Diyabetik Yaşlılarda Polifarmasi ve Malnütrisyon İlişkisinin Değerlendirilmesi

Amaç: Tip 2 diabetes mellitus (T2DM), yaşlı yetişkinlerde sık rastlanan kronik hastalıklardandır. İlerleyen yaşla birlikte kronik hastalıklarla ilişkili polifarmasi ve protein-enerji malnütrisyonu metabolik nedenlere bağlı olarak T2DM hastalarında sık görülebilir ve prognozu olumsuz etkileyebilir. Bu çalışmada T2DM hastalarında polifarmasi ve malnütrisyon ilişkisinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Şubat-Kasım 2021 tarihleri arasında İç Hastalıkları ve Geriatri Polikliniği’ne başvuran, 65 yaş ve üzeri T2DM tanısı olan ve oral anti-diyabetik ilaç tedavisi alan 321 hasta çalışmaya dahil edildi. Hastaların verileri tıbbi dosyalarından retrospektif olarak elde edildi. Beş ve üzeri ilaç kullanımı polifarmasi olarak kabul edildi. Beslenme durum değerlendirmesinde Mini Nutrisyonel değerlendirme- kısa form (MNA-SF) kullanıldı. Bulgular: T2DM tanısı ile takip edilen hastalarda eşzamanlı kullanılan ilaçların medyan sayısı 5 idi. Hastaların 209’unda (%65,1) polifarmasi, 21’inde (%6,5) ise şiddetli polifarmasi saptandı. Polifarmasisi olan hastaların 43’ünde (%20,6) malnütrisyon saptanırken şiddetli polifarmasisi olan 21 hastanın 17’sinde (%80,1) malnütrisyon vardı. İlaç sayısı ile HbA1c arasında pozitif, MNA-SF puanı ile negatif korelasyon saptandı (sırasıyla r=0,792, p

Evaluation of the Relationship Between Polypharmacy and Malnutrition in Diabetic Elderly

Aim: Type 2 diabetes mellitus (T2DM) is one of the most common chronic diseases in older adults. With advancing age, polypharmacy and protein- energy malnutrition associated with chronic diseases can be seen frequently in T2DM patients due to metabolic causes and may adversely affect the prognosis. In this study, it was aimed to evaluate the relationship between polypharmacy and malnutrition in T2DM patients. Materials and Methods: Three hundred and twenty-one patients aged 65 years and over, diagnosed with T2DM and receiving oral anti-diabetic drug therapy, who applied to the Internal Medicine and Geriatrics outpatient clinic between February and November 2021, were included in the study. The data of the patients were obtained retrospectively from their medical files. The use of 5 or more drugs was considered as polypharmacy. Mini Nutritional Assessment-short form (MNA-SF) was used for nutritional status assessment. Results: The median number of concomitant medications used in patients followed up with the diagnosis of T2DM was 5. Polypharmacy was found in 209 (65.1%) patients, and severe polypharmacy was found in 21 (6.5%) patients. Malnutrition was found in 43 (20.6%) patients with polypharmacy, while 17 (80.1%) of 21 patients with severe polypharmacy had malnutrition. A positive correlation was found between the number of drugs and HbA1c, and a negative correlation with the MNA-SF score (r=0.792, p

