Hypoglycemic episodes are associated with an increased risk of incident frailty among new onset diabetic patients

Chao, Chia-Ter; Wang, Jui; Chan, Ding‐Cheng; Chien, Kuo‐Liong

doi:10.1016/j.jdiacomp.2019.107492

Cited by 20 publications

(14 citation statements)

References 37 publications

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“…Frailty is a degenerative phenotype occurring in conjunction with chronological aging, in the form of cumulative subclinical health deficits as well as a compromised physical capacity (1). Older adults are the most severely affected population; moreover, the construct of frailty has now been deemed applicable to those with premature aging phenotypes such as patients with diabetes mellitus (DM), chronic inflammation, and chronic kidney disease (CKD) (2). The presence of frailty is predictive of a substantially elevated risk of adverse outcomes, including mortality, hospitalization, institutionalization, incident disability, and even cardiovascular events (3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

Elevated Red Cell Distribution Width Is Independently Associated With a Higher Frailty Risk Among 2,932 Community-Dwelling Older Adults

Chao

Chen

et al. 2020

Front. Med.

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Background: Older adults are at an increased risk of frailty, but laboratory surrogates for identifying frailty in this population remain controversial and clinicians frequently encounter difficulty during frailty screening. We examined whether having a high red cell distribution width (RDW) was associated with an increased probability of frailty in older adults. Methods: We prospectively included community-dwelling older adults between 2013 and 2016 from a single institute, with their clinical features/laboratory parameters documented. We used the Study of Osteoporotic Fractures index (malnutrition, poor physical performance, and fatigue) to delineate frailty, and harnessed multiple logistic regression to investigate whether having a high RDW (≥ 15.7%) was associated with an increased risk of having frailty among these participants. Results: A total of 2,932 older adults (mean 73.5 ± 6.7 years; 44.6% male) were included, among whom 113 (3.9%) and 76 (2.6%) had a high RDW and presented frailty, respectively. Older adults with a high RDW were more likely to be frail (p = 0.002) and had more positive SOF items than those with normal RDW levels (p = 0.013). Those with a high RDW exhibited a significantly higher risk of having frailty (odds ratio [OR] 2.689, 95% confidence interval [CI] 1.184-6.109) compared to those without. Sensitivity analyses using RDW as a continuous variable similarly showed that RDW levels were positively associated with frailty risk (OR 1.223 per 1% RDW higher). Conclusions: In older adults, higher RDW can be regarded as a frailty indicator, and the readiness in RDW assessment supports its screening utility.

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Section: Introductionmentioning

confidence: 99%

Elevated Red Cell Distribution Width Is Independently Associated With a Higher Frailty Risk Among 2,932 Community-Dwelling Older Adults

Chao

Chen

et al. 2020

Front. Med.

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“…Strategies aiming to ameliorate frailty, including nutritional care, rehabilitation programs, and exercise sessions, may be harnessed to reduce the probability of developing appetite impairment among patients with CKD [ 31 , 32 , 33 ]. Several risk factors for frailty have been uncovered by our group before, serving as a guide for potential therapeutic targets [ 34 , 35 , 36 ]. In addition, other geriatric phenotypic clusters, such as multimorbidity and cognitive impairment, may also influence the association between frailty and appetite impairment in this study [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

Independent Determinants of Appetite Impairment among Patients with Stage 3 or Higher Chronic Kidney Disease: A Prospective Study

2021

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Protein-energy wasting (PEW) is an important complication resulting from chronic kidney disease (CKD). Appetite impairment contributes significantly to PEW in these patients, but risk factors associated with having appetite impairment in patients with CKD remain elusive. Patients with an estimated glomerular filtration rate <60 mL/min/1.73 m2 for ≥2 times at least three months apart were prospectively enrolled during 2017, with their demographic features, comorbidities, anthropometric parameters, physical and performance indices, functional status, frailty, sensory organ integrity, and laboratory data collected. Their appetite status was measured using the Council on Nutrition Appetite Questionnaire (CNAQ). We examined independent determinants of appetite impairment in these CKD patients using multiple regression analyses. Among 78 patients with CKD, 42.3% had CNAQ-identified impaired appetite. Those with an impaired appetite also had poorer physical performance, a higher degree of functional impairment, higher frail severities, lower serum sodium levels, less intact oral cavity, and a trend toward having less intact nasal structures than those without. Multiple regression analyses revealed that a higher frail severity, in the forms of increasing Study of Osteoporotic Fractures (SOF) scores (odds ratio (OR), 2.74; 95% confidence interval (CI), 1.15–6.57) and a less intact nasal structure (OR, 0.96; 95% CI, 0.92–0.995) were associated with a higher probability of having an impaired appetite, while higher serum sodium (OR, 0.76; 95% CI, 0.6–0.97) correlated with a lower probability. Based on our findings, in patients with CKD, the severity of frailty, serum sodium, and nasal structural integrity might modify appetite status. Therapies targeting these factors might be beneficial for appetite restoration in patients with CKD.

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“…33 Our previous work also suggested that hypoglycaemic episodes, frequently related to anti-diabetic treatments, increased the risk of developing frailty among patients with diabetes mellitus. 34 It is likely that physicians tend to loosen the intensity of glycaemic control through deprescribing antidiabetic medications due to the adverse influences posed by these medications. This may be responsible for the observed lower prevalence of anti-diabetic medications among those with greater frailty.…”

Section: Discussionmentioning

confidence: 99%

Frailty is associated with a higher risk of developing delirium and cognitive impairment among patients with diabetic kidney disease: A longitudinal population‐based cohort study

et al. 2021

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Aims: Delirium, a form of acute brain failure, exhibits a high incidence among older adults. Recent studies have implicated frailty as an under-recognized complication of diabetes mellitus. Whether the presence of frailty increases the risk of delirium/cognitive impairment among patients with diabetic kidney disease (DKD) remains unclear. Methods: From the longitudinal cohort of diabetes patients (LCDP) (n = 840,000) in Taiwan, we identified adults with DKD, dividing them into those without and with different severities of frailty based on a modified FRAIL scale. Cox proportional hazard regression was utilized to examine the frailty-associated risk of delirium/cognitive impairment, identified using approaches validated by others. Results: Totally 149,145 patients with DKD (mean 61.0 years, 44.2% female) were identified, among whom 31.0%, 51.7%, 16.0% and 1.3% did not have or had 1, 2 and >2 FRAIL items at baseline. After 3.68 years, 6613 (4.4%) developed episodes of delirium/cognitive impairment. After accounting for demographic/lifestyle factors, co-morbidities, medications and interventions, patients with DKD and 1, 2 and >2 FRAIL items had a progressively higher risk of developing delirium/cognitive impairment than those without (for those with 1, 2 and >2 items, hazard ratio 1. 18, 1.26

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Hypoglycemic episodes are associated with an increased risk of incident frailty among new onset diabetic patients

Cited by 20 publications

References 37 publications

Elevated Red Cell Distribution Width Is Independently Associated With a Higher Frailty Risk Among 2,932 Community-Dwelling Older Adults

Elevated Red Cell Distribution Width Is Independently Associated With a Higher Frailty Risk Among 2,932 Community-Dwelling Older Adults

Independent Determinants of Appetite Impairment among Patients with Stage 3 or Higher Chronic Kidney Disease: A Prospective Study

Frailty is associated with a higher risk of developing delirium and cognitive impairment among patients with diabetic kidney disease: A longitudinal population‐based cohort study

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