Frailty: An Important Determinant Influencing Glycaemic Control in Elderly Chinese Patients Diagnosed With Type 2 Diabetes
Lei Cao
Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
Search for more papers by this authorShuang-shuang Chen
Medical Administration Office, Zhongshan Hospital, Fudan University, Shanghai, China
Search for more papers by this authorQing Xu
Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
Search for more papers by this authorCan Chen
Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
Search for more papers by this authorQian-zhou Lv
Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
Search for more papers by this authorCorresponding Author
Xiao-mu Li
Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
Correspondence:
Xiao-mu Li ([email protected])
Xiao-yu Li ([email protected])
Search for more papers by this authorCorresponding Author
Xiao-yu Li
Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
Correspondence:
Xiao-mu Li ([email protected])
Xiao-yu Li ([email protected])
Search for more papers by this authorLei Cao
Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
Search for more papers by this authorShuang-shuang Chen
Medical Administration Office, Zhongshan Hospital, Fudan University, Shanghai, China
Search for more papers by this authorQing Xu
Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
Search for more papers by this authorCan Chen
Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
Search for more papers by this authorQian-zhou Lv
Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
Search for more papers by this authorCorresponding Author
Xiao-mu Li
Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
Correspondence:
Xiao-mu Li ([email protected])
Xiao-yu Li ([email protected])
Search for more papers by this authorCorresponding Author
Xiao-yu Li
Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
Correspondence:
Xiao-mu Li ([email protected])
Xiao-yu Li ([email protected])
Search for more papers by this authorFunding: This work was supported by the Shanghai Municipal Key Clinical Specialty (shslczdzk06504) and the Zhongshan Hospital Research Project (2023ZSFZ07).
Lei Cao, Shuangshuang Chen and Qing Xu contributed equally to this study.
ABSTRACT
Few studies have investigated blood glucose levels and complication management in elderly patients with type 2 diabetes (T2D) at community hospitals in China. The objective of this study was to investigate the factors influencing blood glucose control in elderly patients with T2D. One thousand one hundred and fifty elderly patients (age ≥ 65 years) with T2D were involved in the study to assess blood glucose control, health status (including comorbidities and cognitive status), complication management, and adherence to medication according to the guidelines of the American Diabetes Association. The FRAIL scale was used to screen for frailty syndrome in the elderly patients. Univariate and multivariate logistic regression analyses were used to investigate the factors affecting glucose control. Among the 1150 participants, 351 (30.52%) had poor glucose control. Frailty (odds ratio [OR]:2.546; 95% confidence interval [CI]: 1.267–5.117; p = 0.009), male sex (OR:0.679; 95% CI: 0.522–0.884; p = 0.004), and insulin treatment (OR: 0.229; 95% CI: 0.165–0.317; p < 0.001) were significantly independently associated with poor blood glucose control. In conclusion, for elderly patients with T2D, more attention should be paid to men, insulin therapy initiation and screening for frailty.
Conflicts of Interest
The authors declare no conflicts of interest.
Open Research
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
References
- 1 Association AD, “Economic Costs of Diabetes in the U.S. in 2017,” Diabetes Care 41, no. 5 (2018): 917–928, https://doi.org/10.2337/dci18-0007.
- 2A. H. Heald, M. Stedman, M. Davies, et al., “Estimating Life Years Lost to Diabetes: Outcomes From Analysis of National Diabetes Audit and Office of National Statistics Data,” Cardiovascular Endocrinology & Metabolism 9, no. 4 (2020): 183–185.
- 3H. Sun, P. Saeedi, S. Karuranga, et al., “IDF Diabetes Atlas: Global, Regional and Country-Level Diabetes Prevalence Estimates for 2021 and Projections for 2045,” Diabetes Research and Clinical Practice 183 (2022): 109119.
- 4A. Coppola, L. Sasso, A. Bagnasco, A. Giustina, and C. Gazzaruso, “The Role of Patient Education in the Prevention and Management of Type 2 Diabetes: An Overview,” Endocrine 53, no. 1 (2015): 18–27.
- 5N. A. ElSayed, G. Aleppo, V. R. Aroda, et al., “2. Classification and Diagnosis of Diabetes: Standards of Care in Diabetes—2023,” Diabetes Care 46, no. S1 (2023): S19–S40.
- 6C. S. Fox, K. Matsushita, M. Woodward, et al., “Associations of Kidney Disease Measures With Mortality and End-Stage Renal Disease in Individuals With and Without Diabetes: A Meta-Analysis,” Lancet 380, no. 9854 (2012): 1662–1673.
- 7R. T. Gansevoort, R. Correa-Rotter, B. R. Hemmelgarn, et al., “Chronic Kidney Disease and Cardiovascular Risk: Epidemiology, Mechanisms, and Prevention,” Lancet 382, no. 9889 (2013): 339–352.
