Tasci Ilker, Safer Umut, Naharci Mehmet Ilkin
Department of Internal Medicine, University of Health Sciences, Gulhane Faculty of Medicine, Ankara, Turkey.
Department of Internal Medicine, Turkish Ministry of Health, Gulhane Training and Research Hospital, Ankara, Turkey.
Diabetes Ther. 2019 Jun;10(3):1005-1018. doi: 10.1007/s13300-019-0602-x. Epub 2019 Mar 28.
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.
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.
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.
Undernutrition was more common among older adults with T2DM compared with the control group. Undernutrition was further dependent on chronic conditions and diabetes management.
营养不良在老年人中普遍存在。2型糖尿病（T2DM）的当前管理需要调整饮食模式；然而，患有糖尿病的老年人也可能由于年龄、疾病和药物相关因素而面临营养不良的风险。我们在本研究中的目的是调查社区居住的T2DM老年人群中营养不良的比例及其相关因素。
这项前瞻性横断面研究纳入了年龄≥65岁的患有和未患有T2DM的老年门诊患者。我们使用简易营养评估简表评估营养状况。营养不良是指存在营养不良风险或已出现营养不良。通过逻辑回归分析评估与营养不良独立相关的变量。
本研究共纳入546名老年人[n = 215名T2DM患者和n = 331名对照者；平均（标准差）年龄为74.9（6.3）岁；388名（71.1%）为女性]。营养不良的发生率为31.1%，T2DM患者中的发生率高于非T2DM患者（36.7%对27.5%，p < 0.05）。然而，在对协变量（性别、低教育水平、低体重指数、心血管疾病、多种疾病共存、认知功能、功能状态、抑郁症状和多种药物使用）进行调整后，差异不再显著。在T2DM组中，与营养正常者相比，营养不良者使用多种降糖药物（≥2种）的比例更高（78.5%对59.6%，p = 0.005）。多变量分析显示，功能状态下降、抑郁症状以及使用多种降糖药物与T2DM患者的营养不良有关。
与对照组相比，T2DM老年患者中营养不良更为常见。营养不良还进一步取决于慢性疾病和糖尿病管理情况。
