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Chi CY, Wang J, Lee SY, Chao CT, Hung KY, Chien KL. The Impact of Glucose-Lowering Strategy on the Risk of Increasing Frailty Severity among 49,519 Patients with Diabetes Mellitus: A Longitudinal Cohort Study. Aging Dis 2023; 14:1917-1926. [PMID: 37196125 PMCID: PMC10529743 DOI: 10.14336/ad.2023.0225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 02/25/2023] [Indexed: 05/19/2023] Open
Abstract
Patients with diabetes mellitus (DM) have a higher risk of incident and aggravating frailty over time. Frailty-initiating risk factors have been identified, but modulators of frail severity over time remain poorly defined. We aimed to explore the influences of glucose-lowering drug (GLD) strategy on DM patients' risk of increasing frail severity. We retrospectively identified type 2 DM patients between 2008 and 2016, dividing them into "no GLD", oral GLD (oGLD) monotherapy, oGLD combination, and those receiving insulin without or with oGLD at baseline. Increasing frail severity, defined as ≥1 FRAIL component increase, was the outcome of interest. Cox proportional hazard regression was utilized to analyze the risk of increasing frail severity associated with GLD strategy, accounting for demographic, physical data, comorbidities, medication, and laboratory panel. After screening 82,208 patients with DM, 49,519 (no GLD, 42.7%; monotherapy, 24.0%; combination, 28.5%; and insulin user, 4.8%) were enrolled for analysis. After 4 years, 12,295 (24.8%) had increasing frail severity. After multivariate adjustment, oGLD combination group exhibited a significantly lower risk of increasing frail severity (hazard ratio (HR) 0.90, 95% confidence interval (CI) 0.86 - 0.94), while the risk of insulin users increased (HR 1.11, 95% CI 1.02 - 1.21) than no GLD group. Users receiving more oGLD exhibited a trend of less risk reduction relative to others. In conclusion, we discovered that the strategy of oral glucose lowering drugs combination might reduce the risk of frail severity increase. Accordingly, medication reconciliation in frail diabetic older adults should take into account their GLD regimens.
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Affiliation(s)
- Chun-Yi Chi
- Nephrology division, Department of Internal Medicine, National Taiwan University Hospital Yunlin branch, Yunlin County, Taiwan.
| | - Jui Wang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
- Health Management Center, National Taiwan University Hospital, Taipei, Taiwan.
| | - Szu-Ying Lee
- Nephrology division, Department of Internal Medicine, National Taiwan University Hospital Yunlin branch, Yunlin County, Taiwan.
| | - Chia-Ter Chao
- Nephrology division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
- Nephrology division, Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
- Graduate Institute of Toxicology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kuan-Yu Hung
- Nephrology division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
- Nephrology division, Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
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Sanz-Cánovas J, López-Sampalo A, Cobos-Palacios L, Ricci M, Hernández-Negrín H, Mancebo-Sevilla JJ, Álvarez-Recio E, López-Carmona MD, Pérez-Belmonte LM, Gómez-Huelgas R, Bernal-López MR. Management of Type 2 Diabetes Mellitus in Elderly Patients with Frailty and/or Sarcopenia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148677. [PMID: 35886528 PMCID: PMC9318510 DOI: 10.3390/ijerph19148677] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/13/2022] [Accepted: 07/15/2022] [Indexed: 02/04/2023]
Abstract
The life expectancy of the population is increasing worldwide due to improvements in the prevention, diagnosis, and treatment of diseases. This favors a higher prevalence of type 2 diabetes mellitus (T2DM) in the elderly. Sarcopenia and frailty are also frequently present in aging. These three entities share common mechanisms such as insulin resistance, chronic inflammation, and mitochondrial dysfunction. The coexistence of these situations worsens the prognosis of elderly patients. In this paper, we review the main measures for the prevention and management of sarcopenia and/or frailty in elderly patients with T2DM.
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Affiliation(s)
- Jaime Sanz-Cánovas
- Unidad de Gestión Clínica de Medicina Interna, Hospital Regional Universitario de Málaga, Universidad de Málaga (UMA), 29010 Málaga, Spain; (J.S.-C.); (A.L.-S.); (L.C.-P.); (M.R.); (H.H.-N.); (J.J.M.-S.); (E.Á.-R.); (M.D.L.-C.); (L.M.P.-B.)
- Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), 29590 Málaga, Spain
| | - Almudena López-Sampalo
- Unidad de Gestión Clínica de Medicina Interna, Hospital Regional Universitario de Málaga, Universidad de Málaga (UMA), 29010 Málaga, Spain; (J.S.-C.); (A.L.-S.); (L.C.-P.); (M.R.); (H.H.-N.); (J.J.M.-S.); (E.Á.-R.); (M.D.L.-C.); (L.M.P.-B.)
- Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), 29590 Málaga, Spain
| | - Lidia Cobos-Palacios
- Unidad de Gestión Clínica de Medicina Interna, Hospital Regional Universitario de Málaga, Universidad de Málaga (UMA), 29010 Málaga, Spain; (J.S.-C.); (A.L.-S.); (L.C.-P.); (M.R.); (H.H.-N.); (J.J.M.-S.); (E.Á.-R.); (M.D.L.-C.); (L.M.P.-B.)
- Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), 29590 Málaga, Spain
| | - Michele Ricci
- Unidad de Gestión Clínica de Medicina Interna, Hospital Regional Universitario de Málaga, Universidad de Málaga (UMA), 29010 Málaga, Spain; (J.S.-C.); (A.L.-S.); (L.C.-P.); (M.R.); (H.H.-N.); (J.J.M.-S.); (E.Á.-R.); (M.D.L.-C.); (L.M.P.-B.)
- Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), 29590 Málaga, Spain
| | - Halbert Hernández-Negrín
- Unidad de Gestión Clínica de Medicina Interna, Hospital Regional Universitario de Málaga, Universidad de Málaga (UMA), 29010 Málaga, Spain; (J.S.-C.); (A.L.-S.); (L.C.-P.); (M.R.); (H.H.-N.); (J.J.M.-S.); (E.Á.-R.); (M.D.L.-C.); (L.M.P.-B.)
- Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), 29590 Málaga, Spain
| | - Juan José Mancebo-Sevilla
- Unidad de Gestión Clínica de Medicina Interna, Hospital Regional Universitario de Málaga, Universidad de Málaga (UMA), 29010 Málaga, Spain; (J.S.-C.); (A.L.-S.); (L.C.-P.); (M.R.); (H.H.-N.); (J.J.M.-S.); (E.Á.-R.); (M.D.L.-C.); (L.M.P.-B.)
- Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), 29590 Málaga, Spain
| | - Elena Álvarez-Recio
- Unidad de Gestión Clínica de Medicina Interna, Hospital Regional Universitario de Málaga, Universidad de Málaga (UMA), 29010 Málaga, Spain; (J.S.-C.); (A.L.-S.); (L.C.-P.); (M.R.); (H.H.-N.); (J.J.M.-S.); (E.Á.-R.); (M.D.L.-C.); (L.M.P.-B.)
- Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), 29590 Málaga, Spain
| | - María Dolores López-Carmona
- Unidad de Gestión Clínica de Medicina Interna, Hospital Regional Universitario de Málaga, Universidad de Málaga (UMA), 29010 Málaga, Spain; (J.S.-C.); (A.L.-S.); (L.C.-P.); (M.R.); (H.H.-N.); (J.J.M.-S.); (E.Á.-R.); (M.D.L.-C.); (L.M.P.-B.)
- Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), 29590 Málaga, Spain
| | - Luis Miguel Pérez-Belmonte
- Unidad de Gestión Clínica de Medicina Interna, Hospital Regional Universitario de Málaga, Universidad de Málaga (UMA), 29010 Málaga, Spain; (J.S.-C.); (A.L.-S.); (L.C.-P.); (M.R.); (H.H.-N.); (J.J.M.-S.); (E.Á.-R.); (M.D.L.-C.); (L.M.P.-B.)
- Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), 29590 Málaga, Spain
| | - Ricardo Gómez-Huelgas
- Unidad de Gestión Clínica de Medicina Interna, Hospital Regional Universitario de Málaga, Universidad de Málaga (UMA), 29010 Málaga, Spain; (J.S.-C.); (A.L.-S.); (L.C.-P.); (M.R.); (H.H.-N.); (J.J.M.-S.); (E.Á.-R.); (M.D.L.-C.); (L.M.P.-B.)
- Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), 29590 Málaga, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence: (R.G.-H.); (M.R.B.-L.); Tel.: +34-951291169 (R.G.-H.); +34-951290346 (M.R.B.-L.)
| | - Maria Rosa Bernal-López
- Unidad de Gestión Clínica de Medicina Interna, Hospital Regional Universitario de Málaga, Universidad de Málaga (UMA), 29010 Málaga, Spain; (J.S.-C.); (A.L.-S.); (L.C.-P.); (M.R.); (H.H.-N.); (J.J.M.-S.); (E.Á.-R.); (M.D.L.-C.); (L.M.P.-B.)
- Instituto de Investigación Biomédica de Málaga (IBIMA-Plataforma Bionand), 29590 Málaga, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence: (R.G.-H.); (M.R.B.-L.); Tel.: +34-951291169 (R.G.-H.); +34-951290346 (M.R.B.-L.)
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