- 8Z. Marsh, Y. Teegala, and V. Cotter, “Improving Diabetes Care of Community-Dwelling Underserved Older Adults,” Journal of the American Association of Nurse Practitioners 34, no. 10 (2022): 1156–1166.
- 9C. C. McDaniel, W. H. Lo-Ciganic, K. B. Garza, J. Kavookjian, B. I. Fox, and C. Chou, “Medication Use and Contextual Factors Associated With Meeting Guideline-Based Glycemic Levels in Diabetes Among a Nationally Representative Sample,” Frontiers in Medicine 10 (2023): 1158454.
- 10B. Pitt, G. Filippatos, R. Agarwal, et al., “Cardiovascular Events With Finerenone in Kidney Disease and Type 2 Diabetes,” New England Journal of Medicine 385, no. 24 (2021): 2252–2263.
- 11A. J. Garber, Y. Handelsman, G. Grunberger, et al., “Consensus Statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the Comprehensive Type 2 Diabetes Management Algorithm—2020 Executive Summary,” Endocrine Practice 26, no. 1 (2020): 107–139.
- 12N. A. ElSayed, G. Aleppo, V. R. Aroda, et al., “13. Older Adults: Standards of Care in Diabetes—2023,” Diabetes Care 46, no. S1 (2023): S216–S229.
- 13R. L. Sudore, A. J. Karter, E. S. Huang, et al., “Symptom Burden of Adults With Type 2 Diabetes Across the Disease Course: Diabetes & Aging Study,” Journal of General Internal Medicine 27, no. 12 (2012): 1674–1681.
- 14 American Diabetes Association, “5. Lifestyle Management:Standards of Medical Care in Diabetes—2019,” Diabetes Care 42, no. S1 (2019): S46–S60.
- 15Y. Luo, J. Wang, L. Sun, et al., “Isocaloric-Restricted Mediterranean Diet and Chinese Diets High or Low in Plants in Adults With Prediabetes,” Journal of Clinical Endocrinology and Metabolism 107, no. 8 (2022): 2216–2227.
- 16E. Orwoll, “Endogenous Testosterone Levels, Physical Performance, and Fall Risk in Older Men,” Archives of Internal Medicine 166, no. 19 (2006): 2124–2131, https://doi.org/10.1001/archinte.166.19.2124.
- 17K. Mantantzis, J. Drewelies, S. Duezel, et al., “Poor Glucose Regulation Is Associated With Declines in Well-Being Among Older Men, but Not Women,” Psychology and Aging 35, no. 2 (2020): 204–211.
- 18L. Zolla, “On the Need to Distinguish Between Insulin-Normal and Insulin-Resistant Patients in Testosterone Therapy,” International Journal of Molecular Sciences 23, no. 21 (2022): 12730.
- 19D. M. Kelly and T. H. Jones, “Testosterone: A Metabolic Hormone in Health and Disease,” Journal of Endocrinology 217, no. 3 (2013): R25–R45, https://doi.org/10.1530/JOE-12-0455.
- 20R. A. Mekary, E. Giovannucci, W. C. Willett, R. M. van Dam, and F. B. Hu, “Eating Patterns and Type 2 Diabetes Risk in Men: Breakfast Omission, Eating Frequency, and Snacking,” American Journal of Clinical Nutrition 95, no. 5 (2012): 1182–1189.
- 21M. Uemura, H. Yatsuya, E. H. Hilawe, et al., “Breakfast Skipping is Positively Associated With Incidence of Type 2 Diabetes Mellitus: Evidence From the Aichi Workers' Cohort Study,” Journal of Epidemiology 25, no. 5 (2015): 351–358.
- 22K. Khunti, M. B. Gomes, S. Pocock, et al., “Therapeutic Inertia in the Treatment of Hyperglycaemia in Patients With Type 2 Diabetes: A Systematic Review,” Diabetes, Obesity and Metabolism 20, no. 2 (2017): 427–437.
- 23A. Ceriello, L. Monnier, and D. Owens, “Glycaemic Variability in Diabetes: Clinical and Therapeutic Implications,” Lancet Diabetes and Endocrinology 7, no. 3 (2019): 221–230.
- 24A. Zafar, M. A. Stone, M. J. Davies, and K. Khunti, “Acknowledging and Allocating Responsibility for Clinical Inertia in the Management of Type 2 Diabetes in Primary Care: A Qualitative Study,” Diabetic Medicine 32, no. 3 (2014): 407–413.
- 25M. E. Cleasby, P. M. Jamieson, and P. J. Atherton, “Insulin Resistance and Sarcopenia: Mechanistic Links Between Common Co-Morbidities,” Journal of Endocrinology 229, no. 2 (2016): R67–R81.
