The Giant Geriatric Syndromes Are Intensified by Diabetic Complications

A predictive model for hyperuricemia among type 2 diabetes mellitus patients in Urumqi, China

BACKGROUND

Patients with type 2 diabetes Mellitus (T2DM) are more likely to suffer from a higher uric acid level in blood-hyperuricemia (HUA). There are no conclusive studies done to predict HUA among T2DM patients. Therefore, this study aims to explore the risk factors of HUA among T2DM patients and finally suggest a model to help with its prediction.

METHOD

In this retrospective research, all the date were collected between March 2017 and October 2019 in the Medical Laboratory Center of the First Affiliated Hospital of Xinjiang Medical University. The information included sociodemographic factors, blood routine index, thyroid function indicators and serum biochemical markers. The least absolute shrinkage and selection operator (LASSO) and multivariate binary logistic regression were performed to screen the risk factors of HUA among T2DM patients in blood tests, and the nomogram was used to perform and visualise the predictive model. The receiver operator characteristic (ROC) curve, internal validation, and clinical decision curve analysis (DCA) were applied to evaluate the prediction performance of the model.

RESULTS

We total collected the clinical date of 841 T2DM patients, whose age vary from 19-86. In this study, the overall prevalence of HUA in T2DM patients was 12.6%. According to the result of LASSO-logistic regression analysis, sex, ethnicity, serum albumin (ALB), serum cystatin C (CysC), serum inorganic phosphorus (IPHOS), alkaline phosphatase (ALP), serum bicarbonate (CO2) and high-density lipoprotein (HDLC) were included in the HUA risk prediction model. The nomogram confirmed that the prediction model fits well (χ2 = 5.4952, P = 0.704) and the calibration curve indicates the model had a good calibration. ROC analysis indicates that the predictive model shows the best discrimination ability (AUC = 0.827; 95% CI: 0.78-0.874) whose specificity is 0.885, and sensitivity is 0.602.

CONCLUSION

Our study reveals that there were 8 variables that can be considered as independent risk factors for HUA among T2DM patients. In light of our findings, a predictive model was developed and clinical advice was given on its use.

Pilot Study on the Relationship between Malnutrition and Grip Strength with Prognosis in Diabetic Foot

Sarcopenia and malnutrition have been associated in the elderly population with a poor prognosis in wound healing and with other adverse events, such as institutionalization or functional impairment. However, it is not known how these factors influence the prognosis of diabetic foot in the elderly. To answer this question, a prospective observational study of 45 patients over 65 years of age admitted with diagnoses of diabetic foot in a tertiary hospital has been conducted. All patients were assessed at admission and at 3 months after returning home to determine quality of life, pain, mobility and healing, overall hospital stay in relation to the presence of malnutrition (measured by BMI, CIPA scale and analytical parameters at admission of serum proteins and albumin), and sarcopenia measured by grip force, among other geriatric syndromes. The results found a relationship between altered sarcopenia and more pain and poorer quality of life, and altered BMI was related to a lower cure rate and worse mobility at follow-up. This study seems to indicate that, in the elderly population with diabetic foot, malnutrition and sarcopenia should be managed at the same time as the treatment of the diabetic foot itself.

Undernutrition and associated factors among elderly people served in Public Servants Social Security Agency in Harar, Eastern Ethiopia

Objective:

Undernutrition in the elderly has adverse effects on physiological functions and various clinical outcomes. In Ethiopia, similar to many developing countries, there is a dearth of epidemiological data on the nutritional status of the elderly. This study aimed to assess the magnitude of undernutrition and associated factors among the elderly population enrolled in the Public Servants Social Security Agency in Harar, eastern Ethiopia.

Method:

A cross-sectional study was carried out among 337 elderly adults from June to August 2020. The Mini Nutritional Assessment Tool Short Form assessed the nutritional status of the elderly. Data were entered in Epi Data software version 3.1 and transferred to SPSS version 20 for analysis. Ordinal logistic regression assessed factors associated with undernutrition, using variables with a p value less than 0.05 as statistically significant.

Result:

The magnitude of undernutrition was 16.6% and 45.1% were at risk of undernutrition. Being unable to read and write (odds ratio (OR) = 3.64; 95% confidence interval (CI), 1.98–6.72), elderly with morbidities (OR = 2.05; 95% CI, 1.15–3.64), low dietary diversity score (OR = 3.52; 95% CI, 1.63–7.60), and elderly who were food insecure (OR = 0.59; 95% CI, 0.37–0.95) were significantly associated with undernutrition.

Conclusion:

The magnitude of undernutrition among the elderly is a public health issue. Independent predictors include educational status, morbidity, dietary diversity, and food insecurity. Intervention programs need to focus on the elderly’s nutrition, access to healthy foods, and other health issues.

