Top

Journal of Endocrinological Investigation

Open Access 18-06-2023 | Diabetes | Original Article

The multidimensional prognostic index (MPI) predicts long-term mortality in old type 2 diabetes mellitus patients: a 13-year follow-up study

Authors: F. Salis, E. Cossu, A. Mandas

Published in: Journal of Endocrinological Investigation

Abstract

Purpose

The Multidimensional Prognostic Index (MPI) is a tool capable of holistically frame older patients in different settings and affected by different pathologies, establishing a risk of adverse events. Among them, type 2 diabetes mellitus (T2DM), a common metabolic disease in the elderly, is responsible for complications and deaths. Few previous works have focused specifically on MPI and DM, and none have followed up the patients for more than 3 years. The aim of the present study is to analyze MPI accuracy in predicting mortality in a cohort of T2DM patients followed-up for 13 years.

Methods

The enrolled subjects were evaluated with MPI, identifying three levels of risk: MPI1 (low risk, 0.0–0.33), MPI2 (moderate risk, 0.34–0.66), and MPI3 (severe risk, 0.67–1.0), and with glycated hemoglobin, and years since T2DM diagnosis.

Results

One hundred and seven patients met the inclusion criteria. MPI3 was excluded by further analysis since it was made up of only three patients. Overall, cognitive performances, autonomies in daily living, nutritional status, risk of pressure injuries, comorbidities, and taken drugs were better (p ≤ 0.0077) in MPI1 than MPI2; moreover, the story of T2DM was shorter (p = 0.0026). Cox model showed an overall 13-year survival of 51.9%, and survival rates were significantly smaller in MPI2 (HR: 4.71, p = 0.0007). Finally, increased age (HR: 1.15), poorer cognitive abilities (HR: 1.26), vascular (HR: 2.15), and kidney (HR: 2.17) diseases were independently associated with death.

Conclusion

Our results prove that MPI predicts short-, mid-, and even long-term mortality in T2DM patients, whose death seems to be related to age and cognitive status, and even more to vascular and kidney diseases.

Cruz-Jentoft AJ, Sayer AA (2019) Sarcopenia [published correction appears in Lancet. 2019 Jun 29;393(10191):2590]. Lancet 393(10191):2636–2646. https://doi.org/10.1016/S0140-6736(19)31138-9 CrossRefPubMed

Salis F, Mandas A (2023) Physical performance and falling risk are associated with five-year mortality in older adults: an observational cohort study. Medicina 59(5):964. https://doi.org/10.3390/medicina59050964 CrossRefPubMedPubMedCentral

Wang DXM, Yao J, Zirek Y, Reijnierse EM, Maier AB (2020) Muscle mass, strength, and physical performance predicting activities of daily living: a meta-analysis. J Cachexia Sarcopenia Muscle 11(1):3–25. https://doi.org/10.1002/jcsm.12502 CrossRefPubMed

Salis F, Costaggiu D, Mandas A (2023) Mini-mental state examination: optimal cut-off levels for mild and severe cognitive impairment. Geriatrics 8(1):12. https://doi.org/10.3390/geriatrics8010012 CrossRefPubMedPubMedCentral

Moura ARDS, Paz SMRSD, Frota KMG, Carvalho CMRG (2022) Lifestyle associated with risk of metabolic syndrome in adults and the elderly. Nutrition 99–100:111647. https://doi.org/10.1016/j.nut.2022.111647 CrossRefPubMed

Salis F, Locci G, Mura B, Mandas A (2023) Anemia in elderly patients-the impact of hemoglobin cut-off levels on geriatric domains. Diagnostics (Basel) 13(2):191. https://doi.org/10.3390/diagnostics13020191 CrossRefPubMed

Robles NR, Macias JF (2015) Hypertension in the elderly. Cardiovasc Hematol Agents Med Chem 12(3):136–145. https://doi.org/10.2174/1871525713666150310112350 CrossRefPubMed

Sunayama T, Matsue Y, Dotare T, Maeda D, Iso T, Morisawa T, Saitoh M, Yokoyama M, Jujo K, Takahashi T, Minamino T (2022) Multidomain frailty as a therapeutic target in elderly patients with heart failure. Int Heart J 63(1):1–7. https://doi.org/10.1536/ihj.21-839 CrossRefPubMed

Salis F, Palimodde A, Demelas G, Scionis MI, Mandas A (2023) Frailty and comorbidity burden in atrial fibrillation. Front Public Health 9(11):1134453. https://doi.org/10.3389/fpubh.2023.1134453 CrossRef

10.