- 26T. Wang, X. Feng, J. Zhou, et al., “Type 2 Diabetes Mellitus is Associated With Increased Risks of Sarcopenia and Pre-Sarcopenia in Chinese Elderly,” Scientific Reports 6, no. 1 (2016): 38937, https://doi.org/10.1038/srep38937.
- 27E. Gielen, J. Dupont, M. Dejaeger, and M. R. Laurent, “Sarcopenia, Osteoporosis and Frailty,” Metabolism 145 (2023): 155638.
- 28S. Jung, Y. Lee, K. Kim, and S. Park, “Association of the Dietary Inflammatory Index With Sarcopenic Obesity and Frailty in Older Adults,” BMC Geriatrics 24, no. 1 (2024): 654.
- 29L. P. Fried, C. M. T., J. Walston, et al., “Frailty in Older Adults: Evidence for a Phenotype,” Journal of Gerontology 56A, no. 3 (2001): M146–M156.
10.1093/gerona/56.3.M146 Google Scholar
- 30C. W. Bales and C. S. Ritchie, “Sarcopenia, Weight Loss, and Nutritional Frailty in the Elderly,” Annual Review of Nutrition 22, no. 1 (2002): 309–323, https://doi.org/10.1146/annurev.nutr.22.010402.102715.
- 31Y. Yan, T. Wu, M. Zhang, C. Li, Q. Liu, and F. Li, “Prevalence, Awareness and Control of Type 2 Diabetes Mellitus and Risk Factors in Chinese Elderly Population,” BMC Public Health 22, no. 1 (2022): 1382.
- 32Y. Song, C. Zhu, B. Shi, et al., “Social Isolation, Loneliness, and Incident Type 2 Diabetes Mellitus: Results From Two Large Prospective Cohorts in Europe and East Asia and Mendelian Randomization,” eClinical Medicine 64 (2023): 102236.
- 33H. Kim and K. Kim, “Health-Related Quality-of-Life and Diabetes Self-Care Activity in Elderly Patients With Diabetes in Korea,” Journal of Community Health 42, no. 5 (2017): 998–1007.
- 34R. H. Lim and T. Sharmeen, “Medicines Management Issues in Dementia and Coping Strategies Used by People Living With Dementia and Family Carers: A Systematic Review,” International Journal of Geriatric Psychiatry 33, no. 12 (2018): 1562–1581.
- 35D. G. Feil, A. Pearman, T. Victor, et al., “The Role of Cognitive Impairment and Caregiver Support in Diabetes Management of Older Outpatients,” International Journal of Psychiatry in Medicine 39, no. 2 (2009): 199–214.
- 36M. Cardol, M. Rijken, and H. van Schrojenstein Lantman-de Valk, “Attitudes and Dilemmas of Caregivers Supporting People With Intellectual Disabilities Who Have Diabetes,” Patient Education and Counseling 87, no. 3 (2012): 383–388, https://doi.org/10.1016/j.pec.2011.11.010.
- 37A. L. Pilgrim, D. Baylis, K. A. Jameson, et al., “Measuring Appetite With the Simplified Nutritional Appetite Questionnaire Identifies Hospitalised Older People at Risk of Worse Health Outcomes,” Journal of Nutrition, Health & Aging 20, no. 1 (2016): 3–7.
- 38G. A. Van Kan, Y. M. Rolland, J. E. Morley, and B. Vellas, “Frailty: Toward a Clinical Definition,” Journal of the American Medical Directors Association 9, no. 2 (2008): 71–72.
- 39S. Gong, D. Qian, S. Riazi, et al., “Association Between the FRAIL Scale and Postoperative Complications in Older Surgical Patients: A Systematic Review and Meta-Analysis,” Anesthesia and Analgesia 136, no. 2 (2022): 251–261, https://doi.org/10.1213/ANE.0000000000006272.
- 40L. P. Richardson, E. McCauley, D. C. Grossman, et al., “Evaluation of the Patient Health Questionnaire-9 Item for Detecting Major Depression Among Adolescents,” Pediatrics 126, no. 6 (2010): 1117–1123.
- 41E. E. Wæhrens, K. Amris, and A. G. Fisher, “Performance-Based Assessment of Activities of Daily Living (ADL) Ability Among Women With Chronic Widespread Pain,” Pain 150, no. 3 (2010): 535–541.
- 42Z. Wang, Z. Chen, L. Zhang, et al., “Status of Hypertension in China,” Circulation 137, no. 22 (2018): 2344–2356.
- 43L. L. Guo, Y. Q. Chen, Q. Z. Lin, et al., “Non-HDL-C is More Stable Than LDL-C in Assessing the Percent Attainment of Non-Fasting Lipid for Coronary Heart Disease Patients,” Frontiers in Cardiovascular Medicine 8 (2021): 649181.