Taner BAYRAKTAROĞLU, Banu ÜNVER, Gizem ALARÇİN, Tuba ESERLER

Tip 2 Diabetes Mellitus’lu Olgularda Glisemik Kontrol Düzeyinin Fonksiyonel Mobilite ve Ayak Fonksiyonuna Etkisi

Amaç: Çalışmanın amacı, tip 2 diyabetik olgularda glisemik kontrol düzeyinin, açlık plazma glikozunun ve diyabet süresinin fonksiyonelmobiliteye ve ayak fonksiyonuna etkisinin incelenmesidir.Gereç ve Yöntemler: Çalışmamıza ardışık 138 tip 2 diabetes mellitus tanılı olgu alındı. Olguların demografik özellikleri, diyabet süresi,açlık plazma glikozu ve HbA1c değeri kaydedildi ve olgular HbA1c değerlerine göre iki gruba ayrıldı. HbA1c değeri <%7 olanlar, iyiglisemik kontrollü grubu ve ≥%7 olanlar, kötü glisemik kontrollü grubu oluşturdu. Gruplardaki her bir olgunun “Süreli Kalk YürüTesti” ile fonksiyonel mobilite düzeyleri, “Ayak Fonksiyon İndeksi” ile de ayak fonksiyonları değerlendirildi ve gruplar karşılaştırıldı.Bulgular: Çalışma örnekleminde iyi glisemik kontrol düzeyine sahip 65 olgunun yaş ortalaması 53,91±9,28 yıl, kötü glisemik kontroldüzeyine sahip 73 olgunun yaş ortalaması 54,90±8,60 yıl olarak bulundu. İyi ve kötü glisemik kontrollü gruplar arasında Süreli KalkYürü Testi, Ayak Fonksiyon İndeksi ağrı, yetersizlik, kısıtlılık ve toplam skorları açısından anlamlı bir fark olmadığı bulundu (p>0,05).Olguların diyabet süresi ile Süreli Kalk Yürü Testi arasında anlamlı ancak zayıf pozitif korelasyon olduğu (r=0,172, p=0,040), olgularınaçlık plazma glikozu ve HbA1c değerleri ile Ayak Fonksiyon İndeksi ağrı, yetersizlik, kısıtlılık ve toplam skorları arasında anlamlı birkorelasyon olmadığı görüldü (p>0,05). Süreli Kalk Yürü Testi sonucu ile Ayak Fonksiyon İndeksi ağrı, yetersizlik, kısıtlılık ve toplamskoru arasında anlamlı, orta şiddette pozitif korelasyon olduğu saptandı (r=0,336, r=0,393, r=0,357, r=0,413, p<0,001).Sonuç: Çalışmamız, tip 2 diyabetik olgularda glisemik kontrol düzeyinin fonksiyonel mobilite ve ayak fonksiyonunu etkilemediğini,fonksiyonel mobilite düzeyinin diyabet süresiyle ilişkili olduğunu ortaya koymaktadır. Bununla birlikte, diyabetik olguların fonksiyonelmobiliteleri ile ağrı, yetersizlik, kısıtlılık açısından ayak fonksiyonları ilişkili bulundu. Diyabetik olguların, iyi bir fonksiyonel mobiliteiçin, ayak fonksiyonlarını erken dönemde korumalarının önemi göz önünde bulundurulmalıdır.

Anahtar Kelimeler:

Tip 2 Diabetes Mellitus, Glisemik Kontrol, Fonksiyonel Mobilite, Ayak Fonksiyon İndeksi

The Effect of Glycemic Control Level on Functional Mobility and Foot Function in Type 2 Diabetic Individuals

Aim: The purpose of the study was to investigate the effect of glycemic control, fasting blood glucose level and duration of diabetes onfunctional mobility and foot function in type 2 diabetic cases.Material and Methods: The study was conducted among 138 consecutive cases with type 2 diabetes mellitus such that 65 of them hada good glycemic control and a mean age of 53.91 ± 9.28 years and 73 of them had poor glycemic control and a mean age of 54.90±8.60years. Demographic characteristics, duration of diabetes, fasting blood glucose levels and HbA1c values of the subjects were recorded and the subjects were divided into two groups according to their HbA1C valuues. Subjects with HbA1c value below 7% were put intogood glycemic control group and subjects with HbA1c values above were put into poor glycemic control. Functional mobility levels ofeach case in the groups were evaluated with “Timed Up and Go Test” and foot functions were evaluated with “Foot Function Index”and the groups were compared.Results: It was found that among groups with good and poor glycemic control, there was no significant difference between the TimeUp and Go Test and the Foot Function Index, in terms of pain, disability, activity limitation and total scores (p>0.05). There was asignificant but minor positive correlation between the duration of diabetes and the Timed Up and Go Test (r=0.172, p=0.040), and nosignificant correlation was seen between the fasting blood sugar and the HbA1c values and Foot Function Index scores (p>0.05). It wasfound that there was a significant mediocre positive correlation between the Timed Up and Go Test and the Foot Function Index scores(r=0.336, r=0.393, r=0.357, r=0.413, p<0.001).Conclusion: The results of our study indicates that glycemic control does not affect functional mobility and foot function, whereasfunctional mobility level is associated with diabetes duration in type 2 diabetic cases. Besides, functional mobility of diabetic individualswas found to be related to foot functions in terms of pain, disability and limitation. The importance of conserving foot functions in theearly stages for diabetic individuals should be taken into consideration for good functional mobility.