Guthrie RA, Guthrie DW (2004) Pathophysiology of diabetes mellitus. Crit Care Nurs Q 27(2):113–125. https://doi.org/10.1097/00002727-200404000-00003 CrossRefPubMed

11.

American Diabetes Association (2013) Diagnosis and classification of diabetes mellitus. Diabetes Care 36(Suppl 1):S67-74. https://doi.org/10.2337/dc13-S067 CrossRef

12.

Skyler JS, Bakris GL, Bonifacio E, Darsow T, Eckel RH, Groop L, Groop PH, Handelsman Y, Insel RA, Mathieu C, McElvaine AT, Palmer JP, Pugliese A, Schatz DA, Sosenko JM, Wilding JP, Ratner RE (2017) Differentiation of diabetes by pathophysiology, natural history, and prognosis. Diabetes 66(2):241–255. https://doi.org/10.2337/db16-0806. ( Epub 2016 Dec 15) CrossRefPubMed

13.

Brunton S (2016) Pathophysiology of type 2 diabetes: the evolution of our understanding. J Fam Pract 65(4 Suppl):supp_az_0416 PubMed

14.

Desai S, Deshmukh A (2020) Mapping of type 1 diabetes mellitus. Curr Diabetes Rev 16(5):438–441. https://doi.org/10.2174/1573399815666191004112647 CrossRefPubMed

15.

Park JJ (2021) Epidemiology, pathophysiology, diagnosis and treatment of heart failure in diabetes. Diabetes Metab J 45(2):146–157. https://doi.org/10.4093/dmj.2020.0282. ( Epub 2021 Mar 25. Erratum in: Diabetes Metab J. 2021 Sep; 45(5):796) CrossRefPubMedPubMedCentral

16.

Chobot A, Górowska-Kowolik K, Sokołowska M, Jarosz-Chobot P (2018) Obesity and diabetes—not only a simple link between two epidemics. Diabetes Metab Res Rev 34(7):e3042. https://doi.org/10.1002/dmrr.3042. ( Epub 2018 Jul 17) CrossRefPubMedPubMedCentral

17.

Grossman A, Grossman E (2017) Blood pressure control in type 2 diabetic patients. Cardiovasc Diabetol 16(1):3. https://doi.org/10.1186/s12933-016-0485-3 CrossRefPubMedPubMedCentral

18.

Bonora E, Cataudella S, Marchesini G, Miccoli R, Vaccaro O, Fadini GP, Martini N, Rossi E, under the mandate of the Italian Diabetes Society (2021) Incidence of diabetes mellitus in Italy in year 2018. A nationwide population-based study of the ARNO Diabetes Observatory. Nutr Metab Cardiovasc Dis 31(8):2338–2344. https://doi.org/10.1016/j.numecd.2021.04.017. ( Epub 2021 May 3) CrossRefPubMed

19.

Bonora E, Cataudella S, Marchesini G, Miccoli R, Vaccaro O, Fadini GP, Martini N, Rossi E (2020) Clinical burden of diabetes in Italy in 2018: a look at a systemic disease from the ARNO Diabetes Observatory. BMJ Open Diabetes Res Care 8(1):e001191. https://doi.org/10.1136/bmjdrc-2020-001191 CrossRefPubMedPubMedCentral

20.

Kecskemeti V, Bagi Z, Pacher P, Posa I, Kocsis E, Koltai MZ (2002) New trends in the development of oral antidiabetic drugs. Curr Med Chem 9(1):53–71. https://doi.org/10.2174/0929867023371427 CrossRefPubMed

21.

