Research paper|Articles in Press

Complications and comorbidities as influencing factors of health outcomes in older adults with type 2 diabetes mellitus

Published:September 18, 2022DOI:



      Complications and comorbidities might increase medical burdens and lead to poor health outcomes among people aged 65 years and older who suffer from type 2 diabetes mellitus (T2DM).


      The aim of this study was to investigate whether the presence of complications and comorbidities was associated with poor health outcomes among older adults with T2DM.


      A cross-sectional study was conducted in an outpatient endocrinology department of a teaching hospital in Taiwan. In total, 577 community-dwelling participants with T2DM aged 65 years and older were recruited. Health outcomes were measured by a body composition analyser, a blood biochemical examination, and structured self-reported questionnaires, including the Mini Nutritional Assessment, Activities of Daily Living, Healthy Diet Behaviour, International Physical Activity Questionnaire, and self-reported complications (retinopathies, nephropathies, neuropathies, and foot problems) and comorbidities (hypertension, hyperlipidaemia, heart diseases, and sarcopenia).


      Participants' average age was 73.94 ± 6.73 years. Participants with complications exhibited significantly decreased levels of self-rated health (β = −0.09) and significantly higher sedentary times (β = 0.13). Participants with complications (β = −0.14) and sarcopenia (β = −0.13) had significantly decreased levels of activities of daily living. Participants with complications (β = −0.06) and hyperlipidaemia (β = −0.19) had significantly decreased muscle strength. Participants with complications (odds ratio (OR [95% confidence interval]): 0.46 [0.29, 0.72]) and hypertension (OR: 0.64 [0.42, 0.99]) had significantly lower odds of falling in the past year.


      Complications and comorbidities are important factors affecting health outcomes among older adults with T2DM. Complications and hypertension, hyperlipidaemia, and sarcopenia might lead to poor subjective and objective health outcomes. This study makes suggestions for policymakers and clinical health professionals as to the importance of monitoring and preventing complications and comorbidities.