Keywords:

Type 2 Diabetes Mellitus, Glycemic Control, Functional Mobility, Foot Function Index,

PDF

___

1.Hewston, P, Deshpande, N. Falls and balance impairments in older adults with type 2 diabetes: thinking beyond diabetic peripheral neuropathy. Canadian journal of diabetes, 2016; 40: 6-9.
2.Zimmet, P. Z., Magliano, D. J., Herman, W. H., & Shaw, J. E.. Diabetes: a 21st century challenge. The lancet Diabetes & endocrinology, 2014; 2: 56-64.
3. International Diabetes Federation. IDF Diabetes Atlas. Brussels: International Diabetes Federation, 2013; 6th edn.
4. Satman, I., Omer, B., Tutuncu, Y., Kalaca, S., Gedik, S., Dinccag, N., & Turker, F. Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. European journal of epidemiology, 2013; 28: 169-180.
5. Wong, E., Backholer, K., Gearon, E., Harding, J., Freak-Poli, R., Stevenson, C., & Peeters, A. Diabetes and risk of physical disability in adults: a systematic review and meta-analysis. The lancet Diabetes & endocrinology, 2013; 1: 106-114.
6.Cordeiro, R. C., Jardim, J. R., Perracini, M. R., & Ramos, L. R. Factors associated with functional balance and mobility among elderly diabetic outpatients. Arquivos Brasileiros de Endocrinologia & Metabologia, 2009; 53: 834-843.
7. Perkowski, L. C., Stroup‐Benham, C. A., Markides, K. S., Lichtenstein, M. J., Angel, R. J., Guralnik, J. M., & Goodwin, J. S. Lower‐extremity functioning in older Mexican Americans and its association with medical problems. Journal of the American Geriatrics Society, 1998; 46: 411-418.
8. Sinclair, A. J., Conroy, S. P., & Bayer, A. J. Impact of diabetes on physical function in older people. Diabetes Care, 2008; 31: 233-235.
9. IJzerman, T. H., Schaper, N. C., Melai, T., Meijer, K., Willems, P. J., & Savelberg, H. H. Lower extremity muscle strength is reduced in people with type 2 diabetes, with and without polyneuropathy, and is associated with impaired mobility and reduced quality of life. Diabetes research and clinical practice, 2012; 95: 345-351.
10. Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991; 39:142–148.
11. Gregg, E. W., Beckles, G. L., Williamson, D. F., Leveille, S. G., Langlois, J. A., Engelgau, M. M., & Narayan, K. M. Diabetes and physical disability among older US adults. Diabetes care, 2000; 23: 1272-1277.
12.Sims Jr, D. S., Cavanagh, P. R., & Ulbrecht, J. S. Risk factors in the diabetic foot: recognition and management. Physical Therapy, 1988; 68: 1887-1902.
13. D’ambrogi, E., Giacomozzi, C., Macellari, V., & Uccioli, L. Abnormal foot function in diabetic patients: the altered onset of Windlass mechanism. Diabetic medicine, 2005; 22: 1713-1719.
14. Morag, E., & Cavanagh, P. R. Structural and functional predictors of regional peak pressures under the foot during walking. Journal of biomechanics, 1999; 32: 359-370.
15. Andersen, H., Gadeberg, P. C., Brock, B., & Jakobsen, J. Muscular atrophy in diabetic neuropathy: a stereological magnetic resonance imaging study. Diabetologia, 1997; 40: 1062-1069.
16. Rijken, P. M., Dekker, J., Dekker, E., Lankhorst, G. J., Bakker, K., Dooren, J., & Rauwerda, J. A. Clinical and functional correlates of foot pain in diabetic patients. Disability and rehabilitation, 1998; 20: 330-336.
17.Novak, P., Burger, H., Marincek, C., & Meh, D. Influence of foot pain on walking ability of diabetic patients. J Rehabil Med, 2004; 36: 249-252.
18. Middleton, J. The effect of case management on glycemic control in patients with type 2 diabetes. The Case Manager, 2003;14: 43-47.
19. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). The lancet, 1998; 352: 837-853.
20. American Diabetes Association. Standards of medical care in diabetes—2009. Diabetes care, 2009; 32(Suppl 1), S13.
21. Stratton, I. M., Adler, A. I., Neil, H. A. W., Matthews, D. R., Manley, S. E., Cull, C. A., ... & Holman, R. R. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. Bmj, 2000; 321: 405-412.
