Rev. Bras. Geriatr. Gerontol. 2020;23(1):e190196 The frailty syndrome in older adults with type 2 diabetes mellitus and associated factors Original Articles 1 of 13 Bartolomeu Fagundes de Lima Filho1 ID Antônia Gilvanete Duarte Gama1 ID Vanessa da Nóbrega Dias1 ID Eliza Mikaele Tavares da Silva2 ID Fabricia Azevedo da Costa Cavalcanti1 ID Juliana Maria Gazzola1 ID Abstract Objective: To compare clinical-functional factors among groups in relation to the frailty syndrome (pre-frail and frail) phenotype profile in older adults with type 2 diabetes mellitus (DM 2). Methods: A descriptive, analytical, cross-sectional study with a quantitative approach was performed. A total of 113 diabetic older adults of both sexes were evaluated in terms of their personal, socio-demographic, clinical-functional, mental, cognitive and fragility phenotype data. The Chi-square test and a logistic regression model were used. Results: The mean age was 68.66±6.62 years, and the sample was mostly female (61.9%), illiterate or with an incomplete primary education (60.2%), pre-frail (52.2%), Keywords: Health of the sedentary (79.6%), and had been diagnosed with DM2 for more than 5 years (58.3%). Elderly. Frailty . Diabetes There was a significant association between “pre-frail and frail” individuals and schooling Mellitus, Type 2. (p=0.004), social participation (p=0.004), a subjective perception of vision (p=0.004), glycated hemoglobin (p=0.036), limb pain (p=0.012), depressive symptoms (p=0.002) and mobility (p=0.004). The logistic regression model showed an accuracy of 93.6% and the significant variables were education (p=0.039), pain in the lower limbs (p=0.025) and risk of falls (p=0.033). Conclusion: among all the factors related to the “pre-frail” and “frail” phenotype, schooling, pain in the lower limbs and mobility were most related to the worsening of the syndrome and its progress. 1 Universidade Federal do Rio Grande do Norte (UFRN), Programa de Pós-Graduação em Fisioterapia, Departamento de Fisioterapia, Natal, RN, Brasil. 2 Universidade Federal do Rio Grande do Norte (UFRN), Programa de Pós-Graduação em Fonoaudiologia, Departamento de Fonoaudiologia, Natal, RN, Brasil. Funding: The present study was financed in part by the Coordination for the Improvement of Higher Education Personnel (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil or CAPES) - Financial Code 001. The authors declare there are no conflicts of interest in relation to the present study. Correspondence Bartolomeu Fagundes de Lima Filho Received: September 18, 2019 [email protected] Approved: April 17, 2020 http://dx.doi.org/10.1590/1981-22562020023.200196 The frailty syndrome and diabetes INTRODUCTION Therefore, the aim of the present study was to compare the clinical-functional factors between The Frailty Syndrome (FS) among older adults groups in relation to the frailty syndrome phenotype is a complex condition leading to a decline in the profile (pre-frail and frail) in older adults with DM2 body’s homeostatic reserve capacity and also in the and, from this, to discover which of these variables resistance of stressors1. In this sense, the alterations most influence the frailty phenotype. in the body of a frail older adult generate a gradual decline in all biological systems in a pathological 2 of 13 manner, causing vulnerability and varied clinical METHOD problems2. A descriptive, analytical, cross-sectional study There are many consequences of the emergence with a quantitative approach was performed. of the FS in this population, since its characteristics Data collection took place at the Laboratory of encompass all organic systems and cause globalized Technological Innovations in Health, at the Onofre damage to the body of the older adult3. Among these Lopes University Hospital (the Hospital Universitário consequences, the decrease in homeostatic reserves Onofre Lopes, or HUOL) of the Federal University stands out. In this context, sarcopenia (loss of muscle of Rio Grande do Norte (UFRN), in Natal (Rio mass) has a significant influence on FS and is directly Grande do Norte), Brazil. The study took place associated with other chronic diseases, such as type between February and December 2017, after approval 2 Diabetes Mellitus (DM2)4. by the Research Ethics Committee under number 1.808.219, and was financed by Universal Public DM2 is a metabolic disease evidenced by Notice MCTI/CNPq no. 14/2014. blood hyperglycemia, which negatively affects the cardiac, visual, renal and nervous systems, causing The research participants were taken from the insulin resistance. Furthermore, it is associated endocrinology and geriatrics sectors of HUOL, at with dyslipidemia and possible hypertension5. Its the invitation of the doctors responsible for the prevalence can reach up to 30% in those over 65 sector. Older individuals with a clinical diagnosis years of age in certain populations while, in the of DM2 were indicated to go to the sector to make United States, it is estimated that more than