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Guevara E, Simó-Servat A, Perea V, Quirós C, Puig-Jové C, Formiga F, Barahona MJ. Frailty Detection in Older Adults with Diabetes: A Scoping Review of Assessment Tools and Their Link to Key Clinical Outcomes. J Clin Med 2024; 13:5325. [PMID: 39274537 PMCID: PMC11396781 DOI: 10.3390/jcm13175325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 08/26/2024] [Accepted: 09/07/2024] [Indexed: 09/16/2024] Open
Abstract
Objectives: With the increasing prevalence of diabetes and frailty among older adults, there is an urgent need for precision medicine that incorporates comprehensive geriatric assessments, including frailty detection. This scoping review aims to map and synthesize the available evidence on validated tools for detecting pre-frailty and frailty in community-dwelling elderly individuals with diabetes and outpatient diabetes patients. Specifically, it addresses: (1) What validated tools are available for detecting pre-frailty and frailty in this population? (2) How are these tools associated with outcomes such as glycemic control, hypoglycemia, and metabolic phenotypes? (3) What gaps exist in the literature regarding these tools? Methods: The review followed PRISMA-ScR guidelines, conducting a systematic search across PubMed, Cochrane Library, and Web of Science. The inclusion criteria focused on studies involving individuals aged 70 years and older with diabetes, emphasizing tools with predictive capacity for disability and mortality. Results: Eight instruments met the inclusion criteria, including the Frailty Index, Physical Frailty Phenotype, and Clinical Frailty Scale. These tools varied in domains such as physical, psychological, and social aspects of frailty and their association with glycemic control, hypoglycemia, and metabolic phenotypes. The review identified significant gaps in predicting diabetes-related complications and their clinical application. Conclusions: Routine management of older adults with diabetes should incorporate frailty detection, as it is crucial for their overall health. Although widely used, the reviewed tools require refinement to address the unique characteristics of this population. Developing tailored instruments will enhance precision medicine, leading to more effective, individualized interventions for elderly individuals with diabetes.
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Affiliation(s)
- Ernesto Guevara
- Department of Geriatrics, Hospital Universitari Mútua-Terrassa, University of Barcelona, 08007 Barcelona, Spain
| | - Andreu Simó-Servat
- Department of Endocrinology, Hospital Universitari Mútua-Terrassa, University of Barcelona, 08007 Barcelona, Spain
| | - Verónica Perea
- Department of Endocrinology, Hospital Universitari Mútua-Terrassa, University of Barcelona, 08007 Barcelona, Spain
| | - Carmen Quirós
- Department of Endocrinology, Hospital Universitari Mútua-Terrassa, University of Barcelona, 08007 Barcelona, Spain
| | - Carlos Puig-Jové
- Department of Endocrinology, Hospital Universitari Mútua-Terrassa, University of Barcelona, 08007 Barcelona, Spain
| | - Francesc Formiga
- Department of Internal Medicine, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Hospital Universitari de Bellvitge, University of Barcelona, 08007 Barcelona, Spain
| | - María-José Barahona
- Department of Endocrinology, Hospital Universitari Mútua-Terrassa, University of Barcelona, 08007 Barcelona, Spain
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Romera-Liebana L, Urbina-Juez A, Micó-Pérez RM, Mediavilla Bravo JJ, Marco Martinez A, Gómez-Peralta F, Cubo-Romano P, Formiga F. Assessment of frailty in the person with type 2 diabetes mellitus: Expert analysis. Rev Clin Esp 2023; 223:552-561. [PMID: 37722562 DOI: 10.1016/j.rceng.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/18/2023] [Indexed: 09/20/2023]
Abstract
INTRODUCTION People with type 2 diabetes mellitus (DM2) have a higher prevalence of frailty compared to those without DM2. However, there is a lack of consensus on the diagnosis and clinical management of frail individuals with DM2. OBJECTIVES This study aims to identify limitations and current needs in the use of the frailty concept in PCDM2 (people with DM2), as well as define and evaluate the dimensions that should be included in its routine clinical assessment. METHODS A multidisciplinary team of eight health professionals from different hospitals in Spain participated in a process based on the nominal group technique. RESULTS The study identified eight limitations in the assessment of frailty in PCDM2, categorized by importance, and 10 unmet needs related to the diagnosis and follow-up of the disease. Additionally, seven dimensions were identified that should be included in the definition of frail individuals with DM2, prioritized by importance and novelty. CONCLUSIONS This article aims to increase knowledge and usage of the frailty concept in individuals with DM2 within the medical community. It also suggests the potential for future projects to develop a consensus definition of frailty tailored to this specific group.
