Carlos Cano-Gutierrez*, Felipe Botero-RodriÌguez, Diego Andres Chavarro-Carvajal, Elkin Garcia- Cifuentes, Gabriel Gomez, Juan Diego Misas, Daniela Alejandra Gracia, Suela Sulo, Bjoern Schwander and Luis Carlos Venegas-Sanabria
Introduction: Diabetes imposes clinical and economic burdens on healthcare systems worldwide. For people with diabetes, having poor nutritional status increases risks for complications and poor outcomes, thus raising costs for healthcare. Our analysis assessed the impact of a nutrition-focused quality improvement program (QIP) on outcomes for older community-living adults with diabetes.
Research design and methods: Eligible patients were ≥ 60 years and receiving care at an outpatient clinic in Bogotá, Colombia. Enrollees had malnutrition or its risk by Mini Nutritional Assessment-Short Form (MNA-SF) scores. We tracked a subpopulation of patients with diabetes who participated in QIP intervention as
(i) Education on healthy diet+physical exercise,
(ii) Individualized dietary counseling, and
(iii) Diabetes-specific oral nutritional supplements (ONS; Glucerna®, Abbott, USA) for daily intake over 60 days.
Follow-up measures of nutritional outcomes (MNA-SF, calf circumference), physical functionality (Short Physical Performance Battery, SPPB), and healthcare utilization (hospitalizations, emergency department and outpatient visits) were monitored to 30 days after ONS intake ended (90 days after intervention start). Economic modeling was used to estimate corresponding healthcare costs.
Results and conclusion: 618 patients completed intervention and follow-up; of these, 114 (18.4%) had diabetes diagnoses. Patients with diabetes were older adults (74.8 ± 8.5 years) with 3.4 ( ± 1.5) comorbid conditions. Comparing pre-and post-QIP measures, we found improvements in nutritional status (MNA-SF scores 9.2 vs 11.7, p<0.001, and calf circumference 30.9 cm vs 32.8 cm, p<0.001) and functionality (SPPB scores 6.70 to 7.13, p=0.027). Healthcare utilization was significantly decreased (2.99 vs 1.92 incidents, p<0.001). With intervention, relative risk reductions were significant for hospitalizations (↓88%), emergency department visits (↓63%), and outpatient visits (↓24%). Per-patient cost savings were $ 270 for the 90-day study interval. Nutrition-focused intervention for undernourished, older, community-living adults with diabetes was associated with improved nutritional status, higher functionality, and reduced healthcare use/costs-highlighting ‘value’ in nutritional support.
Published Date: 2024-02-06; Received Date: 2024-01-09
