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.

Journal of military pharmaco-medicine No7-2016 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 crosssectional 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: Diabetes; Nutrition; Elderly; 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) 48 Journal of military pharmaco-medicine No7-2016 PATIENTS AND METHODS 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 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 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 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 to 14 The results were assigned into groups: malnourished (0 - 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) 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 Figure 1: Gender distribution (n = 158) 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 49 Journal of military pharmaco-medicine No7-2016 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 Figure 2: Age distribution (n = 158) The figure 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] Figure 4: Treatment therapy (n = 158) 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 Figure 5: Nutritional status (n = 158) Figure 3: Duration of diabetes (n = 158) Half of participants (51.9%) were diagnosed with diabetes more than 10 years Only 4.4% of them had diabetes less than year A study in 2011 showed that 63% of diabetic patients were diagnosed between 50 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 Journal of military pharmaco-medicine No7-2016 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 MNASF 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 Table 1: Relationship between nutritional status, duration of diabetes and treatment therapy (n = 158) Characteristics Duration Treatment therapy Items Risk/mal Normal Less than year 71.4 28.6 - years 10 35.7 18 64.3 - 10 years 12 29.3 29 70.7 > 10 years 22 26.8 60 73.2 Diet/exercise alone 0 100 OAD 29 36.7 50 63.3 Insulin 21.7 18 78.3 OAD and insulin 14 26.4 39 73.6 Nothing 50.0 50.0 p > 0.05 > 0.05 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 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 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 51 Journal of military pharmaco-medicine No7-2016 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 World Health Organization Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia Report of a WHO consultation Geneva (Switzerland) 2006 Office of National Statistics Population trends PT 118, table 14 (population age and sex) 2004 Chapman IM Nutritional disorders in the elderly Med Clin North Am 2006, pp.887-907 Sanz París A et al Malnutrition prevalence in hospitalized elderly diabetic patients Nutr Hosp 2013, 28 (3), pp.592-599 52 Bozzetti F Nutritional aspects of the cancer/aging interface J Geriatric Oncol 2011, pp.177-186 IDF Managing older people with type diabetes global guideline 2013 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 CDC Distribution of age at diagnosis of diabetes among adult incident cases aged 18 - 79 years United States 2011 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  ... 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,... 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... pharmaco-medicine No7-2016 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