Kidney Function and Risk of Physical and Cognitive Impairment in Older Persons with Type 2 Diabetes at an Outpatient Clinic with Geriatric Assessment Implementation

Figures & data

Table 1 Baseline Characteristics of the Participants

Demographic Characteristics
Age (years)	72.0	(67.0–78.0)
Sex, n(%)
Female	446	(51.7%)
Male	417	(48.3%)
Educational level, n(%)
Illiterate	115	(13.4%)
Literate	745	(86.6%)
Geriatric characteristics
Polypharmacy, n (%)
No	351	(40.6%)
Yes	512	(59.3%)
Mini-mental state examination	27.0	(24.0–29.0)
5-item Geriatric Depression Scale	0	(0–1.0)
Barthel index	100.0	(100.0–100.0)
Lawton scale	7.0	(6.0–8.0)
Diabetes characteristics
Duration (years)	13.0	(7.0–19.0)
Cardiovascular disease	572	(66.3%)
Neuropathy	82	(9.5%)
Retinopathy	27	(3.1%)
Body mass index (kg/m^2)	24.8	(22.5–27.3)
Systolic blood pressure (mmHg)	130.0	(121.0–140.0)
Diastolic blood pressure (mmHg)	72.0	(63.0–79.0)
Blood hemoglobin A1c (%)	7.1	(6.5–7.9)
Fasting plasma glucose (mg/dL)	130.0	(112.0–153.0)
Triglycerides (mg/dL)	104.0	(73.0–150.0)
Low-density lipoprotein cholesterols (mg/dL)	82.0	(68.0–99.0)
Blood creatinine (mg/dL)	1.0	(0.8–1.3)
Estimated glomerular filtration rate (mL/min/1.73m^2)	70.4	(50.9–87.0)
Urine albumin-creatinine ratio (mg/g)	25.2	(9.6–99.7)
Treatment
Lifestyle modification	87	(10.1%)
Oral medications only	593	(68.7%)
Insulin only	41	(4.8%)
Oral medications + insulin	142	(16.5%)

Table 2 Characteristics of Participants According to A1C

Characteristics	A1C						p value
	<7 (n = 371)		7 ≤ Value <9 (n = 405)		≥9 (n = 87)
Demographic characteristics
Age	73.0	(68.0–78.0)	71.0	(67.0–77.0)	72.0	(69.0–79.0)	0.068
Gender, n(%)							0.107
Female	177	(47.7%)	224	(55.3%)	45	(51.7%)
Male	194	(52.3%)	181	(44.7%)	42	(48.3%)
Educational level, n(%)							0.540
Illiterate	54	(14.6%)	52	(12.8%)	9	(10.5%)
Literate	315	(85.4%)	353	(87.2%)	77	(89.5%)
Geriatric characteristics
Polypharmacy, n(%)							<0.001
No	188	(50.7%)	142	(35.1%)	21	(24.1%)
Yes	183	(49.3%)	263	(64.9%)	66	(75.9%)
Mini-mental state examination	27.0	(24.0–29.0)	27.0	(24.0–29.0)	26.0	(22.0–28.0)	0.027
5-item Geriatric Depression Scale	0	(0–1.0)	0	(0–1.0)	0	(0–1.0)	0.679
Barthel index	100.0	(100.0–100.0)	100.0	(100.0–100.0)	100.0	(100.0–100.0)	0.014
Lawton scale	7.0	(6.0–8.0)	7.0	(6.0–8.0)	7.0	(6.0–8.0)	0.161
Diabetes characteristics
Duration (years)	11.0	(6.0–16.0)	15.0	(9.0–21.0)	16.0	(11.0–22.0)	<0.001
Cardiovascular disease, n(%)							0.214
No	129	(34.8%)	140	(34.6%)	22	(25.3%)
Yes	242	(65.2%)	265	(65.4%)	65	(74.7%)
Neuropathy, n(%)							0.028
No	346	(93.3%)	361	(89.1%)	74	(85.1%)
Yes	25	(6.7%)	44	(10.9%)	13	(14.9%)
Retinopathy, n(%)							0.426
No	362	(97.6%)	389	(96.1%)	85	(97.7%)
Yes	9	(2.4%)	16	(3.9%)	2	(2.3%)
Body mass index (kg/m^2)	24.7	(22.3–27.1)	24.8	(22.7–27.3)	25.4	(23.3–29.6)	0.040
Systolic blood pressure (mmHg)	130.0	(120.0–138.0)	130.0	(122.0–140.5)	130.0	(119.0–143.0)	0.130
Diastolic blood pressure (mmHg)	71.0	(63.0–78.0)	73.0	(65.0–80.0)	69.0	(59.0–80.0)	0.200
Fasting plasma glucose (mg/dL)	120.0	(107.0–133.0)	138.0	(119.0–163.5)	184.0	(130.0–213.0)	<0.001
Triglycerides (mg/dL)	98.0	(69.0–139.0)	108.0	(76.0–159.0)	131.0	(76.0–184.0)	<0.001
Low-density lipoprotein cholesterols (mg/dL)	82.0	(68.0–95.0)	82.0	(68.0–101.0)	82.0	(63.0–106.0)	0.323
Blood creatinine (mg/dL)	1.0	(0.8–1.3)	1.0	(0.8–1.3)	1.0	(0.7–1.4)	0.227
Estimated glomerular filtration rate (mL/min/1.73m^2)	70.1	(50.2–84.8)	71.5	(53.0–87.9)	68.1	(45.2–88.7)	0.489
Urine albumin-creatinine ratio (mg/g)	19.2	(8.1–67.1)	28.2	(10.0–119.3)	43.9	(16.8–467.1)	<0.001
Treatment							<0.001
Lifestyle modification	43	(11.6%)	36	(8.9%)	8	(9.2%)
Oral medications only	291	(78.4%)	264	(65.2%)	38	(43.7%)
Insulin only	10	(2.7%)	24	(5.9%)	7	(8.1%)
Oral medications + insulin	27	(7.3%)	81	(20.0%)	34	(39.1%)