Dahlén AD, Dashi G, Maslov I, Attwood MM, Jonsson J, Trukhan V, Schiöth HB (2022) Trends in antidiabetic drug discovery: FDA approved drugs, new drugs in clinical trials and global sales. Front Pharmacol 12:807548. https://doi.org/10.3389/fphar.2021.807548 CrossRefPubMedPubMedCentral

22.

Flory J, Lipska K (2019) Metformin in 2019. JAMA 321(19):1926–1927. https://doi.org/10.1001/jama.2019.3805 CrossRefPubMedPubMedCentral

23.

Tsapas A, Avgerinos I, Karagiannis T, Malandris K, Manolopoulos A, Andreadis P, Liakos A, Matthews DR, Bekiari E (2020) Comparative effectiveness of glucose-lowering drugs for type 2 diabetes: a systematic review and network meta-analysis. Ann Intern Med 173(4):278–286. https://doi.org/10.7326/M20-0864. ( Epub 2020 Jun 30) CrossRefPubMed

24.

Mohammed I, Hollenberg MD, Ding H, Triggle CR (2021) A critical review of the evidence that metformin is a putative anti-aging drug that enhances healthspan and extends lifespan. Front Endocrinol (Lausanne). 12:718942. https://doi.org/10.3389/fendo.2021.718942 CrossRefPubMedPubMedCentral

25.

Sayyed Kassem L, Aron DC (2020) The assessment and management of quality of life of older adults with diabetes mellitus. Expert Rev Endocrinol Metab 15(2):71–81. https://doi.org/10.1080/17446651.2020.1737520. ( Epub 2020 Mar 16) CrossRefPubMed

26.

Chellappan DK, Yap WS, Bt Ahmad Suhaimi NA, Gupta G, Dua K (2018) Current therapies and targets for type 2 diabetes mellitus. Panminerva Med 60(3):117–131. https://doi.org/10.23736/S0031-0808.18.03455-9. ( Epub 2018 Apr 24) CrossRefPubMed

27.

Bonora E, Cataudella S, Marchesini G, Miccoli R, Vaccaro O, Fadini GP, Martini N, Rossi E, mandate of the Italian Diabetes Society (2021) Initial treatment of diabetes in Italy. A nationwide population-based study from of the ARNO Diabetes Observatory. Nutr Metab Cardiovasc Dis 31(9):2661–2668. https://doi.org/10.1016/j.numecd.2021.06.006. ( Epub 2021 Jun 22) CrossRefPubMed

28.

Cowie MR, Fisher M (2020) SGLT2 inhibitors: mechanisms of cardiovascular benefit beyond glycaemic control. Nat Rev Cardiol 17(12):761–772. https://doi.org/10.1038/s41569-020-0406-8. ( Epub 2020 Jul 14) CrossRefPubMed

29.

Salvatore T, Galiero R, Caturano A, Rinaldi L, Di Martino A, Albanese G, Di Salvo J, Epifani R, Marfella R, Docimo G, Lettieri M, Sardu C, Sasso FC (2022) An overview of the cardiorenal protective mechanisms of SGLT2 inhibitors. Int J Mol Sci 23(7):3651. https://doi.org/10.3390/ijms23073651 CrossRefPubMedPubMedCentral

30.

Ng E, Shaw JE, Wood A, Maple-Brown LJ, Hare MJ (2022) Glucagon-like peptide-1 receptor agonist (GLP1-RA) therapy in type 2 diabetes. Aust J Gen Pract 51(7):513–518. https://doi.org/10.31128/AJGP-07-21-6057 CrossRefPubMed

31.

Puglisi S, Rossini A, Poli R, Dughera F, Pia A, Terzolo M, Reimondo G (2021) Effects of SGLT2 inhibitors and GLP-1 receptor agonists on renin-angiotensin-aldosterone system. Front Endocrinol (Lausanne). 12:738848. https://doi.org/10.3389/fendo.2021.738848 CrossRefPubMedPubMedCentral

32.

