Malnutrition in older patients with type 2 diabetes is associated with increased frailty

INTRODUCTION. Type 2 diabetes may be associated with malnutrition. This study explored the relationship between this association and frailty features in older patients. METHODS. Cross-sectional study among 172 older diabetic patients (83±4 years; sex ratio 1:1) admitted in a Belgian teaching hospital (2012-2013). Included patients had old age (≥75 years), type 2 diabetes mellitus, risk of functional decline (ISAR≥2) and comprehensive geriatric assessment including a short mini-nutritional assessment (MNA-SF, range 0-14). We compared the patients with malnutrition (MNA-SF ≤ 7/14) to those without malnutrition, using appropriate statistics (chi² and t-tests). RESULTS. The 44 diabetic patients with malnutrition (MNA-SF 5.8±1.6) - as compared to the 128 ones without malnutrition (MNA-SF 10.7±1.7) - were similar in age, gender, co-morbidities (e.g. hypertension 78%, ischaemic disease 62%, grade IV-V renal failure 22%) and common geriatric syndromes (e.g. multiple falls 49%, chronic pain 34%, visual impairment 33%, cognitive decline 32%). Diabetic patients with malnutrition more frequently presented with HbA1c 3/6: 54vs.34%), nursing home residency (36vs.10%) and high risk of functional decline (ISAR ≥ 4: 70vs.46%). Their mortality rate in January 2014 was also higher (34vs.19%, p=0.05). CONCLUSIONS. Malnutrition was present in 1 in 4 older patients with diabetes mellitus. This subgroup of patients with diabetes and malnutrition deserves increased medical attention, as it shows higher prevalence of inappropriately low HbA1c, as well as higher risk of functional decline and mortality