Person-Centered Medication Therapy for Diabetes in Older Adults: A Practical Review

Diabetes is one of the most common disease states in older adults and there are significant risks to the use of antidiabetic medications. The older adult population varies greatly in functional ability, independence, and cognition. These factors, along with increased risk of hypoglycemia, falls, and other comorbidities, add to the complexity of creating medication regimens to treat diabetes in older adults. In the current review, a person-centered approach to diabetes care in older adults is described to aid clinician decision making. By keeping the patient and their individual factors in the center of the decision, risks of over- or under-treating diabetes can be minimized. The review will discuss person-centered goal setting, practical approaches to diabetes medication management, and specific considerations for choosing medication classes based on patient characteristics. [Journal of Gerontological Nursing, 47(10), 7-13.].

Do Long-Term Complications of Type 2 Diabetes Increase Susceptibility to Geriatric Syndromes in Older Adults?

Background and Objectives: Type 2 diabetes is one of the common chronic diseases in the elderly. It is thought that long-term complications of type 2 diabetes will negatively affect the quality of life in elderly individuals. It is possible that geriatric syndromes, especially frailty syndrome, are associated with diabetic complications, too. In this study, we aimed to evaluate the effect of macrovascular and microvascular complications of type 2 diabetes on frailty and other geriatric syndromes. In addition, the effect of these complications on quality of life was also reviewed. Materials and Methods: We conducted a cross-sectional study for four months. Comprehensive geriatric assessment tests were done on all patients. The Fried frailty index (FFI) was used for the evaluation of frailty syndrome. We assessed malnutrition by mini nutritional assessment short-form (MNA-SF), and Global Leadership Initiative on Malnutrition criteria (GLIM). The EWGSOP 2 criteria were used for the diagnosis of sarcopenia. Quality of life (QoL) was evaluated using the short form-36 (SF-36) questionnaire. Data analysis was done by SPSS version 22. Results: 237 females and 142 males with a mean age of 71.7 ± 6.1 years were included in the study. The frequency of macrovascular and microvascular complications was 41.4% and 68.1%, respectively. Frailty was found to be associated with macrovascular complications (p = 0.003). Handgrip strength, skeletal muscle mass index, and gait speed were decreased in the presence of macrovascular complications (p = 0.043, p < 0.001, p < 0.001). QoL was also decreased in patients with macrovascular complications (p = 0.003). Nutritional status and handgrip strength were negatively affected in patients with diabetic neuropathy (p = 0.019, p = 0.014). Polypharmacy was also found to be associated with macrovascular complications (p < 0.001, p < 0.001). Macrovascular complications were 2.5 times more common in malnourished patients according to GLIM and 3.2 times more common in patients with decreased gait speed. Conclusion: In this study, we observed that both macrovascular and microvascular complications of diabetes increase susceptibility to geriatric syndromes in elderly individuals. It could be useful to conduct prospective studies in which we can compare the effectiveness of treatment methods on this subject.

Malnutrition among the Elderly in Malaysia and Its Associated Factors: Findings from the National Health and Morbidity Survey 2018

Background

Malaysia is predicted to become an ageing population by 2035. Malnutrition among the elderly is one of growing concern. This study aims to identify the prevalence of malnutrition and its associated factors among the elderly in Malaysia.

Methods

Data from the National Health and Morbidity Survey (NHMS) 2018 was analysed. This survey applied a multistage stratified cluster sampling design to ensure national representativeness. Malnutrition was identified using a validated Mini Nutrition Assessment-Short Form (MNA-SF). Variables on sociodemographic, health status, and dietary practices were also obtained. The complex sampling analysis was used to determine the prevalence and associated factors of at-risk or malnutrition among the elderly.

Result

A total of 3,977 elderly completed the MNA-SF. The prevalence of malnutrition and at-risk of malnutrition was 7.3% and 23.5%, respectively. Complex sample multiple logistic regression found that the elderly who lived in a rural area, with no formal or primary level of education, had depression, Instrumental Activity of Daily Living (IADL) dependency, and low quality of life (QoL), were underweight, and had food insecurity and inadequate plain water intake were at a significant risk of malnutrition (malnutrition and at-risk), while Chinese, Bumiputra Sarawak, and BMI more than 25 kgm^-2 were found to be protective.

Conclusions

Currently, three out of ten elderly in Malaysia were at-risk or malnutrition. The elderly in a rural area, low education level, depression, IADL dependency, low QoL, underweight, food insecurity, and inadequate plain water intake were at risk of malnutrition in Malaysia. The multiagency approach is needed to tackle the issue of malnutrition among the elderly by considering all predictors identified from this study.