Salis F, Loddo S, Zanda F, Peralta MM, Serchisu L, Mandas A (2022) Comprehensive geriatric assessment: application and correlations in a real-life cross-sectional study. Front Med (Lausanne). 9:984046. https://doi.org/10.3389/fmed.2022.984046 CrossRefPubMedPubMedCentral

33.

Pilotto A, Ferrucci L, Franceschi M, D’Ambrosio LP, Scarcelli C, Cascavilla L, Paris F, Placentino G, Seripa D, Dallapiccola B, Leandro G (2008) Development and validation of a multidimensional prognostic index for one-year mortality from comprehensive geriatric assessment in hospitalized older patients. Rejuvenation Res 11(1):151–161. https://doi.org/10.1089/rej.2007.0569 CrossRefPubMed

34.

Overbeek FCMS, Goudzwaard JA, van Hemmen J, van Bruchem-Visser RL, Papma JM, Polinder-Bos HA, Mattace-Raso FUS (2022) The multidimensional prognostic index predicts mortality in older outpatients with cognitive decline. J Clin Med 11(9):2369. https://doi.org/10.3390/jcm11092369 CrossRefPubMedPubMedCentral

35.

Gallucci M, Battistella G, Bergamelli C, Spagnolo P, Mazzuco S, Carlini A, Di Giorgi E, Boldrini P, Pilotto A (2014) Multidimensional prognostic index in a cognitive impairment outpatient setting: mortality and hospitalizations. The Treviso Dementia (TREDEM) study. J Alzheimers Dis 42(4):1461–1468. https://doi.org/10.3233/JAD-140516 CrossRefPubMed

36.

Veronese N, Vianello S, Danesin C, Tudor F, Pozzobon G, Pilotto A (2021) Multidimensional prognostic index and mortality in intermediate care facilities: a retrospective study. J Clin Med 10(12):2632. https://doi.org/10.3390/jcm10122632 CrossRefPubMedPubMedCentral

37.

Custodero C, Senesi B, Pinna A, Floris A, Vigo M, Fama M, Mastropierro V, Sabbà C, Prete C, Pilotto A (2021) Validation and implementation of telephone-administered version of the multidimensional prognostic index (TELE-MPI) for remote monitoring of community-dwelling older adults. Aging Clin Exp Res 33(12):3363–3369. https://doi.org/10.1007/s40520-021-01871-6. ( Epub 2021 May 18) CrossRefPubMedPubMedCentral

38.

Cammalleri V, Bonanni M, Bueti FM, Matteucci A, Cammalleri L, Stifano G, Muscoli S, Romeo F (2021) Multidimensional prognostic index (MPI) in elderly patients with acute myocardial infarction. Aging Clin Exp Res 33(7):1875–1883. https://doi.org/10.1007/s40520-020-01718-6. ( Epub 2020 Oct 1) CrossRefPubMed

39.

Custodero C, Gandolfo F, Cella A, Cammalleri LA, Custureri R, Dini S, Femia R, Garaboldi S, Indiano I, Musacchio C, Podestà S, Tricerri F, Pasa A, Sabbà C, Pilotto A (2021) Multidimensional prognostic index (MPI) predicts non-invasive ventilation failure in older adults with acute respiratory failure. Arch Gerontol Geriatr 94:104327. https://doi.org/10.1016/j.archger.2020.104327. ( Epub 2020 Dec 24) CrossRefPubMed

40.

Vitale E, Notarnicola A, Moretti L, Antonio E, Pesce V, Moretti B (2012) Multidimensional prognostic index in the elderly with hip or neck femur fracture. Orthop Rev (Pavia). 4(2):e15. https://doi.org/10.4081/or.2012.e15. ( Epub 2012 Apr 12) CrossRefPubMedPubMedCentral

41.

Musacchio C, Custodero C, Razzano M, Raiteri R, Delrio A, Torriglia D, Stella M, Puntoni M, Sabbà C, Barone A, Pilotto A (2022) Association between multidimensional prognostic index (MPI) and pre-operative delirium in older patients with hip fracture. Sci Rep 12(1):16920. https://doi.org/10.1038/s41598-022-20734-2 CrossRefPubMedPubMedCentral

42.