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        • Akalu Y.
        • Belsti Y.
        Hypertension and its associated factors among type 2 diabetes mellitus patients at Debre Tabor general hospital, Northwest Ethiopia.
        Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. 2020; 13: 1621-1631
        • Brown C.D.
        • Higgins M.
        • Donato K.A.
        • Rohde F.C.
        • Garrison R.
        • Obarzanek E.
        • et al.
        Body mass index and the prevalence of hypertension and dyslipidemia.
        Obesity Research. 2000; 8: 605-619
        • Bukht M.
        • Ahmed K.R.
        • Hossain S.
        • Masud P.
        • Sultana S.
        • Khanam R.
        Association between physical activity and diabetic complications among Bangladeshi type 2 diabetic patients.
        Diabetes and Metabolic Syndrome Clinical Research and Reviews. 2018; 13: 806-809
        • Cederlund R.I.
        • Thomsen N.
        • Thrainsdottir S.
        • Eriksson K.F.
        • Sundkvist G.
        • Dahlin L.B.
        Hand disorders, hand function, and activities of daily living in elderly men with type 2 diabetes.
        Journal of Diabetes and Its Complications. 2009; 23: 32-39
        • Chang K.V.
        • Hung C.Y.
        • Li C.M.
        • Lin Y.H.
        • Wang T.G.
        • Tsai K.S.
        • Han D.S.
        Reduced flexibility associated with metabolic syndrome in community-dwelling elders.
        Plos One. 2015; 10e0117167
        • Chang A.H.
        • Liu C.Y.
        • Yang C.Y.
        A relativity study of dietary behavior and metabolic syndrome among the patients suffering from chronic schizophrenia in the rehabilitation wards of specialized hospitals.
        The Journal of Psychiatric Mental Health Nursing. 2018; 13: 19-28
        • Chen L.K.
        • Woo J.
        • Assantachai P.
        • Auyeung T.W.
        • Chou M.Y.
        • Iijima K.
        • et al.
        Asian Working Group for Sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment.
        Journal of the American Medical Directors Association. 2020; 21: 300-307
        • Chu J.J.
        • Chen X.J.
        • Shen S.S.
        • Zhang X.F.
        • Chen L.Y.
        • Zhang J.M.
        • He J.
        • Zhao J.F.
        A poor performance in comprehensive geriatric assessment is associated with increased fall risk in elders with hypertension: a cross-sectional study.
        Journal of Geriatric Cardiology: JGC. 2015; 12: 113-118
        • Chung S.M.
        • Moon J.S.
        • Chang M.C.
        Prevalence of sarcopenia and its association with diabetes: a meta-analysis of community-dwelling Asian population.
        Frontiers in Medicine. 2021; 8: 1-9
        • Cohen J.
        Statistical power analysis for the behavioral sciences.
        Routledge, New York2013
        • Deshpande A.D.
        • Harris-Hayes M.
        • Schootman M.
        Epidemiology of diabetes and diabetes-related complications.
        Physical Therapy. 2008; 88: 1254-1264
        • Du Y.
        • Karvellas C.J.
        • Baracos V.
        • Williams D.C.
        • Khadaroo R.G.
        • Group E.S.A.
        Sarcopenia is a predictor of outcomes in very elderly patients undergoing emergency surgery.
        Surgery. 2014; 156: 521-527
        • Fan D.
        • Li L.
        • Li Z.
        • Zhang Y.
        • Ma X.
        • Wu L.
        • Qin G.
        Effect of hyperlipidemia on the incidence of cardio-cerebrovascular events in patients with type 2 diabetes.
        Lipids in Health and Disease. 2018; 17: 102
        • Göbl C.
        • Tura A.
        Focus on nutritional aspects of sarcopenia in diabetes: current evidence and remarks for future research.
        Nutrients. 2022; 14: 312
        • Gangavati A.
        • Hajjar I.
        • Quach L.
        • Jones R.N.
        • Kiely D.K.
        • Gagnon P.
        • et al.
        Hypertension, orthostatic hypotension, and the risk of falls in a community-dwelling elderly population: the maintenance of balance, independent living, intellect, and zest in the elderly of Boston study.
        Journal of the American Geriatrics Society. 2011; 59: 383-389
        • Huang J.
        • He F.
        • Gu X.
        • Chen S.
        • Tong Z.
        • Zhong S.
        Estimation of sarcopenia prevalence in individuals at different ages from Zheijang province in China.
        Aging. 2021; 13: 1-10
        • Iglay K.
        • Hannachi H.
        • Howie P.J.
        • Xu J.
        • Li X.
        • Engel S.S.
        • Moore L.M.
        • Rajpathak S
        Prevalence and co-prevalence of comorbidities among patients with type 2 diabetes mellitus.
        Current Medical Research and Opinion. 2016; 32: 1243-1252
        • Jelinek H.F.
        • Osman W.M.
        • Khandoker A.H.
        • Khalaf K.
        • Lee S.
        • Almahmeed W.
        • Alsafar H.S.
        Clinical profiles, comorbidities and complications of type 2 diabetes mellitus in patients from United Arab Emirates.
        BMJ Open Diabetes Research and Care. 2017; 5e000427
        • Kanazawa I.
        • Takeno A.
        • Tanaka K.I.
        • Yamane Y.
        • Sugimoto T.
        Osteoporosis and vertebral fracture are associated with deterioration of activities of daily living and quality of life in patients with type 2 diabetes mellitus.
        Journal of Bone and Mineral Metabolism. 2019; 37: 503-511
        • Kawada T.
        Body mass index is a good predictor of hypertension and hyperlipidemia in a rural Japanese population.
        International Journal of Obesity. 2002; 26: 725-729
        • Ko G.J.
        • Kalantar-Zadeh K.
        • Goldstein-Fuchs J.
        • Rhee C.M.
        Dietary approaches in the management of diabetic patients with kidney disease.
        Nutrients. 2017; 9: 824
        • Li R.
        • Bilik D.
        • Brown M.B.
        • Zhang P.
        • Ettner S.L.
        • Ackermann R.T.
        • Crosson J.C.
        • Herman W.H.
        Medical costs associated with type 2 diabetes complications and comorbidities.
        American Journal of Managed Care. 2013; 19: 421-430
        • Lin X.
        • Xu Y.
        • Pan X.
        • Xu J.
        • Ding Y.
        • Sun X.
        • et al.
        Global, regional, and national burden and trend of diabetes in 195 countries and territories: an analysis from 1990 to 2025.
        Scientific Reports. 2020; 10: 14790
        • Liou T.M.
        Doctor thesis.
        National Taiwan University, Taiwan2004
        • Lloyd A.
        • Sawyer W.
        • Hopkinson P.
        Impact of long-term complications on quality of life in patients with type 2 diabetes not using insulin.
        Value in Health. 2001; 4: 392-400
        • Mauricio D.
        • Alonso N.
        • Gratacos M.
        Chronic diabetes complications: the need to move beyond classical concepts.
        Trends in Endocrinology & Metabolism. 2020; 31: 287-295
        • Mazloomzadeh S.
        • Zarandi F.K
        • Shoghli A.
        • Dinmohammadi H.
        Metabolic syndrome, its components and mortality: a population-based study.
        Medical Journal of The Islamic Republic Iran. 2019; 33: 1-5
        • Nomura T.
        • Kawae T.
        • Kataoka H.
        • Ikeda Y.
        Aging, physical activity, and diabetic complications related to loss of muscle strength in patients with type 2 diabetes.
        Physical Therapy Research. 2018; 21: 33-38
        • Nowakowska M.
        • Zghebi S.S.
        • Ashcroft D.M.
        • Buchan I.
        • Chew-Graham C.
        • Holt T.
        • Mallen C.
        • Marwijk H.V.
        • Peek N.
        • Perera-Salazar R.
        • Reeves D.
        • Rutter M.K.
        • Weng S.F.
        • Qureshi N.
        • Mamas M.A.
        • Kontopantelis E.
        The comorbidity burden of type 2 diabetes mellitus: patterns, clusters and predictions from a large English primary care cohort.
        BMC Medicine. 2019; 17: 1-10
        • Oh S.W.
        Obesity and metabolic syndrome in Korea.
        Diabetes & Metabolism Journal. 2011; 35: 561-566
        • Okur M.E.
        • Karantas I.D.
        • Siafaka P.I.
        Diabetes mellitus: a review on pathophysiology, current status of oral pathophysiology, current status of oral medications and future perspectives.
        Acta Pharmaceutica Sciencia. 2017; 55: 61-82
        • Opperman A.M.
        • de Klerk M.
        A total cost perspective of type 1 and 2 diabetes mellitus in two South African medical schemes servicing the public healthcare sector.
        South African Medical Journal. 2021; 111: 635-641
        • Pacifico J.
        • Geerlings M.A.J.
        • Reijnierse E.M.
        • Phassouliotis C.
        • Lim W.K.
        • Maier A.B.
        Prevalence of sarcopenia as a comorbid disease: a systematic review and meta-analysis.
        Experimental Gerontology. 2020; 131110801
        • Qiao Y.S.
        • Chai Y.H.
        • Gong H.J.
        • Zhuldyz Z.
        • Stehouwer C.D.
        • Zhou J.B.
        • et al.
        The ssociation between diabetes mellitus and risk of sarcopenia: accumulated evidences from observational studies.
        Frontiers in Endocrinology. 2021; 12: 1-10
        • Rubenstein L.Z.
        • Harker J.O.
        • Salva A.
        • Guigoz Y.
        • Vellas B.
        Screening for undernutrition in geriatric practice: developing the Short-Form Mini Nutritional Assessment (MNA-SF).
        Journal of Gerontology. 2001; 56: M366-M372
      1. Taiwan Health Promotion Administration, Ministry of Health and Welfare. (2019). Diet behavior questionnaire.

