126 32nd World Congress of Internal Medicine (October 24-28, 2014) WCIM 2014
PS 0296 Geriatrics
Cyanocobalamin Defi ciency in Diabetic Patient
G. Halina KUSZ1, Erin SHEPPARD1 Mclaren-Flint/Michigan State University, USA1
Background: Cyanocobalamin (vitamin B12) defi ciency is common in the elderly and in people who are strict vegetarians. This defi ciency, associated with the use of met- formin, has recently been brought to medical attention.
Methods: A 102 year-old male who suffers from deafness since his young adulthood was referred by his son for a geriatric evaluation regarding confusion. Over the past three months he noticed signifi cant memory and concentration problems. The patient’s main concern was that he might have “Alzheimer’s”. The son’s concern was that “He is sharp like a shark... just recently became confused”. New onset of symptoms included forgetting family members’ names, how to use the dishwasher familiar to him for 50 years, and loss of his “sharpness’’. His past medical history included diabetes mellitus, for which he was taking, metformin. His laboratory data revealed only abnormal vita- min B12 level of 143 pg/ml. A clinical diagnosis of vitamin B12 defi ciency was made.
Cognitive symptoms improved signifi cantly after 3 months of parental B12 supple- mentation.
Results: Cyanocobalamin is one of the essential nutrients for a healthy nervous system, while metformin use may interfere with its absorption. Neurological manifes- tations of B12 defi ciency may include: ataxia, fatigue, memory problem, mood distur- bances and lack of concentration. Laboratory reports of normal total serum vitamin B12 values ranging between 130-777 pg/ml. However, functional level may be higher and values > 450 pg/ml should be considered as a cutoff for the optimal vitamin B12 level in the geriatric population. Oral supplementation may be as effective as parental.
Conclusions: As vitamin B12 defi ciency is common in elderly patients and it may be aggravated by treatment with metformin. We support some experts’ recommendation for annual screening and replacement of vitamin B12 for all older patients who are prescribed metformin.
PS 0297 Geriatrics
The Relationship of Metformin and Frailty Syndrome in Elderly with Type 2 Diabetes Mellitus
Stevent SUMANTRI1, Siti SETIATI2, Esthika DEWIASTY2, Dyah PURNAMASARI2 Universitas Pelita Harapan, Indonesia1, Universitas Indonesia, Indonesia2
Background: Type 2 diabetes (T2DM) was characterised with insulin resistance and defi ciency, furthermore with advancing age the was also an increase in insulin resist- ance. Clinical studies has proven that insulin resistance and T2DM increase the inci- dence of frailty syndrome in the elderly. Oral antidiabetics metformin was associated with the inhibition of aging process. Eventhough, there was no data that showed the relationship of metformin therapy to frailty syndrome.
Methods: This was a case control study conducted in subjects =60 years old who visited the Geriatrics and Diabetes outpatient clinic of Cipto Mangunkusumo National Referral Hospital between March and June 2013. Diagnosis of frailty was established using the FI-40 item criteria. Statistical analysis was done with SPSS 20.0, where chi- square method was used in bivariate and logistic regression method in multivariate analysis.
Results: Frailty syndrome was found in 25% of subjects (n=59), with median age of 72 years old (SD 6.27) and median of FI-40 item score was 0.18 (SD 0.085). Metformin was found to have a signifi cant relationship with frailty syndrome in the elderly dia- betics, which retained signifi cant value after multivariate analysis (adjusted OR 0.043;
95% CI 0.019-0.099; p<0.001).
Conclusions: Metformin was associated with independently lower risk of frailty syn- drome in elderly diabetics.
PS 0298 Geriatrics
Diagnostic Test of Cardiovascular Health Study(CHS), Study of Osteoporotic Fracture (SOF) and Frailty In- dex-Comprehensive Geriatric Assessment (FI-CGA) Scoring System for the Diagnosis of Frailty Syndrome Compared with Frailty Index 40 (FI-40) Items in Elderly Patients
Euphemia SETO1, Siti SETIATI2, Purwita WIJAYA LAKSMI2, Tirza TAMIN3
Universitas Pelita Harapan, Indonesia1, Universitas Indonesia, Indonesia2, Universitas Indonesia, Indonesia3 Background: Type 2 diabetes (T2DM) was characterised with insulin resistance and defi ciency, furthermore with advancing age the was also an increase in insulin resist- ance. Clinical studies has proven that insulin resistance and T2DM increase the inci- dence of frailty syndrome in the elderly. Oral antidiabetics metformin was associated with the inhibition of aging process. Eventhough, there was no data that showed the relationship of metformin therapy to frailty syndrome.
Methods: This was a case control study conducted in subjects =60 years old who visited the Geriatrics and Diabetes outpatient clinic of Cipto Mangunkusumo National Referral Hospital between March and June 2013. Diagnosis of frailty was established using the FI-40 item criteria. Statistical analysis was done with SPSS 20.0, where chi- square method was used in bivariate and logistic regression method in multivariate analysis.
Results: Frailty syndrome was found in 25% of subjects (n=59), with median age of 72 years old (SD 6.27) and median of FI-40 item score was 0.18 (SD 0.085). Metformin was found to have a signifi cant relationship with frailty syndrome in the elderly dia- betics, which retained signifi cant value after multivariate analysis (adjusted OR 0.043;
95% CI 0.019-0.099; p<0.001).
Conclusions: Metformin was associated with independently lower risk of frailty syn- drome in elderly diabetics.
PS 0299 Geriatrics
Effect of Chewing Gum Containing Xylitol on Reduc- tion of Complaints and Saliva pH in Elderly Xerostomia Patients
Dwi NGESTININGSIH1, Gunawan WIBISONO2, Rejeki RAHAYU1, Annisa RIZQI1 Medical Faculty of Diponegoro University, Indonesia1, Medical Faculty of Diponegoro University, Indonesia2 Background: In the elderly organ degeneration process occurs, either due to natural factors or because of illness. One of the things associated with degeneration in the elderly is the complaint of dry mouth (xerostomia). Xerostomia prevalence increases with age. Complaints arising from xerostomia can affect the health of teeth and oral cavity which will affect the quality of life. These complaints are infl uenced by the production of saliva and saliva pH. Nowadays there is no adequate therapy xerosto- mia, but comprehensive treatment can be cultivated in improving oral comfort and function areas. Xylitol is one of the chemicals that have been shown to be effective in inducing the production and increase the pH of saliva. Aims. Proving effect of chew- ing gum containing xylitol for decrease in complaints and saliva pH in elderly patients with xerostomia.
Methods: This study is a clinical trial (clinical trial) with Randomized Control Trial (RCT) Group Design. The study sample are 34 people were divided into two groups by simple random sampling, which is given a control group without xylitol chewing gum and the treatment group were given a xylitol chewing gum. Decrease in complaints of xerostomia were measured by a score of Xerostomia Inventory (XI), salivary pH was measured using a digital pH meter. Statistical tests using independent t test.
Results: Statistical analysis of independent t test to score XI was signifi cant differ- ence (p <0.05), but the pH of saliva was not found signifi cant difference between the control and treatment groups.
Conclusions: There is the effect of chewing gum containing xylitol in reducing XI score in elderly patients with xerostomia.
