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Malnutrition worsens mortality risk in type 2 diabetes

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February 7, 2018

Among older adults with type 2 diabetes, those diagnosed with malnutrition are nearly 70% more likely to die of any cause vs. those without diagnosed nutrition deficiencies, according to findings from a retrospective study.

“Although the term ‘malnutrition’ is most often associated with undernutrition, it can also result from overnutrition, specific nutrient deficiencies, increased dietary requirements or poor nutrient absorption, or increased nutrient losses due to certain diseases,” Naseer Ahmed, MD, director of clinical development at Abbott Nutrition in Columbus, Ohio, and colleagues wrote in the study background. “Acute or chronic diseases and treatment interventions may also lead to the aggravation of malnutrition, especially undernutrition, due to changes in metabolism. This disease-related malnutrition complicates treatment plans and negatively impacts patient outcomes, such as recovery time, risk for complications and readmission rates, which exert a greater pressure on health services.”

In a retrospective, observational study, Ahmed and colleagues analyzed CMS claims data from 1999 to 2014 for beneficiaries without diabetes for at least 1 year before receiving an initial diagnosis of diabetes (n = 15,121,131). The cohort was then stratified into two groups: those diagnosed with a form of malnutrition (n = 801,272; mean age, 75 years; 57.63% women; 74.93% white) and those without a nutrition deficiency (n = 14,319,859; mean age, 71 years; 52.79% women; 79.24% white). The primary outcome was survival time, calculated as the time from diagnosis of diabetes until death. Health care utilization, including total annual cost, was a secondary outcome.

The analysis on propensity score-matched data for the effect of common conditions on survival showed that the risk for death in beneficiaries with diabetes increased by 69% in malnourished older adults vs. those without nutrition deficiencies (HR = 1.69; 99.9% CI, 1.64-1.75), according to researchers. Compared with patients without nutrition deficiencies, patients with diabetes and malnutrition were more likely to die of ischemic heart disease (HR = 1.63; 95% CI, 1.58-1.68), chronic obstructive pulmonary disorder (HR = 1.6; 95% CI, 1.55-1.65), stroke or transient ischemic attack (HR = 1.57; 95% CI, 1.53-1.62), heart failure (HR = 1.54; 95% CI, 1.5-1.59), chronic kidney disease (HR = 1.5; 95% CI, 1.46-1.55) and acute myocardial infarction (HR = 1.47; 95% CI, 1.43-1.52).

After propensity score matching, researchers found that the Kaplan-Meier survival curve for time to death from diagnosis of diabetes revealed that median survival times for malnourished adults and older adults without nutrition deficiencies were 2.38 years and 5.08 years, respectively.

Additionally, average annual health care costs for patients with malnutrition was 1.7 times higher vs. those without diagnosed nutrition deficiencies (median, $36,079 vs. $20,787; P < .0001).

“Malnutrition in patients with diabetes further compounded the cost of diabetes care with a well over 50% increase,” the researchers wrote. “The results of this study may help guide nutrition assessment and clinical decision-making for the betterment of care for patients with diabetes, as well as lead to potentially significant cost savings. Given that patients experience short-term and long-term impact on survival after being diagnosed with diabetes, malnutrition assessment and diagnosis should be crucially considered and initiated at the time of diabetes diagnosis.” – by Regina Schaffer

Disclosures: Abbott Nutrition sponsored this study. All but one study author report being employees and shareholders of Abbott. Another author reports serving on the advisory board for Abbott Nutrition.

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