Kidney Function and Risk of Physical and Cognitive Impairment in Older Persons with Type 2 Diabetes at an Outpatient Clinic with Geriatric Assessment Implementation

Abstract

Purpose: Diabetes is associated with an increased risk of cognitive and physical functional decline that may impede disease self-management. By incorporating cognitive and physical function assessment, this study aimed to evaluate prevalence and factors associated with cognitive and physical dysfunction in older diabetic people. Methods: The cross-sectional study was performed from August 1, 2017 to November 30, 2018. The patients aged 65 years or older with type 2 diabetes mellitus were enrolled and the disease was routinely evaluated by blood hemoglobin A1c (A1C), blood pressure, lipids, and kidney function measured by estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine rate (UACR). Besides, cognitive dysfunction through Mini-mental State Examination (MMSE), and functional disabilities by Activities of Daily Living (ADL) questionnaire were assessed simultaneously. Results: Among 863 patients (48.3% men) with a median age of 72.0 years (interquartile range or IQR: 67.0-78.0 years), 159 (18.5%) had cognitive impairment assessed by MMSE, while 40 (4.6%) experienced at least one problem in ADL. With different A1C stratifications, it was shown that both MMSE and ADL scores were associated with glycemic control. Patients with impaired MMSE and ADL scores were older, had lower eGFR, lower blood pressure, and higher UACR levels. After adjustment of possible confounders, it was shown that age and eGFR predicted MMSE and ADL score impairment. Conclusion: By incorporating physical and cognitive function screening program into routine care at a diabetes outpatient clinic, our study found that both cognitive and physical function impairment were common in older diabetic patients, and their relevant factors, including older age, and lower eGFR. It was recommended that in older individuals with diabetes, particularly those with risk factors, an additional assessment of cognitive and physical functions can be integrated into routine clinical process to provide more comprehensive management plans.

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“…In disease states, abnormalities in any of these systems can initiate and perpetuate structural and functional dysfunction in other organs. Not surprisingly, renal impairment, abnormalities in mineral-bone metabolism, numerous diseases encompassing T2DM, CAD, hypertension, heart failure, anaemia, dementia, COPD, etc., activate each other (via the autocrine, paracrine and nervous systems), creating metabolic dysregulation and vicious cycles of damage [11,27,78,79], leading to multimorbidity (i.e., renal osteodystrophy [80], cardiorenal syndrome [81], brainkidney axis/cross-talk [82][83][84][85][86][87]; CKD-COPD interaction [78,88]) which is strongly associated with falls and fractures (Figure 2). Clearly, in the elderly multiple chronic diseases, falls and fractures are competing events that cluster, and CKD is a risk factor for abovementioned conditions, death, and other adverse outcomes.…”

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