Key summary points
The present aim of the GERODIAB study was to examine the evolution of geriatric syndromes and their relationship with survival in 987 older type 2 diabetic patients over 5 years.
AbstractSection FindingsInstitutional living, impaired activity and difficulties in instrumental daily activity, cognitive disorders, orthostatic hypotension and hypoglycaemia strongly increased during the follow-up.
Institutional living, impaired activities, cognitive disorders and hypoglycaemia were strongly associated with reduced survival but not falls.
AbstractSection MessageOur results confirm the prognostic interest of using yearly geriatric markers in older diabetic patient management.
Abstract
Purpose
Although one in three patients with diabetes in Western countries is over 70 years-old, geriatric syndromes and their relationship with survival remain seldom studied. The present aim of the GERODIAB study was to examine the evolution of geriatric disorders and their relationship with survival in older type 2 patients with diabetes with initial sufficient autonomy.
Methods
We performed a prospective, observational study over 5 years in patients with diabetes aged 70 years or above. A total of 987 consecutive type 2 patients with diabetes (mean age 77 years, range 70–94 years, 65.2% were 75 years and above, 52.1% women) were included from 56 French diabetic centres. Individual characteristics, diabetes parameters and geriatric parameters (autonomy, nutrition, cognitive alteration, depression, orthostatic hypotension, falls) were annually recorded. Survival was analysed using the Kaplan–Meier method and proportional hazards regression models.
Results
Institutional living, impaired activity and difficulties in instrumental daily activity, cognitive disorders, malnutrition, depression, orthostatic hypotension and hypoglycaemia strongly increased during the follow-up. Institutional living, impaired activity and difficulties in instrumental daily activity, cognitive disorders and hypoglycaemia were strongly associated with reduced survival, but not falls. In hazard ratio models, living in an institution (HR = 2.39; CI = 1.77–3.24; p < 0.0001) and impaired Activity of Daily Living scale score were the most significant and independent predictors of death (HR = 1.59; CI = 1.19–2.13; p = 0.0016), associated with HbA1c ≥ 70 mmol/mol (HR = 1.62; CI = 1.12–2.36; p = 0.011).
Conclusion
Our findings show the considerable alteration of geriatric parameters and their relationship with decreased survival after a 5-year follow-up in type 2 patients with diabetes, independent of HbA1c and age. They, therefore, confirm the prognostic interest of using yearly geriatric markers in older diabetic patient management, especially the ADL, IADL and MMSE scales. Taking into account these prognostic parameters should contribute to target appropriate HbA1c goals.
Trial Registration
Registered at clinicaltrials.gov (21/01/2011): NCT01282060.
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Data availability
No additional unpublished data available.
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Acknowledgements
We would like to thank C. Hilbert (CRO Umanis) for data collection and management. We also thank S. Martin for her contribution to statistical analyses and J. Klain-Ratziu for her contribution to the translation. The list of all investigators is presented in Appendix 1.
Funding
All authors had financial support (unrestricted grants) from The French National PHRC, the Francophone Society for Diabetes (SFD), Novo-Nordisk Foundation and Merck-Serono Company for the submitted work; there were no financial relationships with any organisations that might have an interest in the submitted work. during the preceding 3 years; there were no other relationships or activities that might have influenced the submitted work.
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JD and BB designed the study, analysed the results and wrote the article. CV and LB designed the study and wrote the article. AR, AAZ and CBB analysed the results.
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The study protocol was submitted to the French CCTIRS and CNOM ethics committees and was approved on April 9, 2009 and May 7, 2009, respectively.
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Patients were required to give their verbal consent to participate in the study after being fully informed (for patients with cognitive disorders, consent was required from family).
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Doucet, J., Verny, C., Bordier, L. et al. Evolution in geriatric syndromes and association with survival over 5 years in the GERODIAB cohort of older French diabetic patients. Eur Geriatr Med 12, 619–625 (2021). https://doi.org/10.1007/s41999-020-00425-9
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DOI: https://doi.org/10.1007/s41999-020-00425-9