursing

homes, in three Swedish municipalities

using the full MNA According to

accommodation type, the percentages of

malnutrition were 21%, 33%, 38%, 71%,

respectively This means the nutritional

status had a close relationship with living condition Elderly who lived at home like participants in our study had better nutritional status than others However the proportion of patients at risk of malnutrition (29.1%) was much higher than that in Germany (15.1%) [7] The difference might

be explained by the measurement and the sample Our study used MNA-SF for assessing nutritional status in elderly diabetes patients while other researches used the full MNA in general elderly

MNA-SF was a good screening tool which was validated and recommended However, a further evaluating using the full MNA was needed to identify exactly malnutrition status Some of at risk patients in our study might be classified as malnutrition if we performed a deeper assessment

therapy (n = 158)

Duration

There were no relation between nutritional status and any disease-related factors (p > 0.05) However, there was a trend that the patients with less than 1 year of diabetes had the highest risk of malnutrition (71.4%) The risk reduced with the duration of diabetes It can be explained that in MNA screening, some questions required information about signs of malnutrition within 3 months, such as weight loss, food intake decrease, and acute injury In addition, newly diagnosed diabetes needed to adapt with the new diet Hence, their MNA scores were lower than others

CONCLUSION

The results of this study provided the

high prevalence of risks of malnutrition

among elderly outpatients with diabetes,

no relationship between nutritional status

and duration of diabetes and treatment

therapy was found MNA-SF is useful for

screening risk of malnutrition and the full

MNA is required for futher evaluation on

the real malnutrition of this diabetes

REFERENCES

1 World Health Organization Definition

and diagnosis of diabetes mellitus and intermediate

hyperglycemia Report of a WHO consultation

Geneva (Switzerland) 2006

trends PT 118, table 14 (population age and

sex) 2004

elderly Med Clin North Am 2006, pp.887-907

in hospitalized elderly diabetic patients Nutr Hosp

2013, 28 (3), pp.592-599

5 Bozzetti F Nutritional aspects of the

cancer/aging interface J Geriatric Oncol 2011, pp.177-186

diabetes global guideline 2013

7 Julia Bollwein, D Volkert, R Diekmann

et al Nutritional status according to the Mini Nutritional Assessment (MNA®) and frailty in community dwelling older persons: A close relationship The Journal of Nutrition, Health & Aging 2013, 17, pp.351-356

diabetes among adult incident cases aged

18 - 79 years United States 2011

9 Valéria Maria Caselato-Sousa, Maria Elena Guariento, Gilberto Crosta et al Using the Mini Nutritional Assessment to evaluate the profile of elderly patients in a geriatric outpatient clinic and in long-term institutions International Journal of Clinical Medicine 2011, pp.582-587

10 Saletti A, Lindgren EY, Johansson L et al Nutritional status according to mini nutritional assessment in an institutionalized elderly

population in Sweden Gerontology 2011, 46,

pp.139-145