Pilotto A, Panza F, Sancarlo D, Paroni G, Maggi S, Ferrucci L (2012) Usefulness of the multidimensional prognostic index (MPI) in the management of older patients with chronic kidney disease. J Nephrol 25(Suppl 19):S79-84. https://doi.org/10.5301/jn.5000162 CrossRefPubMed

43.

Pilotto A, Noale M, Maggi S, Addante F, Tiengo A, Perin PC, Rengo G, Crepaldi G (2014) Hypoglycemia is independently associated with multidimensional impairment in elderly diabetic patients. Biomed Res Int 2014:906103. https://doi.org/10.1155/2014/906103. ( Epub 2014 Feb 13) CrossRefPubMedPubMedCentral

44.

Pilotto A, Panza F, Copetti M, Simonato M, Sancarlo D, Gallina P, Strandberg T, MPI_AGE Project Investigators (2015) Statin treatment and mortality in community-dwelling frail older patients with diabetes mellitus: a retrospective observational study. PLoS ONE 10(6):e0130946. https://doi.org/10.1371/journal.pone.0130946 CrossRefPubMedPubMedCentral

45.

Giantin V, Falci C, De Luca E, Valentini E, Iasevoli M, Siviero P, Maggi S, Martella B, Crepaldi G, Monfardini S, Manzato E (2018) Performance of the multidimensional geriatric assessment and multidimensional prognostic index in predicting negative outcomes in older adults with cancer. Eur J Cancer Care (Engl). 27(1):e12585. https://doi.org/10.1111/ecc.12585. ( Epub 2016 Oct 10) CrossRef

46.

Giantin V, Valentini E, Iasevoli M, Falci C, Siviero P, De Luca E, Maggi S, Martella B, Orrù G, Crepaldi G, Monfardini S, Terranova O, Manzato E (2013) Does the multidimensional prognostic index (MPI), based on a comprehensive geriatric assessment (CGA), predict mortality in cancer patients? Results of a prospective observational trial. J Geriatr Oncol 4(3):208–217. https://doi.org/10.1016/j.jgo.2013.04.008. ( Epub 2013 May 24) CrossRefPubMed

47.

Pilotto A, Azzini M, Cella A, Cenderello G, Castagna A, Pilotto A, Custureri R, Dini S, Farinella ST, Ruotolo G, Padovani A, Custodero C, Veronese N, Italian Geriatric Society Hospital and Community (SIGOT) Study Group (2021) The multidimensional prognostic index (MPI) for the prognostic stratification of older inpatients with COVID-19: a multicenter prospective observational cohort study. Arch Gerontol Geriatr 95:104415. https://doi.org/10.1016/j.archger.2021.104415. ( Epub 2021 Apr 5) CrossRefPubMedPubMedCentral

48.

Pfeiffer E (1975) A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc 23(10):433–441. https://doi.org/10.1111/j.1532-5415.1975.tb00927.x CrossRefPubMed

49.

Pashmdarfard M, Azad A (2020) Assessment tools to evaluate activities of daily living (ADL) and instrumental activities of daily living (IADL) in older adults: a systematic review. Med J Islam Repub Iran 13(34):33. https://doi.org/10.34171/mjiri.34.33 CrossRef

50.

Vellas B, Guigoz Y, Garry PJ, Nourhashemi F, Bennahum D, Lauque S, Albarede JL (1999) The mini nutritional assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition 15(2):116–122. https://doi.org/10.1016/s0899-9007(98)00171-3 CrossRefPubMed

51.

Loddo S, Salis F, Rundeddu S, Serchisu L, Peralta MM, Mandas A (2022) Nutritional status and potentially inappropriate medications in elderly. J Clin Med 11(12):3465. https://doi.org/10.3390/jcm11123465 CrossRefPubMedPubMedCentral

52.

Bliss MR, McLaren R, Exton-Smith AN (1966) Mattresses for preventing pressure sores in geriatric patients. Mon Bull Minist Health Public Health Lab Serv 25:238–268 PubMed

53.