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Affiliation(s)
- L Romera-Liebana
- Unidad Homecare, Atención Domiciliaria de Cuidados Paliativos y Atención a la Cronicidad, Teladoc Health, Barcelona, Spain
| | - A Urbina-Juez
- Unidad Atención Primaria de Sopela, Organización Sanitaria Integrada de Uribe, Sopela, Spain
| | - R M Micó-Pérez
- Departamento de Salud Xátiva-Ontinyent, Centro Fontanars dels Alforins, Valencia, Spain
| | | | - A Marco Martinez
- Servicio de Endocrinología y Nutrición, Hospital Universitario de Toledo, Toledo, Spain
| | - F Gómez-Peralta
- Unidad de Endocrinología y Nutrición, Hospital General de Segovia, Segovia, Spain
| | - P Cubo-Romano
- Servicio de Medicina Interna, Hospital Universitario Infanta Cristina, Parla, Spain
| | - F Formiga
- Unidad de Geriatría, Servicio de Medicina Interna, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Spain.
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Guerrero-Carreño S, Elías-Sanz E, Gomez-Umbert M, Quintela-Martínez M, Gabarró-Taulé T, Arias-Guillén M. Valoración de la fragilidad en un centro de diálisis. ¿son más frágiles los pacientes con diabetes? ENFERMERÍA NEFROLÓGICA 2023. [DOI: 10.37551/s225428842023003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Introducción: El incremento en la inclusión de personas de edad avanzada a los programas de hemodiálisis se relaciona con un aumento de la prevalencia de fragilidad, considerada predictora de discapacidad y asociada a eventos adversos de salud. Dado su carácter reversible, es importante hacer un cribaje para mejorar la práctica clínica.
Objetivo: Evaluar el grado de fragilidad y estado funcional del paciente en nuestra unidad de hemodiálisis y analizar las diferencias entre diabéticos y no diabéticos.
Material y Método: Estudio observacional de corte transversal. La fragilidad se midió utilizando el fenotipo de Fried y la valoración funcional mediante las escalas Barthel, Lawton, Downton y la Short Physical Performance Battery. Se evaluó comorbilidad y riesgo de caídas con las escalas Charlson y Downton respectivamente. Se comparó entre grupos de diabéticos y no diabéticos y se analizó la relación entre la fragilidad y la edad, dependencia, comorbilidad y riesgo de caídas.
Resultados: Se incluyeron 128 pacientes. El 45% tenían Diabetes. Los pacientes con diabetes tenían una edad media mayor que los no diabéticos (74,2±11 vs 67,8±15 años) y mayor comorbilidad (Charlson 8,2±2,2 vs 5,8±2,4). El 25% de los pacientes presentaron fragilidad, observando una tendencia que sugirió mayor fragilidad, peor capacidad funcional y mayor grado de dependencia en los pacientes diabéticos, aunque de forma no significativa.
Conclusiones: Una cuarta parte de la población estudiada presenta fragilidad, con una tendencia más acusada a padecerla los pacientes diabéticos, que podría estar relacionada con mayor edad, mayor comorbilidad y menor capacidad funcional que los no diabéticos.
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Formiga F, Rodríguez-Mañas L. Diabetes mellitus tipo 2 en las personas de edad avanzada o frágiles. Aspectos a tener en cuenta. Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Formiga F, Rodríguez-Mañas L. Type 2 diabetes mellitus in elderly or frail individuals. Topics to be considerer. Rev Clin Esp 2022; 222:506. [DOI: 10.1016/j.rceng.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 06/20/2022] [Indexed: 10/16/2022]
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Formiga F, Tarazona-Santabalbina FJ. [Diabetes and COVID-19 in the elderly, harmful symbiosis]. Rev Esp Geriatr Gerontol 2020; 55:315-316. [PMID: 32900513 PMCID: PMC7434451 DOI: 10.1016/j.regg.2020.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Francesc Formiga
- Servicio de Medicina Interna, Hospital de Bellvitge, ĹHospitalet de Llobregat, Barcelona, España.
