Saadet KOÇ OKUDUR, Pinar SOYSAL

Yaşlı Diyabetik Hastalarda Malnutrisyonun Klinik Sonuçları ve Önemi

Diabetes mellitus ve malnutrisyon, yaşlı hastalarda sık görülen sağlık problemleridir. Her ikisi de çok sayıda olumsuz sağlık durumlarıyla ilişkilidir. Çalışmamızın amacı, yaşlı diyabetik hastalarda malnutrisyon ile ayrıntılı geriatrik değerlendirme parametreleri arasındaki ilişkiyi değerlendirmektir. Kesitsel araştırma tasarımı kullanıldı. Çalışmaya geriatri polikliniğine başvuran ≥ 65 yaş, 506 diyabetik hasta dahil edildi. Hastaların demografik verileri, komorbiditeler, kullanılan ilaç sayısı, üriner inkontinans, ortostatik hipotansiyon varlığı ve laboratuar tetkikleri kaydedildi. Tüm hastalara ayrıntılı geriatrik değerlendirme yapıldı. Nörokognitif değerlendirme için Mini Mental Durum Değerlendirme testi (MMSE), duygu durum değerlendirmesi için Geriatrik Depresyon Skalası (GDS), fonksiyonellik değerlendirmesi için Temel Günlük Yaşam Aktiviteleri (TGYA) ve Enstrümantal Günlük Yaşam Aktiviteleri (EGYA) ölçekleri, yürüyüş ve denge fonksiyonları değerlendirmesi için Tinetti Denge ve Yürüme Testi ile Kalk ve Yürü testi (KYT), uyku durumu değerlendirmesi için Uykusuzluk Şiddet İndeksi (UŞİ) ve kas gücü için el kavrama gücü (EKG) testi dosya verileri kullanıldı. Çalışma grubu Mini Nutrisyonel Değerlendirme skorları>23,5, 17-23,5 ve <17 olması sırasıyla normal nutrisyon, malnutrisyon riski ve malnutrisyon olarak kategorize edildi. Katılımcıların yaş ortalaması 76,86 ± 6,97 yıl ve %74,7’si kadın idi. Normal nutrisyonel durum, malnutrisyon riski ve malnutrisyon prevalansı sırasıyla %60,8, %30,43’ü ve %8,7 idi. Ayrıntılı geriatrik değerlendirme parametreleri gruplar arasında lojistik regresyon analizine göre değerlendirildiğinde malnütrisyon olan grupta TGYA, EGYA, Tinetti yürüme ve denge skorları, MMSE ve EKG skorları anlamlı olarak düşük iken, GDS, UŞİ ve KYT skorları anlamlı olarak yüksek saptandı (p<0,05). Yaşlı diyabetik hastalarda malnütrisyon fonksiyonel gerileme, yürüme-denge bozuklukları, kognisyon ve duygu durum bozuklukları, el kavrama gücünde azalma ve uyku bozuklukları için bir risk faktörüdür. Yaşlı diyabetik hastalarda diyabet tedavi ilkeleri gözetilirken nutrisyonel değerlendirmenin de göz önünde bulundurulması gerekmektedir.

Anahtar Kelimeler:

Diyabetes mellitus, malnutrisyon, ayrıntılı geriatrik değerlendirme, yaşlı

The Clinical Implications and Importance of Malnutrition in Elderly Diabetic Patients

Diabetes mellitus and malnutrition are common health problems in older adults. Both are associated with numerous adverse health conditions. The aim of our study is to evaluate the relationship between comprehensivez geriatric assessment parameters and malnutrition in elderly diabetic patients. A cross-sectional study design was used. A total of 506 diabetic outpatients aged ≥ 65 years were included. Demographic data, comorbidities, number of drugs used, urinary incontinence, orthostatic hypotension and laboratory tests were recorded. All patients underwent comprehensive geriatric assessment. Mini mental state examination (MMSE) test was used for neurocognitive assessment, Geriatric Depression Scale (GDS) for mood assessment, Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL) scales for functionality assessment, Tinetti Balance and Gait Test and Time up and go test (TUG) for gait and balance assessment, Insomnia Severity Index (ISI) for sleep status assessment and hand grip strength for muscle strength assessment. Mini Nutritional Assessment (MNA) scores>23.5, 17-23.5, or <17 were categorized as normal nutritional status, malnutrition risk, and malnutrition, respectively. The mean age of the participants was 76.86 ± 6.97 years and 74.7% were women. Prevalence of normal nutritional status, malnutrition risk, and malnutrition were 60.8%, 30.43%, and 8.7%, respectively. Comprehensive geriatric assessment parameters were evaluated according to logistic regression analysis between the groups. BADL, IADL, Tinetti walking and balance scores, MMSE and hand grip strength test scores were significantly lower in the malnourished group, while GDS, ISI, and TUG scores were significantly higher (p<0.05). Malnutrition is a risk factor for functional decline, gait-balance disorders, cognition and mood disorders, decreased hand grip strength and sleep disorders in elderly diabetic patients. Nutritional assessment should be considered while evaluating elderly diabetic patients for diabetes treatment principles.

Keywords:

Diabetes mellitus, malnutrition, comprehensive geriatric assessment, older adults,

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