Table 3 Characteristics of Participants with and without Possible Dementia by MMSE^†

	Normal		Possible Dementia		p value
Demographic characteristics
Age (years)	71.0	(67.0–76.5)	76.0	(71.0–83.0)	<0.001
Gender, n (%)					0.274
Female	356	(50.8%)	89	(56.0%)
Male	345	(49.2%)	70	(44.0%)
Educational level, n (%)					<0.001
Illiterate	112	(16.0%)	3	(1.9%)
Literate	589	(84.0%)	156	(98.1%)
Geriatric characteristics
Polypharmacy	406	(57.9%)	104	(65.4%)	0.100
Mini-mental state examination	28.0	(26.0–29.0)	22.0	(20.0–23.0)	<0.001
5-item Geriatric Depression Scale	0	(0–1.0)	0	(0–1.0)	0.003
Barthel index	100.0	(100.0–100.0)	100.0	(100.0–100.0)	<0.001
Lawton scale	7.0	(6.0–8.0)	6.0	(4.0–8.0)	<0.001
Diabetes characteristics
Duration (years)	13.0	(7.0–19.0)	16.0	(9.0–21.0)	0.011
Cardiovascular disease	465	(66.3%)	105	(66.0%)	1.000
Neuropathy	62	(8.8%)	20	(12.6%)	0.194
Retinopathy	25	(3.6%)	2	(1.3%)	0.204
Body mass index (kg/m^2)	24.8	(22.6–27.3)	24.9	(22.4–27.5)	0.632
Systolic blood pressure (mmHg)	130.0	(122.0–139.0)	129.0	(118.0–145.0)	0.888
Diastolic blood pressure (mmHg)	72.0	(64.0–79.0)	70.0	(60.0–78.0)	0.021
Blood hemoglobin A1c (%)	7.1	(6.5–7.8)	7.2	(6.5–8.1)	0.161
Fasting plasma glucose (mg/dL)	129.0	(113.0–151.0)	134.0	(110.0–167.0)	0.288
Triglycerides (mg/dL)	103.0	(73.0–147.5)	104.0	(74.0–154.0)	0.812
Low-density lipoprotein cholesterols (mg/dL)	82.0	(68.0–98.0)	84.0	(68.0–99.0)	0.500
Blood creatinine (mg/dL)	1.0	(0.8–1.3)	1.1	(0.9–1.5)	<0.001
Estimated glomerular filtration rate (mL/min/1.73m^2)	71.9	(53.7–87.8)	60.9	(41.6–78.6)	<0.001
Urine albumin-creatinine ratio (mg/g)	21.3	(9.0–83.4)	40.4	(13.6–180.7)	<0.001
Treatment					0.027
Lifestyle modification	71	(10.1%)	16	(10.1%)
Oral medications only	496	(70.8%)	96	(60.4%)
Insulin only	31	(4.4%)	9	(5.7%)
Oral medications + insulin	103	(14.7%)	38	(23.9%)

Notes: ^†Literate & mini-mental state examination ≤24/Illiterate & mini-mental state examination ≤13.

Abbreviation: MMSE, Mini-mental State Examination.