half appointments for evaluation. After the first survey, of diabetic individuals are older adults6. Brazil is the evaluation was scheduled on specific days and fourth in the global diabetes ranking, with about times and lasted for about 1h30min, alternating tests 11.9 million cases registered in recent years7. The with and without physical effort, so as not to exhaust projection for 2025 is that 300 million people will the individual. The complete evaluation took place have diabetes worldwide8. on the same day, and was performed by a previously trained evaluator in the presence of the researcher, DM2 generates a decline in functional capacities to provide support for the tests and minimize the and reserves9 and frequent hospitalizations, risk of falls. culminating in a tendency of the onset of symptoms that result in the frailty syndrome, demanding more Older individuals aged over 60 years of age, who services from the health system10. were diagnosed with DM2 in accordance with the criteria of the American Diabetes Association11, The association of two chronic conditions makes whether male or female, who were able to walk treatment more difficult due to the sum of their independently and who agreed to participate by comorbidities. In this sense, the adequate treatment signing an Informed Consent Term (ICF) were of one condition is not necessarily effective for the included in the study. Older adults who did not other, hindering the desired response. A correct complete the entire assessment were excluded from and accurate diagnosis is necessary, since the the study. measurement of these diseases can be carried out in a simple, low-cost and tangible manner in any To perform the sample calculation, 80% power health system. and 5% significance level were used for the two- Rev. Bras. Geriatr. Gerontol. 2020;23(1):e190196 The frailty syndrome and diabetes tailed hypothesis tests. Among the variables with as follows: illiterate individuals should score ≥20 the greatest statistical significance for the sample points; schooling of 1-4 years ≥25 points; schooling (income, marital status, glycated hemoglobin, use of 5-8 years ≥26.5 points; schooling of 9-11 years of insulin and MMSE), the largest sample size was ≥28 points and schooling over 11 years ≥29 points12. for “income”, totaling 123 individuals, avoiding possible β error in the variables close to significance. The Geriatric Depression Scale (GDS) was In this sense, a sample size of 125 individuals was used in its reduced (or short) version to screen adopted as it is a multiple of 5 and facilitates the for depressive symptoms. A total of 15 questions 3 of 13 presentation of data. were asked with yes or no answers. An individual has depressive symptoms if reaching a score ≥5 After sample selection, an interview was points and an “absence of depressive symptoms” conducted with personal, sociodemographic, clinical- in individuals with a score ≤4 points13. functional and cognitive screening data, assessment of depressive symptoms, assessment of functional Functional mobility was assessed using the mobility and frailty phenotype. Timed Up and Go (TUG) test. This consists of measuring the time spent getting up from a chair, Personal data were assessed using a semi- walking 3 meters then returning and sitting with the structured questionnaire containing identification, back completely supported in the chair. Individuals contact details (cell phone of the older adult or with a time greater than 13.5 seconds have impaired a family member living in the same household, mobility14. or home phone), date and address. In addition, the sociodemographic data included a list with In accordance with the frailty phenotype, the demarcation of the following items: sex, age, skin following were evaluated: color, marital status, education, living arrangement, Unintentional weight loss: it was asked whether income, occupation and social participation. the individual had lost 4.5 kg or more in the year until the date of the assessment and whether this loss The clinical-functional data were: subjective was unintentional. If the answers to both questions perception of vision of excellent, very good, good, were positive, 1 point was awarded; poor and very poor; height, in meters; weight in kilograms, measured by scale, and Body Mass Index Decrease in handgrip strength assessed by the (BMI); number of diseases and medications used, SH5002 Smedley - Saehaen® Hand Dynamometer. time since diagnosis of DM2, laboratory tests of Measured with the individual sitting in a comfortable fasting glycemia and glycated hemoglobin in the last chair, supporting both feet on the floor and placing six months (from the date of the evaluation) for the their dominant hand on the assessment table, holding control of DM2; use of antidiabetic drugs and/or the dynamometer grip three times to obtain an insulin; presence of leg pain and intensity, using the average, adjusted according to Table 115. Visual Analogue Scale (VAS); falls in the last year.