Geriatric rehabilitation with diabetes mellitus and frailty: a subanalysis of POSTSCRIPTUM study

Introduction. Functional activity and independence of elderly people with type 2 diabetes mellitus (DM2) depend not only on the glycaemic control, but also on the severity of geriatric syndromes. This subanalysis was conducted to study the peculiarities of the effect of individual geriatric rehabilitation (GR) programs on functional status in patients with type 2 DM2 and frailty. Aim. Evaluation of the effect of geriatric rehabilitation on the level of functional activity in patients with DM2 and frailty. Materials and methods. A subanalysis of data from POSTSCRIPTUM, a multicentre, prospective study, was conducted to evaluate the effectiveness of 21-day geriatric rehabilitation programmes for patients aged 60 years and over with senile asthenia syndrome. The subanalysis included 475 patients, who were divided into two groups: 91 patients with type 2 diabetes mellitus (DM2+ group) and 384 patients without DM (DM2– group). On visit 1, a comprehensive geriatric assessment (CGA) was performed, and a personalized 21-day GR program was developed. Visit 2 took place after the completion of GR to evaluate the effectiveness of the course. Results and discussion. The frequency of diagnosing geriatric syndromes (GS) and the distribution of frailty severity were comparable in the DM2+ and DM2– groups. Frailty was found in 38 % in the DM2+ group and 34 % in the DM2– group. Median age in the DM2+ and DM2– groups was 76 [71; 81.5] vs 80 [73; 84] years, p = 0.001. After the 3-week GR program, the DM2+ group showed an improvement in a brief battery of physical functioning tests (p 0.001), an increase in the mean MoCA (Montreal Cognitive Assessment) score of 2.06 ± 0.38 (p 0.001), a decrease in pain intensity in self-assessments according to the visual analog scale in the last week (p 0.001), decreased insomnia severity index p = 0.03), and improved MNA (Mini Nutritional Assessment) score (p = 0.006). The subgroup of patients with preasthenia gravis additionally demonstrated improvements in baseline activities of daily living, nutritional status, and a decrease in the insomnia severity index. Conclusion. The POSTSCRIPTUM study demonstrated the effectiveness of short-term individualized GR programs based on CGA results in patients with DM2 and frailty in improving physical and cognitive status; pain severity; while the subgroup of patients with preasthenia gravis showed improvement in baseline activities of daily living, nutritional status, and a decrease in the insomnia severity index.