Table 4 Characteristics of Participants with and without Dependence by ADL^†

	ADL Independence		ADL Dependence		p value
Demographic characteristics
Age (years)	72.0	(67.0–78.0)	79.5	(73.3–86.0)	<0.001
Gender, n (%)					0.011
Female	417	(50.7%)	29	(72.5%)
Male	406	(49.3%)	11	(27.5%)
Educational level, n (%)					0.014
Illiterate	104	(12.7%)	11	(27.5%)
Literate	716	(87.3%)	29	(72.5%)
Geriatric characteristics
Polypharmacy	484	(58.8%)	28	(70.0%)	0.214
Mini-mental state examination	27.0	(24.0–29.0)	20.5	(17.0–25.0)	<0.001
5-item Geriatric Depression Scale	0	(0–1.0)	1.0	(0–1.0)	<0.001
Barthel index	100.0	(100.0–100.0)	80.0	(65.0–90.0)	<0.001
Lawton scale	7.0	(6.0–8.0)	3.0	(2.0–4.8)	<0.001
Diabetes characteristics
Duration (years)	13.0	(7.0–19.0)	13.0	(7.0–24.0)	0.679
Cardiovascular disease	547	(66.5%)	25	(62.5%)	0.729
Neuropathy	75	(9.1%)	7	(17.5%)	0.092
Retinopathy	27	(3.3%)	0	(0%)	0.631
Body mass index (kg/m^2)	24.8	(22.5–27.2)	25.4	(21.9–29.3)	0.336
Systolic blood pressure (mmHg)	130.0	(121.0–140.0)	122.5	(112.3–135.8)	0.019
Diastolic blood pressure (mmHg)	72.0	(64.0–79.0)	74.5	(58.5–78.0)	0.443
Blood hemoglobin A1c (%)	7.1	(6.5–7.9)	7.1	(6.3–8.5)	0.762
Fasting plasma glucose (mg/dL)	130.0	(113.0–153.0)	130.0	(104.3–157.8)	0.755
Triglycerides (mg/dL)	102.0	(73.0–147.0)	140.0	(87.8–182.3)	0.009
Low-density lipoprotein cholesterols (mg/dL)	82.0	(68.0–99.0)	78.0	(66.0–92.8)	0.454
Blood creatinine (mg/dL)	1.0	(0.8–1.3)	1.2	(0.9–1.4)	0.008
Estimated glomerular filtration rate (mL/min/1.73m^2)	71.3	(51.5–87.4)	49.4	(39.0–65.1)	<0.001
Urine albumin-creatinine ratio (mg/g)	24.5	(9.2–94.9)	40.2	(14.1–108.8)	0.063
Treatment					0.445
Lifestyle modification	84	(10.2%)	3	(7.5%)
Oral medications only	567	(68.9%)	26	(65.0%)
Insulin only	40	(4.9%)	1	(2.5%)
Oral medications + insulin	132	(16.0%)	10	(25.0%)

Note: ^†ADL <100.

Abbreviation: ADL, activities of daily living.

Table 5 Characteristics of Participants with and without Dependence by IADL^†

	IADL Independence		IADL Dependence		p value
Demographic characteristics
Age (years)	70.0	(67.0–75.0)	74.0	(68.0–80.0)	<0.001
Gender, n (%)					<0.001
Female	283	(72.0%)	163	(34.7%)
Male	110	(28.0%)	307	(65.3%)
Educational level, n (%)					0.322
Illiterate	47	(12.0%)	68	(14.5%)
Literate	345	(88.0%)	400	(85.5%)
Geriatric characteristics
Polypharmacy	226	(57.5%)	286	(60.9%)	0.354
Mini-mental state examination	27.0	(25.0–29.0)	26.0	(23.0–28.0)	<0.001
5-item Geriatric Depression Scale	0	(0–1.0)	0	(0–1.0)	0.120
Barthel index	100.0	(100.0–100.0)	100.0	(100.0–100.0)	<0.001
Lawton scale	8.0	(8.0–8.0)	6.0	(5.0–7.0)	<0.001
Diabetes characteristics
Duration (years)	12.0	(7.0–18.0)	14.0	(8.0–21.0)	0.006
Cardiovascular disease	251	(63.9%)	321	(68.3%)	0.194
Neuropathy	31	(7.9%)	51	(10.9%)	0.173
Retinopathy	12	(3.1%)	15	(3.2%)	1.000
Body mass index (kg/m^2)	24.6	(22.4–27.1)	25.0	(22.6–27.4)	0.337
Systolic blood pressure (mmHg)	130.0	(122.0–139.0)	130.0	(120.0–140.0)	0.528
Diastolic blood pressure (mmHg)	72.0	(65.0–79.0)	71.0	(62.8–78.0)	0.131
Blood hemoglobin A1c (%)	7.1	(6.5–7.8)	7.1	(6.5–8.0)	0.301
Fasting plasma glucose (mg/dL)	128.0	(114.0–153.5)	131.0	(111.0–152.3)	0.908
Triglycerides (mg/dL)	102.0	(70.0–145.0)	105.0	(76.0–153.0)	0.216
Low-density lipoprotein cholesterols (mg/dL)	83.0	(69.0–99.0)	82.0	(67.0–98.3)	0.357
Blood creatinine (mg/dL)	0.8	(0.7–1.1)	1.1	(0.9–1.4)	<0.001
Estimated glomerular filtration rate (mL/min/1.73m^2)	76.7	(60.41–92.3)	65.0	(44.8–80.9)	<0.001
Urine albumin-creatinine ratio (mg/g)	19.6	(8.7–63.3)	31.6	(10.4–143.4)	<0.001
Treatment					0.005
Lifestyle modification	40	(10.2%)	47	(10.0%)
Oral medications only	290	(73.8%)	303	(64.5%)
Insulin only	17	(4.3%)	24	(5.1%)
Oral medications + insulin	46	(11.7%)	96	(20.4%)

