Diabetics should be screened for malnutrition to avoid complications
Blood glucose regulation and nutrition are inextricably linked and several research papers have highlighted a relationship between malnutrition and diabetes. Endocrinologist and nutritionist Agnès Sallé recently published the latest findings on the consequences of diabetes in French journal Nutrition Clinique et Métabolisme.
Higher prevalence of protein-energy malnutrition in diabetes patients
Data combined from various studies and observations reveals a link between diabetes and a lack of vitamins B12 and D, zinc and magnesium. Protein-energy malnutrition was also observed, especially in elderly people. This issue reduces the quality of life of diabetics and leads to more frequent hospitalisation. Several population studies, including the well-known NHANES, reveal a lower level of plasma albumin in diabetics and a higher prevalence of malnutrition (over 20% of participants) or a risk of malnutrition (over 30%). Malnutrition increases the risk of dying in hospital by 2.7 times, increases the length of a hospital stay by 3-6 days and reduces the chances of returning home.
More serious illness linked with malnutrition
Malnutrition in diabetics worsens their state, especially foot sores. Where foot ulcers are present, malnutrition – assessed by the MNA or GRNI – is often the culprit. According to studies, only 15-38% of patients do not suffer from malnutrition. Nutritional status affects the risk of infection and amputation. A study of 262 type 2 diabetics reports that 62% of subjects with foot ulcers are moderately to severely malnourished and 69.6% are severely infected. The risk of amputation is multiplied by 11 in the case of severe malnutrition (MNA<17) compared to a non-malnourished patient.
To Sallé, screening of patients with a foot wound and the treatment of any malnutrition is essential and could change the outlook for the patient. According to Gau et al (2016), an one-percentage-point increase in MNA lessens the risk of major amputation by 19% and minor amputation by 10%.
The factors at play in malnutrition are the same as for non-diabetics: physiological alterations related to age that affect appetite and sensory perception, psycho-sociological alterations that affect the quantity and nutritional quality of diet. This is combined with inefficient glycaemic control, which alters protein metabolism, insulin resistance and insulinopenia which lead to the catabolism of muscle protein and therefore muscle wasting.
Le diabète, facteur de dénutrition et de carences en micronutriments. Agnès Sallé. Nutrition Clinique et métabolisme 32 (2018) 8-21. https://www.sciencedirect.com/science/article/pii/S0985056217301942