Nutritional Status and Dietary Management of Elderly Diabetic Patients

Malnutrition in elderly patients with type 2 diabetes mellitus in a Nigerian tertiary hospital: A cross-sectional study

Introduction

The global population of the elderly with type 2 diabetes mellitus (T2DM) is growing due to improvement in DM care and increased life expectancy. Malnutrition is a recognized complication of DM especially in the elderly. However, despite the impact of malnutrition on the overall outcome of the elderly with DM, it has not received adequate attention.

Aim

To determine the prevalence of malnutrition and associated factors in the elderly with T2DM.

Methods

This was a cross-sectional study that involved 96 elderly with T2DM and 96 age and sex matched elderly without T2DM as controls. Malnutrition was assessed using mini-nutritional assessment-short form (MNA-SF), hypoalbuminemia and body mass index (BMI). The factors associated with some malnutrition indices were determined.

Results

The mean age of T2DM and non-T2DM groups were 66.73 ± 5.18 years and 66.78 ± 5.25 years respectively. The observed malnutrition indices among elderly with T2DM and controls were hypoalbuminemia (79.2% vs 25.0%; P ≤0.001); overweight and obesity (58.3% vs 24.0%); and underweight (16.7% vs 4.2%). According to MNA-SF, malnutrition (7.3% vs 0%) and at risk of malnutrition (42.7% vs 16.7%) were significantly more prevalent among elderly with T2DM compared to controls (P ≤0.001). On logistic regression, the significant predictors of malnutrition were male gender (AOR:2.70; CI:1.11-6.55; P = 0.028) and albuminuria (AOR:3.14; CI:1.18-8.35; P = 0.022) and poor glycemic control (AOR:7.05; CI:2.01-24.71; P = 0.002).

Conclusion

Malnutrition is highly prevalent in elderly with T2DM. Poor glycemic control, albuminuria and male gender were significant predictors of malnutrition in this study. Nutritional assessment should be included in the routine DM care especially among the elderly.

Evidence-Based Management of Diabetes in Older Adults

The number of older adults with diabetes is rapidly increasing worldwide. A variety of factors contribute to the age-related increase in the incidence of diabetes. The lack of empiric evidence in the field has limited the management guidelines to mostly expert opinion. Given uncertainty over the rate at which to lower blood glucose levels and the optimal method of doing so, the goals of diabetes control in older people must be individualized. If the patient requires insulin therapy, the newer insulins, with their improved pharmacodynamic consistency and reduced risk of hypoglycemia, should be preferred. Several oral agents are preferable for people with sufficient endogenous insulin because they do not cause hypoglycemia when used as monotherapy. Some of these oral agents have been found to have cardioprotective effects. Older people with diabetes also require management of the other risk factors for cardiovascular disease, with antihypertensive drugs, cholesterol-lowering agents and low-dose aspirin. However, the precise targets for blood pressure control and low-density lipoprotein (LDL) cholesterol levels continue to evolve as more data become available. Diabetes care in older adults should focus on enhancing the individual's quality of life rather than trying to normalize blood glucose levels or reach predetermined blood pressure and LDL cholesterol targets.

The relationship between nutritional status, functional capacity, and health-related quality of life in older adults with type 2 diabetes: a pilot explanatory study

OBJECTIVE

To explore the relationship between nutritional status, functional capacity and health-related quality of life (HRQoL) in older adults with type 2 diabetes (T2DM).

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

Forty two non-insulin dependent older adults from a primary care center in Seville, Spain.

MEASUREMENTS

Function was assessed with a battery of standardized physical fitness tests. Nutritional status was assessed using the Mini Nutritional Assessment (MNA) and the European Quality of Life Questionnaire (EQ-5D-3L) was used to assess HRQoL.

RESULTS

There was an association between MNA-nutritional status and lower body strength as assessed by the chair sit-stand test (rho= .451; p= .037) and between MNA-nutritional status and EQ-5D-3L-HRQoL (EQ-5D-3Lutility, rho= .553; p<.001 and EQ-5D-3LVAS rho= .402; p<.001). An MNA item by item correlation analysis with HRQoL and lower limb strength demonstrated that HRQoL appears to be related to functional capacity (principally lower body strength, motor agility and cardiorespiratory fitness) among participants. These results were maintained when correlations were adjusted for co-morbidity.

CONCLUSION

Our results demonstrated that nutritional status is moderately associated with HRQoL and lower limb strength in patients with T2DM. Our data suggest that more emphasis should be placed on interventions to encourage a correct diet and stress the needed to improve lower body strength to reinforce better mobility in T2DM population.

Dietary prescription in diabetes mellitus

No one specific diet is recommended by the ADA for the management of diabetes. The prescribed diet should be based on nutritional assessment, treatment goals, and desired outcome. The nutritional therapy should be individualized to meet the patient's nutritional requirements. Glycemic control should be maintained by monitoring metabolic parameters, adjusting medication, and patient education.