Note: ^†IADL <8.

Abbreviation: IADL, instrumental activities of daily living.

Table 6 Logistic Regression Analysis for Predictors of MMSE, ADL, and IADL Impairment

MMSE Impairment	Univariate			Multivariate
	OR	95% CI	p value	OR	95% CI		p value
Age (years)	1.08	(1.06–1.11)	<0.001	1.07	(1.04–1.09)		<0.001
Diastolic blood pressure (mmHg)	0.98	(0.97–0.99)	0.009	0.99	(0.98–1.01)		0.310
Cerebral vascular disease	2.42	(1.29–4.54)	0.006	2.43	(1.25–4.74)		0.009
Disease duration (years)	1.03	(1.01–1.05)	0.003	1.01	(0.99–1.03)		0.362
Blood hemoglobin A1c (%)	1.14	(1.01–1.29)	0.034	1.10	(0.94–1.28)		0.226
Fasting plasma glucose (mg/dL)	1.00	(1.00–1.01)	0.024	1.00	(1.00–1.01)		0.257
Blood creatinine (mg/dL)	1.35	(1.07–1.70)	0.011	0.75	(0.45–1.25)		0.272
Estimated glomerular filtration rate (mL/min/1.73m^2)	0.98	(0.98–0.99)	<0.001	0.99	(0.97–1.00)		0.026
5-item Geriatric Depression Scale	1.35	(1.10–1.66)	0.005	–	–	–	–
Barthel index	0.95	(0.93–0.98)	<0.001	–	–	–	–
Lawton scale	0.69	(0.62–0.75)	<0.001	–	–	–	–
ADL Impairment	Univariate			Multivariate
	OR	95% CI	p value	OR	95% CI		p value
Age (years)	1.12	(1.08–1.17)	<0.001	1.13	(1.08–1.19)		<0.001
Male vs Female	0.39	(0.19–0.79)	0.009	0.24	(0.11–0.53)		<0.001
Systolic blood pressure (mmHg)	0.98	(0.97–1.00)	0.017	0.98	(0.97–1.00)		0.013
Estimated glomerular filtration rate (mL/min/1.73m^2)	0.98	(0.96–0.99)	<0.001	0.98	(0.97–1.00)		0.044
Mini-mental state examination	0.79	(0.73–0.84)	<0.001	–	–	–	–
5-item Geriatric Depression Scale	1.79	(1.32–2.42)	<0.001	–	–	–	–
Lawton scale	0.43	(0.36–0.52)	<0.001	–	–	–	–
IADL Impairment	Univariate			Multivariate
	OR	95% CI	p value	OR	95% CI		p value
Age (years)	1.07	(1.05–1.10)	<0.001	1.07	(1.04–1.10)		<0.001
Male vs Female	4.85	(3.62–6.48)	<0.001	4.91	(3.49–6.90)		<0.001
Disease duration (years)	1.02	(1.01–1.04)	0.005	1.01	(0.99–1.03)		0.233
Oral medications only vs Diet	0.89	(0.57–1.40)	0.610	1.19	(0.72–1.98)		0.501
Insulin only vs Diet	1.20	(0.57–2.55)	0.632	0.90	(0.38–2.13)		0.812
Oral medications + insulin vs Diet	1.78	(1.03–3.08)	0.040	2.32	(1.24–4.34)		0.009
Blood creatinine (mg/dL)	3.24	(2.31–4.54)	<0.001	1.21	(0.73–2.01)		0.458
Estimated glomerular filtration rate (mL/min/1.73m^2)	0.98	(0.98–0.99)	<0.001	0.99	(0.98–1.00)		0.219
Mini-mental state examination	0.89	(0.86–0.93)	<0.001	–	–	–	–
Barthel index	0.88	(0.81–0.96)	0.003	–	–	–	–

Abbreviations: MMSE, mini-mental state examination; ADL, activities of daily living; IADL, instrumental activities of daily living.