Evidence-based Practice for an Old Diabetic Patient with Frailty Syndrome_Chinese Journal of Evidence-Based Medicine

Authors：

 NIEShuang-shuang , LIAOZai-bo , SUNQian-qian ,  WANGShuang

Department of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

WANGShuang, Email: wangs0211@hotmail.com

Keywords：

Diabetes in elderly; Frailty syndrome; Dementia; CVD event; Glycemic control; Evidence-based practice

DOI：

10.7507/1672-2531.20160152

Video：

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Objective To provide the best evidence for an old diabetic patient who combined with frailty syndrome with the goal of glycemic control, treatment strategy and their prognosis. Methods PubMed, MEDLINE (Ovid), EMbase, The Cochrane Library (Issue 11, 2015) and CNKI were searched from their inception to Nov. 2015, to collect evidence about the management of glycemic control. Evidences were analyzed by the way of evidenced-based criterions. Results One clinical guideline, one meta-analysis, three RCTs, seven cohort studies and four case-control studies were included. Evidence showed that compared with patient uncombined with frailty, old diabetic patients with frailty had a higher prevalence of dementia, cardiovascular diseases and death; Aggressive glycemic control could not reduce the prevalence of cardiovascular events and the risk of death, while it could increase the risk of falling. Glycemic control was more comprehensive which would be taken frailty into consideration. Diet rich in protein (especially leucine), resistance exercise and reasonable medications based on comprehensive geriatric assessment were proved benefit for the old diabetic patient. Conclusion The incidence of cardiovascular events, hypoglycemia and mortality are increased in this old diabetic patient who combined with frailty. Maintaining HbA1c around 7.5% is reasonable and diet with enough calorie and rich in protein (especially leucine), resistance exercises should be recommended for the person.

Citation： NIEShuang-shuang, LIAOZai-bo, SUNQian-qian, WANGShuang. Evidence-based Practice for an Old Diabetic Patient with Frailty Syndrome. Chinese Journal of Evidence-Based Medicine, 2016, 16(8): 988-992. doi: 10.7507/1672-2531.20160152 Copy