22. Hartz, A., Kent, S., James, P., Xu, Y., Kelly, M., & Daly, J. Factors that influence improvement for patients with poorly controlled type 2 diabetes. Diabetes research and clinical practice, 2006; 74: 227-232.
23. Bains, S. S., & Egede, L. E. Associations between health literacy, diabetes knowledge, self-care behaviors, and glycemic control in a low income population with type 2 diabetes. Diabetes technology & therapeutics, 2011; 13: 335-341.
24. Green, A. J., Fox, K. M., Grandy, S., & SHIELD Study Group. Self-reported hypoglycemia and impact on quality of life and depression among adults with type 2 diabetes mellitus. Diabetes research and clinical practice, 2012; 96: 313-318.
25. Podsiadlo, D., & Richardson, S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. Journal of the American geriatrics Society, 1991; 39: 142-148.
26. Podsiadlo, D., & Richardson, S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. Journal of the American geriatrics Society, 1991; 39: 142-148.
27. SooHoo NF, Samimi DB, Vyas RM, Botzler T. Evaluation of the validity of the Foot Function Index in measuring outcomes in patients with foot and ankle disorders. Foot Ankle Int. 2006; 27: 38-42.
28. Haghighatpanah, M., Nejad, A. S. M., Haghighatpanah, M., Thunga, G., & Mallayasamy, S. Factors that correlate with poor glycemic control in type 2 diabetes mellitus patients with complications. Osong public health and research perspectives, 2018; 9: 167
29. The Diabetes Control and Complications Trial Research Group: The effect of intensive treatment of diabetes on the development and progression of longterm complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329: 977–986.
30. Selvin E, Marinopoulos S, Berkenblit G, Rami T, Brancati FL, Powe NR, Golden SH: Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus. Ann Intern Med 2004; 141: 421–431.
31. Kayar, Y., Ilhan, A., Kayar, N. B., Unver, N., Coban, G., Ekinci, I., ... & Eroglu, H. Relationship between the poor glycemic control and risk factors, life style and complications. Biomedical Research-India, 2017; 28: 1581-1586.
32. Khattaba M, Khader YS, Al-Khawaldehd A, Ajlounid K. Factors associated with poor glycemic control among patients with Type 2 diabetes. J Diabetes Complicat 2010; 24: 84-89.
33.Hartz A, Kent S, James P, Xu Y, Kelly M, Daly J. Factors that influence improvement for patients with poorly controlled type 2 diabetes. Diabetes Res Clin Pract 2006; 74: 227-232.
34. Gregg EW, Beckles GL, Williamson DF, Leveille SG, Langlois JA, Engelgau MM, et al. Diabetes and physical disability among U.S. adults. Diabetes Care 2000; 23:1272-7.
35. Manson, J. E., Nathan, D. M., Krolewski, A. S., Stampfer, M. J., Willett, W. C., & Hennekens, C. H. A prospective study of exercise and incidence of diabetes among US male physicians. Jama, 1992; 268: 63-67.
36. Hu, F. B., Sigal, R. J., Rich-Edwards, J. W., Colditz, G. A., Solomon, C. G., Willett, W. C., & Manson, J. E. Walking compared with vigorous physical activity and risk of type 2 diabetes in women: a prospective study. Jama, 1999; 282: 1433-1439.
37. Gregg, E. W., Engelgau, M. M., & Narayan, V. Complications of diabetes in elderly people: Underappreciated problems include cognitive decline and physical disability 2002; 325: 916-917.
38. Kalyani, R. R., Saudek, C. D., Brancati, F. L., & Selvin, E. Association of diabetes, comorbidities, and A1C with functional disability in older adults: results from the National Health and Nutrition Examination Survey (NHANES), 1999–2006. Diabetes care, 2010; 33: 1055-1060.
39. Guralnik JM, LaCroix AZ, Abbott RD, Berkman LF, Satterfield S, Evans DA, Wallace RB: Maintaining mobility in late life. I. Demographic characteristics and chronic conditions. Am J Epidemiol 1993; 137: 845–857.
40. Resnick HE, Vinik AI, Schwartz AV, Leveille SG, Brancati FL, Balfour J, Guralnik JM: Independent effects of peripheral nerve dysfunction on lower extremity physical function in old age: the Women’s Health and Aging Study.Diabetes Care 2000; 13: 1642–1647.