Abstract
Aging patients with type 2 diabetes (T2DM) have a high risk of frailty and disability. This narrative review summarizes the current findings and future tasks regarding the following issues: (1) the optimum body mass index (BMI) target for patients with T2DM, (2) energy expenditure and requirements of patients with T2DM, and (3) the significance of low-intensity physical activity (LPA) as a key determinant of total energy expenditure (TEE) among the older population. While weight reduction is associated with an improvement in glycemic control, an increased risk of mortality as well as disability related to unhealthy BMI must also be considered, especially in older patients. The optimum BMI range and energy requirements for maintaining a healthy BMI should be identified. Limited evidence has shown that the TEE measured using the doubly labeled water method in patients with T2DM did not differ from that of subjects without diabetes, suggesting that the energy requirement data of subjects without diabetes may be applicable to these populations. LPA is one of the determinants of variability in the energy requirements of older patients with T2DM, and the beneficial effects of increasing LPA on nutritional intake and frailty prevention should be investigated further.
Highlights
Sports Medicine Research Center, Keio University, Yokohama 223-8521, Japan; Abstract: Aging patients with type 2 diabetes (T2DM) have a high risk of frailty and disability
Type 2 diabetes mellitus (T2DM) is associated with an increased risk of loss of muscle mass and strength, which will eventually lead to frailty and disability in older patients [1]
The purpose of this review is to summarize the current findings and future tasks regarding the following issues: (1) the optimum body mass index (BMI) target for patients with T2DM, (2) energy expenditure and requirements of patients with T2DM, and
Summary
A systematic review of weight loss interventions revealed a linear relationship between weight loss and HbA1c reduction, with an HbA1c reduction of 0.1% for each 1 kg of weight lost in the entire population [4]. 24–28 presented a decreasing risk of disability compared with the reference BMI These findings remain to be confirmed in patients with T2DM, the increased disability risk associated with a higher BMI must be considered in the older population. In the systematic reviews of obesity guidelines from the American College of Cardiology/American Heart Association/The Obesity Society [14], the weight reduction pattern with energy-restricted dietary intervention has been summarized as follows: (1) maximum weight loss of 4–12 kg was achieved after 6 months, and thereafter (2) slow weight regain was observed, with a total weight loss of 4–10 kg at 1 year and 3–4 kg at 2 years. Optimum BMI ranges should be considered in terms of mortality and disability in older patients, and more data are needed to determine the optimal BMI ranges for older patients with T2DM
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