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Formiga F, Montero A, Lopez Carmona D. [Do we think of peripheral arterial disease of the lower limbs in our elderly patients with diabetes when complications appear?]. Rev Esp Geriatr Gerontol 2020; 55:236-238. [PMID: 32247636 DOI: 10.1016/j.regg.2020.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Francesc Formiga
- Programa de Geriatría, Servicio de Medicina Interna, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
| | - Abelardo Montero
- Programa de Geriatría, Servicio de Medicina Interna, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Dolores Lopez Carmona
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Málaga, España
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Padrós G, Ferrer A, Formiga F, Cunillera O, Badia T, Corbella X, Almeda J, Badia T, Fernández C, Ferrer A, Formiga F, Gil A, Llopart C, Megido M, Padrós G, Sarró M, Tobella A. Prevalence of Prediabetes and Associated Factors in the Oldest Old. A Cross Sectional Study in the Octabaix Cohort. INT J GERONTOL 2017. [DOI: 10.1016/j.ijge.2016.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Formiga F, Chivite D, Ruiz D, Navarro M, Perez Castejon JM, Duaso E, Montero A, Lopez-Soto A, Corbella X. Clinical evidence of diabetes mellitus end-organ damage as risk factor for falls complicated by hip fracture: A multi-center study of 1225 patients. Diabetes Res Clin Pract 2015; 109:233-7. [PMID: 26070216 DOI: 10.1016/j.diabres.2015.05.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/14/2015] [Accepted: 05/28/2015] [Indexed: 01/08/2023]
Abstract
AIMS To identify the differential characteristics of patients with type 2 diabetes mellitus (T2DM) complicated by end-organ damage who experience a fall-related hip fracture. METHODS We analyzed the socio-demographic data and index fall clinical characteristics of a group of patients with nephropathy, neuropathy or retinopathy related to T2DM consecutively admitted to six hospitals in Barcelona, Spain because of a fall-related hip fracture. RESULTS Out of 1225 patients admitted because of a fall-related hip fracture, 107 (8.7%) had clinical evidence of end-organ damage related to T2DM. Among this cohort the mean number of falls during the year prior to the index admission was 2.6±3.2; and 29 of them (27.1%) had already experienced three or more falls. Most falls leading to the index admission took place at the patients' home, from a standing position, and during daylight time. An intrinsic cause of falling was identified in all but one of these patients. Multiple stepwise logistic regression analysis showed that, compared to patients without this diagnosis, patients with complicated T2DM were younger (odds ratio 0.762), had less prevalence of dementia (odds ratio 0.078), but had experienced a higher number of falls in the previous year (odds 1.183). CONCLUSIONS A significant amount of patients with clinical evidence of end-organ damage due to T2DM who experience a fall-related hip fracture have a history of recurrent falling in the previous year. These patients should be identified and offered preventive actions aimed at reducing their risk of falling.
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Affiliation(s)
- Francesc Formiga
- Geriatric Unit, Internal Medicine Service, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - David Chivite
- Geriatric Unit, Internal Medicine Service, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Domingo Ruiz
- Geriatric Unit, Internal Medicine Service, Hospital Sant Pau, IDIBAPS, Barcelona, Spain
| | - Margarita Navarro
- Geriatric Unit, Internal Medicine Service, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - J M Perez Castejon
- Geriatric Unit, Hospital Sociosanitari Isabel Roig (Centres Blauclinic), Barcelona, Spain
| | - Enric Duaso
- Geriatric Service, Hospital d'Igualada, Consorci Santiàri de l'Anoia, Barcelona, Spain
| | - Abelardo Montero
- Geriatric Unit, Internal Medicine Service, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Alfonso Lopez-Soto
- Geriatric Unit, Internal Medicine Service, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Xavier Corbella
- Geriatric Unit, Internal Medicine Service, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Albert Jovell Institute for Public Health and Patients, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
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Formiga F, Gómez-Huelgas R, Rodríguez Mañas L. [Differential characteristics of type 2 diabetes in the elderly. Role of dipeptidyl peptidase 4 inhibitors]. Rev Esp Geriatr Gerontol 2015; 51:44-51. [PMID: 26073221 DOI: 10.1016/j.regg.2015.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 04/21/2015] [Indexed: 12/30/2022]
Abstract
The prevalence of type 2 diabetes mellitus increases with age, reaching rates around 30% in those over 75 years. The type 2 diabetes mellitus in the elderly has different pathophysiological and clinical characteristics from those of the younger diabetic patient. Some differential aspects in this population are the lower life expectancy and the frequent comorbidity, frailty and associated disability. Avoiding hypoglycemia is a therapeutic priority, given their increased risk of severe hypoglycemia. It is a situation in which the benefits of intensive glycemic control are virtually non-existent, thus prevention of side effects of treatments becomes a priority. Therefore, the goals of glycemic control should be less stringent than in the general population (glycated hemoglobin>7%), and the drugs of choice should be those with a low risk of side effects (especially hypoglycemia) and well tolerated. Dipeptidyl peptidase 4 inhibitors (iDPP4) are particularly useful in this age group, either as a second drug added to metformin monotherapy, or as first line when metformin is contraindicated or not tolerated. In this article the evidence available on the efficacy and tolerance of different pharmacological options available in population over 70 years is reviewed.
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Affiliation(s)
- Francesc Formiga
- Programa de Geriatría, Servicio de Medicina Interna, Hospital Universitari de Bellvitge, IDIBELL, ĹHospitalet de Llobregat, Barcelona, España.
| | - Ricardo Gómez-Huelgas
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Málaga, España
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Formiga F, Rodríguez Mañas L. [Diabetes, depression and dementia. Three interrelated «d's» in the elderly]. Rev Esp Geriatr Gerontol 2015; 50:107-108. [PMID: 25725902 DOI: 10.1016/j.regg.2015.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 01/22/2015] [Indexed: 06/04/2023]
Affiliation(s)
- Francesc Formiga
- Programa de Geriatría, Servicio de Medicina Interna, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España.
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