Detecting Frailty in Elderly Type 2 Diabetes Mellitus (T2DM) Patients in the Southeast of Brazil

摘要

Introduction: Brazil is the fifth country with the highest number of diabetes cases in the world, which has been increasing significantly over the last 35 years. In Brazil, the prevalence of diabetes in 2019 was 16.8 million people, 21.8% of whom are elderly. Diabetes potentialize geriatric syndromes, such as frailty, a state of increased vulnerability to stressors and cumulative decline in multiple physiological systems over lifespan. Objective: To identify frailty in elderly patients with T2DM treated in a tertiary care outpatient clinic in the southeast of Brazil and to estimate their cognition. Methods: This is a cross-sectional analytical study. The patients were classified according to the five Fried frailty phenotype criteria: (1) unintentional weight loss ≥ 4.5 kg or 5% of body weight in the previous year; (2) exhaustion assessed by self-reported fatigue, indicated by two questions on the Center for Epidemiological Studies Depression Scale; (3) weakness measured with a dynamometer in the dominant hand and adjusted according to gender and body mass index (BMI); (4) low level of physical activity measured by weekly energy expenditure in kcal (based on self-reported activities and physical exercises); (5) slowness, according to the time spent walking 4.6 meters adjusted by gender and height. In addition, we also evaluated fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), BMI, calf and waist circumference. To estimate the cognition, we used the 10-point cognitive screener (10-CS) to indicate temporal orientation, category fluency and words recall. Results: 50 elderly patients (39 women and 11 men) with mean age of 69.8 years were evaluated. The mean FPG levels was 168 ± 72 mg/dl and HbA1c > 7% was present in 82% of them. BMI ≥ 25 kg/m2 was observed in 40 patients (80%). All male patients have a normal calf circumference (> 34 cm) and 30/39 female patients (76.9%) have a normal calf circumference (> 33 cm). Waist circumferences ≥ 80 cm in women and ≥ 94 cm in men were present in 100% of women and 90.9% of men. Frailty was observed in 34% (n=17) and cognitive impairment in 40% (n=20) of the patients, according to the five Fried frailty phenotype criteria and CS-10, respectively. Conclusion: Early detection of frailty is very important for considering interventions aimed at elderly people. These interventions could reduce the functional decline and the risk of disability in these individuals over time and, besides that, are able to promote a better quality of life.