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1. Kaiser AB, Zhang N, der Pluijm WVAN. Global prevalence of type 2 diabetes over the next ten years (2018–2028). Diabetes 2018.
2. Lipska KJ, Krumholz H, Soones T, Lee SJ. Polypharmacy in the Aging Patient: A Review of Glycemic Control in Older Adults With Type 2 Diabetes. JAMA. 2016;315:1034-45.
3. Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17:230.
4. Ruths S, Viktil KK, Blix HS. Klassifisering av legemiddelrelaterte problemer [Classification of drug-related problems]. Tidsskr Nor Laegeforen. 2007;127:3073-6.
5. Bailey C, Peddie D, Wickham ME, Badke K, Small SS, Doyle-Waters MM, et al. Adverse drug event reporting systems: a systematic review. Br J Clin Pharmacol. 2016;82:17-29.
6. Abizanda P, Sinclair A, Barcons N, Lizán L, Rodríguez-Mañas L. Costs of Malnutrition in Institutionalized and Community-Dwelling Older Adults: A Systematic Review. J Am Med Dir Assoc. 2016;17:17-23.
7. Visser M, Volkert D, Corish C, Geisler C, de Groot LC, Cruz-Jentoft AJ, et al. Tackling the increasing problem of malnutrition in older persons: the malnutrition in the elderly (MaNu EL) knowledge hub. Nutr Bull. 2017;42:178-86.
8. Jyrkkä J, Enlund H, Lavikainen P, Sulkava R, Hartikainen S. Association of polypharmacy with nutritional status, functional ability and cognitive capacity over a three-year period in an elderly population. Pharmacoepidemiol Drug Saf. 2011;20:514-22.
9. Fávaro-Moreira NC, Krausch-Hofmann S, Matthys C, Vereecken C, Vanhauwaert E, Declercq A, et al. Risk Factors for Malnutrition in Older Adults: A Systematic Review of the Literature Based on Longitudinal Data. Adv Nutr. 2016;7:507-22.
10. Haider SI, Johnell K, Thorslund M, Fastbom J. Trends in polypharmacy and potential drug-drug interactions across educational groups in elderly patients in Sweden for the period 1992 - 2002. Int J Clin Pharmacol Ther. 2007;45:643-53.
11. Tamura Y, Omura T, Toyoshima K, Araki A. Nutrition Management in Older Adults with Diabetes: A Review on the Importance of Shifting Prevention Strategies from Metabolic Syndrome to Frailty. Nutrients. 2020;12:3367.
12. Arik G, Varan HD, Yavuz BB, Karabulut E, Kara O, Kilic MK, et al. Validation of Katz index of independence in activities of daily living in Turkish older adults. Arch Gerontol Geriatr. 2015;61:344-50.
13. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9:179-86.
14. Isik EI, Yilmaz S, Uysal I, Basar S. Adaptation of the Lawton Instrumental Activities of Daily Living Scale to Turkish: Validity and Reliability Study. Ann Geriatr Med Res. 2020;24:35-40.
15. Thal LJ, Grundman M, Golden R. Alzheimer’s disease: a correlational analysis of the Blessed Information-Memory-Concentration Test and the Mini- Mental State Exam. Neurology. 1986;36:262-4.
16. Babacan-Yıldız G, Ur-Özçelik E, Kolukısa M, Işık AT, Gürsoy E, Kocaman G, et al. Eğitimsizler İçin Modifiye Edilen Mini Mental Testin (MMSE-E) Türk Toplumunda Alzheimer Hastalığı Tanısında Geçerlik ve Güvenilirlik Çalışması [Validity and Reliability Studies of Modified Mini Mental State Examination (MMSE-E) For Turkish Illiterate Patients With Diagnosis of Alzheimer Disease]. Turk Psikiyatri Derg. 2016;27:41-6.
17. Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res. 1982-1983;17:37-49.
18. Guigoz Y, Vellas B. The Mini Nutritional Assessment (MNA) for grading the nutritional state of elderly patients: presentation of the MNA, history and validation. Nestle Nutr Workshop Ser Clin Perform Programme. 1999;1:3- 11; discussion 11-2.
19. Jyrkkä J, Mursu J, Enlund H, Lönnroos E. Polypharmacy and nutritional status in elderly people. Curr Opin Clin Nutr Metab Care. 2012;15:1-6.
20. Bernstein M, Munoz N; Academy of Nutrition and Dietetics. Position of the Academy of Nutrition and Dietetics: food and nutrition for older adults: promoting health and wellness. J Acad Nutr Diet. 2012;112:1255-77.
21. Burgos R JC, Blay C, Ledesma A, Figueiras G, Pe ́rez-Portabella C, Granados A, ve ark. editor Strategy to fight against malnutrition in chronic patients with complex health needs. 16th International Conference on Integrated Care; 2016; Barcelona: International Journal of Integrated Care.
22. Noale M, Veronese N, Cavallo Perin P, Pilotto A, Tiengo A, Crepaldi G, et al. Polypharmacy in elderly patients with type 2 diabetes receiving oral antidiabetic treatment. Acta Diabetol. 2016;53:323-30.
23. Maseda A, Gómez-Caamaño S, Lorenzo-López L, López-López R, Diego-Diez C, Sanluís-Martínez V, et al. Health determinants of nutritional status in community-dwelling older population: the VERISAÚDE study. Public Health Nutr. 2016;19:2220-8.
24. Fávaro-Moreira NC, Krausch-Hofmann S, Matthys C, Vereecken C, Vanhauwaert E, Declercq A, et al. Risk Factors for Malnutrition in Older Adults: A Systematic Review of the Literature Based on Longitudinal Data. Adv Nutr. 2016;7:507-22.
25. Haider SI, Johnell K, Thorslund M, Fastbom J. Trends in polypharmacy and potential drug-drug interactions across educational groups in elderly patients in Sweden for the period 1992 - 2002. Int J Clin Pharmacol Ther. 2007;45:643-53.
26. Fenton R, Brook-Barclay L, Delaney CL, Spark JI, Miller MD. Do Medications Commonly Prescribed to Patients with Peripheral Arterial Disease Have an Effect on Nutritional Status? A Review of the Literature. Ann Vasc Surg. 2016;32:145-75.
27. Schilp J, Wijnhoven HA, Deeg DJ, Visser M. Early determinants for the development of undernutrition in an older general population: Longitudinal Aging Study Amsterdam. Br J Nutr. 2011;106:708-17.
28. Ibrahim IA, Kang E, Dansky KH. Polypharmacy and possible drug-drug interactions among diabetic patients receiving home health care services. Home Health Care Serv Q. 2005;24:87-99.
29. Alwhaibi M, Balkhi B, Alhawassi TM, Alkofide H, Alduhaim N, Alabdulali R, et al. Polypharmacy among patients with diabetes: a cross-sectional retrospective study in a tertiary hospital in Saudi Arabia. BMJ Open. 2018;8:e020852.
30. Formiga F, Agustí A, José AS. Polypharmacy in elderly people with diabetes admitted to hospital. Acta Diabetol. 2016;53:857-8.
31. Silva MRRD, Diniz LM, Santos JBRD, Reis EA, Mata ARD, Araújo VE, et al. Drug utilization and factors associated with polypharmacy in individuals with diabetes mellitus in Minas Gerais, Brazil. Cien Saude Colet. 2018;23:2565- 74.
32. Badedi M, Solan Y, Darraj H, Sabai A, Mahfouz M, Alamodi S, et al. Factors Associated with Long-Term Control of Type 2 Diabetes Mellitus. J Diabetes Res. 2016;2016:2109542.
33. Ismail-Beigi F, Craven T, Banerji MA, Basile J, Calles J, Cohen RM, et al. Effect of intensive treatment of hyperglycaemia on microvascular outcomes in type 2 diabetes: an analysis of the ACCORD randomised trial. Lancet. 2010;376:419-30.
34. van Oort S, Rutters F, Warlé-van Herwaarden MF, Schram MT, Stehouwer CD, Tack CJ, et al. Characteristics associated with polypharmacy in people with type 2 diabetes: the Dutch Diabetes Pearl cohort. Diabet Med. 2021;38:e14406.