Multiple Antihyperglycemic Drug Use is Associated with Undernutrition Among Older Adults with Type 2 Diabetes Mellitus: A Cross-Sectional Study

Abstract

Introduction Undernutrition is prevalent in older age. Current management of type 2 diabetes mellitus (T2DM) requires modified diet patterns; however, older adults with diabetes may also be at the risk of undernutrition due to age, disease, and medication-related factors. Our objectives in this study were to examine the proportion and associations of undernutrition among community-dwelling older adults with T2DM. Methods This prospective, cross-sectional study involved older outpatient adults (≥ 65 years) with and without T2DM. We assessed the nutritional status using the Mini Nutritional Assessment-Short Form. Undernutrition referred to being either at risk of malnutrition or malnourished. Variables independently associated with undernutrition were evaluated by logistic regression analysis. Results Five hundred forty-six older adults [ n = 215 with T2DM and n = 331 control; mean (SD) age, 74.9 (6.3) years; 388 (71.1%) female] were included in the study. The frequency of undernutrition was 31.1%, which was higher in patients with T2DM than in those without (36.7% vs. 27.5%, p < 0.05). However, the difference was no longer significant after adjustment for covariates (gender, lower education, lower body mass index, cardiovascular disease, multimorbidity, cognitive performance, functional performance, depressive symptoms, and polypharmacy). In the T2DM group, the ratio of multiple antihyperglycemic drug use (≥ 2) was higher in those with undernutrition compared with normal nutritional status (78.5% vs. 59.6%, p = 0.005). On multivariable analysis, decreased functional performance, depressive symptoms, and use of multiple antihyperglycemic drugs were associated with undernutrition in patients with T2DM. Conclusions Undernutrition was more common among older adults with T2DM compared with the control group. Undernutrition was further dependent on chronic conditions and diabetes management.

Association between glycaemic control and malnutrition in older adults with type 2 diabetes mellitus: a cross-sectional study

“…However, functional ability (both basic and instrumental ADL) was correlated with MNA scores ( 65 ) . However, unlike previous research ( 51 , 66 ) , no association was found between these factors and poor nutrition in the current study. This disparity could be due to differences in the measures and tools used to assess functional capacity between this and previous studies.…”

“…Vischer et al ( 19 ) reported a positive association between MNA scores and HbA1c levels but focused on older patients with T2DM admitted to a geriatric hospital, unlike our outpatient clinic cohort. Junaid et al ( 9 ) and Tasci et al ( 51 ) showed that older adults with poorly controlled diabetes had an increased risk of poor nutritional status (50–88 %), whereas the present study found a lower prevalence of poor nutrition (15·0 %) and malnutrition (0·03 %). The main difference lies in the criteria for categorising patients into the adequate alchemically controlled group.…”

“…Cognitive impairment can affect eating habits, food preparation and disorders of chewing or swallowing ( 60 ) . However, some studies did not find similar correlation because of variations in the levels of cognitive impairment and its effects on nutritional status ( 51 , 61 ) .…”

The Frequency of Malnutrition in Patients with Type 2 Diabetes

“…In a study including 2329 geriatric patients hospitalized in Belgium, malnutrition was detected in 31% of the diabetic patients 17 . Although nutritional evaluation studies conducted with outpatients are rarely cited in the literature, in a study conducted by İlker Taşci et al 7 in our country, undernutrition was more common among older patients with type 2 diabetes. NRS scores of our patients with lower education levels were higher than those with higher education levels.…”

“…In a study conducted at Istanbul University, malnutrition risk was 31% and malnutrition rate was 13% in patients who were admitted to the outpatient clinic, whereas malnutrition risk was determined as 39% and malnutrition rate as 25% in hospitalized patients 5 , 6 . In another study, it was found that malnutrition is a common nutritional problem in older outpatient adults 7 . In a study conducted in Turkey, it was reported that the prevalence of malnutrition increases especially with age, making management of diabetes difficult 8 .…”