1.	Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci, 2001, 56(3): M146-156.
2.	Cacciatore F, Testa G, Galizia G, et al. Clinical frailty and long-term mortality in elderly subjects with diabetes. Acta diabetologica, 2013, 50(2):251-260.
3.	Van Hateren K, Landman G, Kleefstra N, et al. Glycaemic control and the risk of mortality in elderly type 2 diabetic patients (ZODIAC-20). Int J Clin Pract, 2011, 65(4):415-419.
4.	Gray SL, Anderson ML, Hubbard RA, et al. Frailty and incident dementia. J Gerontol A Biol Sci Med Sci, 2013:glt013.
5.	Rosenqvist U. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med, 1993, 329(14): 977-986.
6.	[No authors listed]. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet, 1998, 352(9131):837-853.
7.	Stratton IM, Adler AI, Neil HA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35):prospective observational study. BMJ, 2000, 321(7258): 405-412.
8.	Sosnowski C, Janeczko-Sosnowska E. The Action to Control Cardiovascular Risk in Diabetes Study Group. Effects of intensive glucose lowering in type 2 diabetes. Kardiologia Polska, 2008, 66(9): 1013-1019.
9.	Duckworth W, Abraira C, Moritz T, et al. Glucose Control and Vascular Complications in Veterans with Type 2 Diabetes. N Engl J Med, 2009, 360(2):129-162.
10.	Nelson JM, Dufraux K, Cook PF. The relationship between glycemic control and falls in older adults. J Am Geriatr Soc, 2007, 55(12): 2041-2044.
11.	Mallery LH, Ransom T, Steeves B, et al. Evidence-informed guidelines for treating frail older adults with type 2 diabetes:from the Diabetes Care Program of Nova Scotia (DCPNS) and the Palliative and Therapeutic Harmonization (PATH) program. J Am Med Dir Assoc, 2013, 14(11):801-808.
12.	Lee SJ, Eng C. Goals of glycemic control in frail older patients with diabetes. JAMA, 2011, 305(13):1350-1351.
13.	Dunning T, Sinclair A, Colagiuri S. New IDF Guideline for managing type 2 diabetes in older people. Diabetes Res Clin Pract, 2014, 103(3):538-540.
14.	Diabetic Diets for Frail Elderly Long-Term Care Residents with Type II Diabetes Mellitus:A Review of Guidelines. Ottawa ON:2015 Canadian Agency for Drugs and Technologies in Health, 2015.
15.	Bartali B, Frongillo EA, Bandinelli S, et al. Low nutrient intake is an essential component of frailty in older persons. J Gerontol A Biol Sci Med Sci, 2006, 61(6):589-593.
16.	Kobayashi S, Asakura K, Suga H, et al. High protein intake is associated with low prevalence of frailty among old Japanese women:a multicenter cross-sectional study. Nutr J, 2013, 12:164.
17.	Dickinson JM, Gundermann DM, Walker DK, et al. Leucineenriched amino acid ingestion after resistance exercise prolongs myofibrillar protein synthesis and amino acid transporter expression in older men. J Nutr, 2014, 144(11):1694-1702.
18.	Bernstein MA, Tucker KL, Ryan ND, et al. Higher dietary variety is associated with better nutritional status in frail elderly people. J Am Diet Assoc, 2002, 102(8):1096-1104.
19.	Peterson MJ, Giuliani C, Morey MC, et al. Physical activity as a preventative factor for frailty:the health, aging, and body composition study. J Gerontol A Biol Sci Med Sci, 2009, 64(1):61-68.
20.	Lakey W, Barnard K, Batch B, et al. Are current clinical trials in diabetes addressing important issues in diabetes care? Diabetologia, 2013, 56(6):1226-1235.
21.	Sumantri S, Setiati S, Purnamasari D, et al. Relationship between Metformin and Frailty Syndrome in Elderly People with Type 2 Diabetes. Acta Med Indones, 2014, 46(3):183-188.
22.	Zhang Y, Hong J, Chi J, et al. Head-to-head comparison of dipeptidyl peptidase-IV inhibitors and sulfonylureas-a metaanalysis from randomized clinical trials. Diabetes Metab Res Rev, 2014, 30(3):241-256.
23.	Rosenstock J, Fonseca V, Schinzel S, et al. Reduced risk of hypoglycemia with once-daily glargine versus twice-daily NPH and number needed to harm with NPH to demonstrate the risk of one additional hypoglycemic event in type 2 diabetes:Evidence from a long-term controlled trial. J Diabetes Complications, 2014, 28(5): 742-749.
24.	Aschner P, Chan J, Owens DR, et al. Insulin glargine versus sitagliptin in insulin-naive patients with type 2 diabetes mellitus uncontrolled on metformin (EASIE):a multicentre, randomised open-label trial. Lancet, 2012, 379(9833):2262-2269.

1. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci, 2001, 56(3): M146-156.
2. Cacciatore F, Testa G, Galizia G, et al. Clinical frailty and long-term mortality in elderly subjects with diabetes. Acta diabetologica, 2013, 50(2):251-260.
3. Van Hateren K, Landman G, Kleefstra N, et al. Glycaemic control and the risk of mortality in elderly type 2 diabetic patients (ZODIAC-20). Int J Clin Pract, 2011, 65(4):415-419.
4. Gray SL, Anderson ML, Hubbard RA, et al. Frailty and incident dementia. J Gerontol A Biol Sci Med Sci, 2013:glt013.
5. Rosenqvist U. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med, 1993, 329(14): 977-986.
6. [No authors listed]. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet, 1998, 352(9131):837-853.
7. Stratton IM, Adler AI, Neil HA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35):prospective observational study. BMJ, 2000, 321(7258): 405-412.
8. Sosnowski C, Janeczko-Sosnowska E. The Action to Control Cardiovascular Risk in Diabetes Study Group. Effects of intensive glucose lowering in type 2 diabetes. Kardiologia Polska, 2008, 66(9): 1013-1019.
9. Duckworth W, Abraira C, Moritz T, et al. Glucose Control and Vascular Complications in Veterans with Type 2 Diabetes. N Engl J Med, 2009, 360(2):129-162.
10. Nelson JM, Dufraux K, Cook PF. The relationship between glycemic control and falls in older adults. J Am Geriatr Soc, 2007, 55(12): 2041-2044.
11. Mallery LH, Ransom T, Steeves B, et al. Evidence-informed guidelines for treating frail older adults with type 2 diabetes:from the Diabetes Care Program of Nova Scotia (DCPNS) and the Palliative and Therapeutic Harmonization (PATH) program. J Am Med Dir Assoc, 2013, 14(11):801-808.
12. Lee SJ, Eng C. Goals of glycemic control in frail older patients with diabetes. JAMA, 2011, 305(13):1350-1351.
13. Dunning T, Sinclair A, Colagiuri S. New IDF Guideline for managing type 2 diabetes in older people. Diabetes Res Clin Pract, 2014, 103(3):538-540.
14. Diabetic Diets for Frail Elderly Long-Term Care Residents with Type II Diabetes Mellitus:A Review of Guidelines. Ottawa ON:2015 Canadian Agency for Drugs and Technologies in Health, 2015.
15. Bartali B, Frongillo EA, Bandinelli S, et al. Low nutrient intake is an essential component of frailty in older persons. J Gerontol A Biol Sci Med Sci, 2006, 61(6):589-593.
16. Kobayashi S, Asakura K, Suga H, et al. High protein intake is associated with low prevalence of frailty among old Japanese women:a multicenter cross-sectional study. Nutr J, 2013, 12:164.
17. Dickinson JM, Gundermann DM, Walker DK, et al. Leucineenriched amino acid ingestion after resistance exercise prolongs myofibrillar protein synthesis and amino acid transporter expression in older men. J Nutr, 2014, 144(11):1694-1702.
18. Bernstein MA, Tucker KL, Ryan ND, et al. Higher dietary variety is associated with better nutritional status in frail elderly people. J Am Diet Assoc, 2002, 102(8):1096-1104.
19. Peterson MJ, Giuliani C, Morey MC, et al. Physical activity as a preventative factor for frailty:the health, aging, and body composition study. J Gerontol A Biol Sci Med Sci, 2009, 64(1):61-68.
20. Lakey W, Barnard K, Batch B, et al. Are current clinical trials in diabetes addressing important issues in diabetes care? Diabetologia, 2013, 56(6):1226-1235.
21. Sumantri S, Setiati S, Purnamasari D, et al. Relationship between Metformin and Frailty Syndrome in Elderly People with Type 2 Diabetes. Acta Med Indones, 2014, 46(3):183-188.
22. Zhang Y, Hong J, Chi J, et al. Head-to-head comparison of dipeptidyl peptidase-IV inhibitors and sulfonylureas-a metaanalysis from randomized clinical trials. Diabetes Metab Res Rev, 2014, 30(3):241-256.
23. Rosenstock J, Fonseca V, Schinzel S, et al. Reduced risk of hypoglycemia with once-daily glargine versus twice-daily NPH and number needed to harm with NPH to demonstrate the risk of one additional hypoglycemic event in type 2 diabetes:Evidence from a long-term controlled trial. J Diabetes Complications, 2014, 28(5): 742-749.
24. Aschner P, Chan J, Owens DR, et al. Insulin glargine versus sitagliptin in insulin-naive patients with type 2 diabetes mellitus uncontrolled on metformin (EASIE):a multicentre, randomised open-label trial. Lancet, 2012, 379(9833):2262-2269.

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