住院老年2型糖尿病患者合并营养不良的影响因素分析

Analysis of malnutrition prevalence and its influencing factors in hospitalized elderly patients with type 2 diabetes

目的分析住院老年2型糖尿病(T2DM)患者合并营养不良情况及其影响因素。方法采用横断面研究,连续入选2021年1月至2024年3月在北京协和医院老年医学科住院治疗的年龄≥65岁T2DM患者,采用单因素分析及多因素logistic回归分析老年T2DM患者营养不良的影响因素。结果共入选资料完整、年龄≥65岁的T2DM患者420例,其中男性187例(44.5%);年龄65~91岁,中位年龄76岁。所有入选患者中,合并营养不良者150例(35.7%)。与无营养不良的T2DM患者相比,营养不良患者的住院时间更长;营养风险筛查评分、体重指数、白蛋白及前白蛋白水平更低;手握力、步速、日常生活活动能力及工具性日常生活活动能力(IADL)评分明显更低;需要辅助行走、过去1年内有跌倒史的比例更高;空腹血糖及三酰甘油水平较低,超敏C反应蛋白水平更高(均P<0.05)。多因素logistic回归分析显示,握力(OR=0.945,95%CI:0.914~0.977,P=0.001)、步速(OR=2.888,95%CI:1.110~7.518,P=0.030),IADL(OR=0.757,95%CI:0.655~0.875,P<0.001),以及1年内跌倒史(OR=1.849,95%CI:1.135~3.012,P=0.014)是老年T2DM患者合并营养不良的影响因素。结论住院老年T2DM患者合并营养不良的患病率高。握力和步速减低、低IADL,以及过去1年内有跌倒史是老年T2DM患者合并营养不良的影响因素。

Objective To analyze the malnutrition prevalence and its influencing factors in hospitalized elderly patients with type 2 diabetes(T2DM).Methods A cross-sectional study was conducted on T2DM patients aged 65 years or older who were hospitalized in the Department of Geriatric of Peking Union Medical College Hospital from January 2021 to March 2024.Univariate analysis and multivariate logistic regression were utilized to analyze the factors related to malnutrition in elderly patients with T2DM.Results A total of 420 elderly patients with Type 2 Diabetes Mellitus(T2DM)were included in the study,with complete data and aged 65 years or older.Among them,187 cases(44.5%)were male,with ages ranging from 65 to 91 years and a median age of 76 years.Of the total patients,150 cases(35.7%)were identified as malnourished.Patients with malnutrition had longer hospital stays compared to those without malnutrition.Additionally,they exhibited lower NRS 2002 score,BMI,albumin,and prealbumin levels,as well as reduced handgrip strength,walking speed,ADL,and IADL scores.Furthermore,a higher proportion of malnourished patients required assisted walking and had experienced falls within the past year.Fasting blood glucose and triglyceride levels were lower in malnourished patients,while high-sensitivity C-reactive protein levels were significantly higher(all P<0.05).Multivariate logistic regression analysis showed grip strength(OR=0.945,95%CI:0.914-0.977,P=0.001),walking speed(OR=2.888,95%CI:1.110-7.518,P=0.030),instrumental activity of daily living(IADL)(OR=0.757,95%CI:0.655-0.875,P<0.001),and history of falls within 1 year(OR=1.849,95%CI:1.135-3.012,P=0.014)were associated with malnutrition in elderly T2DM patients.Conclusions The prevalence of malnutrition is notably high among hospitalized elderly patients with T2DM.Factors such as reduced grip strength and gait speed,limitations in Instrumental Activities of Daily Living(IADL),and a recent history of falls within the past year are significant indicators associated with malnutrition in elderly T2DM patients.