In diabetics, screening for undernutrition is essential to limit the complications of diabetes

There are many interactions between glycoregulation disorder and nutrition. Several studies seem to associate the presence of certain deficiencies and undernutrition with diabetes. Agnès Sallé, endocrinologist and nutritionist, provides an update on the nutritional consequences of diabetes in the journal Nutrition Clinique et Métabolisme.

More frequent protein-energy malnutrition
Data from cross-sectional and observational studies show strong links between diabetes and deficiencies in vitamin B12, vitamin D, zinc and magnesium. An association with protein-energy malnutrition is also reported, especially in the elderly. This morbid association alters the quality of life of diabetics and makes their hospitalization more frequent. Several population studies including the famous NHANES report a lower plasma albumin level in diabetics and a greater prevalence of undernutrition (over 20% of subjects) or risk of undernutrition (over 30%). This undernutrition is often associated with a 2.7 times greater risk of dying in hospital, an increase in the length of stay in hospital (from 3 to 6 additional days) and a decrease in the chances of returning to hospital. home.

A worsened prognosis and complications
In diabetic patients, undernutrition worsens the prognosis, especially that of foot wounds. When there are foot wounds, undernutrition, assessed by the MNA or the GRNI is particularly common. According to studies only 15 to 38% of patients are not undernourished. Nutritional status also influences the risk of infection and amputation: a study of 262 type 2 diabetics reports that 62% of people with a foot ulcer are moderately to severely malnourished and 69.6% of them are severely infected. The risk of major amputation is multiplied by 11 in the event of severe undernutrition (MNA <17) compared to an undernourished subject.

For the endocrinologist, the nutritional assessment of patients with a foot ulcer and the management of undernutrition is essential and can condition the patient’s future. The 1 point increase in MNA is associated with a 19% decrease in major amputations and a 10% decrease in minor amputations in the study by Gau et al (2016).

As for the factors involved in the appearance of undernutrition, they are the same as in non-diabetic subjects: age-related physiological changes affecting appetite and sensory perceptions, psychosocial changes impacting quantity and quality nutritional intake. Added to these are poor glycemic control which impairs protein metabolism as well as insulin resistance and insulinopenia causing muscle protein catabolism and muscle wasting.