Parmelee PA, Thuras PD, Katz IR, Lawton MP (1995) Validation of the cumulative illness rating scale in a geriatric residential population. J Am Geriatr Soc 43(2):130–137. https://doi.org/10.1111/j.1532-5415.1995.tb06377.x CrossRefPubMed

54.

Weykamp C (2013) HbA1c: a review of analytical and clinical aspects. Ann Lab Med 33(6):393–400. https://doi.org/10.3343/alm.2013.33.6.393. ( Epub 2013 Oct 17) CrossRefPubMedPubMedCentral

55.

Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE (2017) What is polypharmacy? A systematic review of definitions. BMC Geriatr 17(1):230 ( Published 2017 Oct 10) CrossRefPubMedPubMedCentral

56.

Salis F, Palimodde A, Rundeddu S, Mandas A (2023) STOPP/START anti-aggregation and anticoagulation alerts in atrial fibrillation [published online ahead of print, 2023 Apr 18]. Curr Vasc Pharmacol. https://doi.org/10.2174/1570161121666230418163016 CrossRefPubMed

57.

Rankin A, Cadogan CA, Patterson SM, Kerse N, Cardwell CR, Bradley MC, Ryan C, Hughes C (2018) Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev 9(9):CD008165. https://doi.org/10.1002/14651858.CD008165.pub4 CrossRefPubMed

58.

Farcet A, Delalande G, Oliver C, Retornaz F (2016) À propos du dosage de l’HbA1c chez le sujet âgé [about the HbA1c in the elderly]. Geriatr Psychol Neuropsychiatr Vieil 14(1):42–48. https://doi.org/10.1684/pnv.2016.0588 CrossRefPubMed

59.

Nanayakkara N, Curtis AJ, Heritier S et al (2021) Impact of age at type 2 diabetes mellitus diagnosis on mortality and vascular complications: systematic review and meta-analyses. Diabetologia 64(2):275–287. https://doi.org/10.1007/s00125-020-05319-w CrossRefPubMed

60.

Koye DN, Magliano DJ, Nelson RG, Pavkov ME (2018) The global epidemiology of diabetes and kidney disease. Adv Chronic Kidney Dis 25(2):121–132. https://doi.org/10.1053/j.ackd.2017.10.011 CrossRefPubMed

61.

Schlesinger S, Neuenschwander M, Barbaresko J et al (2022) Prediabetes and risk of mortality, diabetes-related complications and comorbidities: umbrella review of meta-analyses of prospective studies. Diabetologia 65(2):275–285. https://doi.org/10.1007/s00125-021-05592-3 CrossRefPubMed

62.

Faselis C, Katsimardou A, Imprialos K, Deligkaris P, Kallistratos M, Dimitriadis K (2020) Microvascular complications of type 2 diabetes mellitus. Curr Vasc Pharmacol 18(2):117–124. https://doi.org/10.2174/1570161117666190502103733 CrossRefPubMed

Title: The multidimensional prognostic index (MPI) predicts long-term mortality in old type 2 diabetes mellitus patients: a 13-year follow-up study
Authors: F. Salis
E. Cossu
A. Mandas
Publication date: 18-06-2023
Publisher: Springer International Publishing
Keywords: Diabetes
Type 2 Diabetes
Geriatric Assessment
Published in: Journal of Endocrinological Investigation
Electronic ISSN: 1720-8386
DOI: https://doi.org/10.1007/s40618-023-02135-y

Webinar | 08-11-2023 | 18:00 (CET)

Keynote Webinar | Spotlight on Diet and Diabetes

Watch now

An expert-led symposium exploring the prevention and management of type 2 diabetes through dietary interventions. Highlights include discussion of the recent EASD guidelines, therapeutic diets, food types and processing, plus psychological factors that influence patient success, and the drivers of healthy eating and diabetes control.

Prof. Mike Lean

Prof. Falko Sniehotta

Keynote Webinar | Spotlight on Diet and Diabetes

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Keynote Webinar | Spotlight on Diet and Diabetes