        • Tilling L.M.
        • Darawil K.
        • Britton M.
        Falls as a complication of diabetes mellitus in older people.
        Journal of Diabetes and its Complications. 2006; 20: 158-162
        • Tugwell P.
        • Knottnerus J.A.
        Multimorbidity and comorbidity are now separate MESH headings.
        Journal of Clinical Epidemiology. 2019; 105: vi-viii
        • Urina-Jassir M.
        • Herrera-Parra L.J.
        • Vargas J.A.H.
        • Valbuena-García A.M.
        • Acuña-Merchán L.
        • et al.
        The effect of comorbidities on glycemic control among Colombian adults with diabetes mellitus: a longitudinal approach with real-world data.
        BMC Endocrine Disorders. 2021; 21 (2021): 128
        • Velazquez-Alva M.C.
        • Irigoyen-Camacho M.E.
        • Zepeda-Zepeda M.A.
        • Lazarevich I.
        • Arrieta-Cruz I.
        • D'Hyver C
        Sarcopenia, nutritional status and type 2 diabetes mellitus: a cross-sectional study in a group of Mexican women residing in a nursing home.
        Nutrition & Dietetics. 2020; 77: 515-522
        • Wallace M.
        • Shelkey M.
        Monitoring functional status in hospitalized older adults.
        American Journal of Nursing. 2008; 108: 64-71
        • Wang D.
        • Li Y.
        • Lee S.G.
        • Wang L.
        • Fan J.
        • Zhang G.
        • Wu J.
        • Ji Y.
        • Li S.
        Ethnic differences in body composition and obesity related risk factors: study in Chinese and white males living in China.
        Plos One. 2011; 6: e19835
      2. World Health Organization. (2022). Diabetes.

        • Yang Y.
        • Hu X.
        • Zhang Q.
        • Zou R.
        Diabetes mellitus and risk of falls in older adults: a systematic review and meta-analysis.
        Age and Ageing. 2016; 45: 761-767