Abstract Background Poor self-management in older patients with diabetes undergoing hemodialysis contributes to adverse outcomes, including malnutrition. However, practical tools to identify patients who require targeted support are lacking. This study aimed to establish and validate a clinical cutoff value for a Diet-Related Life Skills Scale (DRLSS) to predict poor self-care and nutritional risk in this population. Methods This multicenter, cross-sectional study included 140 patients with diabetes undergoing hemodialysis aged 65 years or older. We assessed diet-related life skills, self-care behavior, nutritional status (using the Geriatric Nutritional Risk Index GNRI), and functional/psychosocial status. Receiver operating characteristic (ROC) curve analysis was performed to determine a cutoff value for predicting poor self-care. The validity of this cutoff was tested against GNRI-defined nutritional risk, including a sensitivity analysis using an alternative GNRI threshold ( 116) demonstrated significantly better self-care ( p < 0.001) but paradoxically had a higher prevalence of moderate or higher nutritional risk ( p = 0.009). Multiple regression analysis identified the total life skills score ( β = 0.53, p < 0.001) and depression ( β = −0.198, p = 0.007) as significant independent predictors of self-care behavior. Conclusions The DRLSS is a valuable tool for assessing self-management capabilities in older patients with diabetes undergoing hemodialysis, particularly in the early old population. A clinical cutoff of 116 may help identify individuals with complex needs, including poor self-care or hidden nutritional risk, and support the design of targeted, multidisciplinary interventions. The paradoxical association between higher life skills and poorer nutritional status warrants further investigation into potential over-restriction.
Hamano et al. (Sat,) studied this question.