Nutrition Management in Elderly with Diabetes Mellitus: Literature Review

. Diabetes often occurs in the elderly who have become a great social burden. The effects of diabetes are weakness, cognitive dysfunction which is closely related to the aging mechanism. Nutritional management is one of the therapeutic diets as the cornerstone of diabetes treatment based on healthy and wise dietary guidelines. The purpose of this study was to determine the nutritional management of the elderly in diabetes mellitus. The research method used is a literature review and to select studies using the PRISMA Checklist protocol and PICOS format To determine the articles to be reviewed from Googlescholar and PubMed, 15 articles were found that met the criteria indicating that nutritional management in the elderly with diabetes mellitus must consider the quality of health (health status, activity, functional and psychological status), nutritional intake (vitamins, minerals, and fiber). ), and changing eating habits by following a healthy diet.


Introduction
Diabetes Mellitus is a disease caused by inadequate control of blood sugar levels.Diabetes mellitus has many subclassifications, including type 1, type 2, young adult-onset diabetes (MODY), gestational diabetes, neonatal diabetes, and steroid-induced diabetes (Sapra & Bhandari, 2021).The incidence in 2019 is estimated at 37.3 million or 11.3% of people in America suffer from diabetes mellitus and 1.9 million people have type 1 diabetes, including approximately 244,000 children and adolescents who are diagnosed or undiagnosed (ADA, 2018).
Complications of diabetes often occur due to microvascular and macrovascular complications due to increased blood sugar levels, so dietary management is needed in order to prevent complications and a consequent increase in knowledge, attitudes and dietary practices leading to better disease control.(Khazrai et al., 2014).The elderly have two-thirds of the diabetes population by 2025 who are at risk of coexisting chronic conditions such as hypertension, dyslipidemia, and cardiovascular disease that affect nutritional needs.The problem of achieving and maintaining optimal body weight in elderly diabetics is not as easy as in other age groups (Rizvi, 2009).Diabetes in the elderly increases the risk of suboptimal nutrition, and malnutrition (Sanz-París & Lardiés-Sánchez, 2019).In Indonesia, the prevalence of diabetes mellitus is ranked 7th as a country with the highest number of around 10.7 million people (Lestari, 2021).The prevalence of diabetes at the age of 20-79 years globally in 2019 was 9.3 percent and in the North Sumatra region, 1.8 percent had been diagnosed with DM (Manao, 2021).Elderly with diabetes mellitus, often experience poor and irregular eating patterns that cause a very drastic drop in blood sugar levels.Low fluid intake in the elderly can also cause dehydration, and will result in the disease experienced.Nutritional and dietary assessments should be part of the elderly personal care plan (Hartono, 2021).The increase in prevalence due to being overweight in the elderly has an impact on insulin resistance and hyperglycemia which tends to require long treatment.Excess and underweight in diabetics can signal nutritional status that causes increased morbidity and mortality if nutritional guidelines are not adjusted to the needs of diabetic patients.diabetes can cause problems accompanied by changes in appetite, food delicacy, dietary restrictions, loneliness, and depression that can affect the type and amount of food consumed by diabetics (Rizvi, 2009).Nutritional problems experienced by people with diabetes mellitus can be overcome by performing nutritional management.Nutritional management is an integral component of nutritional therapy and diabetes self-management education (Marion et al., 2002).This is the nutritional management of the elderly with diabetes mellitus is a topic that will be carried out in this literature study.The purpose of this study is to determine the nutritional management of the elderly with diabetes mellitus based on several literature studies references.

a. Study protocol
The protocol in this study used the PRISMA statement (Moher et al., 2009) and the Joanna Briggs Institute (JBI) Reviewer's Manual (JBI, 2020).

b. Inclusion and exclusion criteria
The inclusion and exclusion criteria in this study used the PICOS format (Bettany-Saltikov, 2010).
This study included all quantitative studies related to the nutritional management of diabetes mellitus in the elderly.The approach in this systematic review looks at the extent to which the results of previous research differ and do not involve qualitative research because there is far from empirical evidence that would contradict each other.This is to avoid heterogeneity and complexity of integration.

Research Results
The 15 (fifteen) articles reviewed are presented in the following table:

Research Discussion
The main strategies in Diabetes Mellitus: 1. Considering the needs, risks and treatment of people with DM The average sodium ranges from 2.5 grams to 5.9 grams / day in the intake of vegetables that are safe for consumption in people with Diabetes Mellitus (Horikawa et al., 2021).Adequate fiber intake will cause a feeling of fullness for longer, thereby delaying hunger (Paruntu et al., 2018).
Patients with diabetes mellitus need nutritional recommendations that will meet the needs of vitamins, minerals, magnesium, sodium, and iron (Burch et al., 2018;Pena et al., 2020).

Conclusion and Future Research
The conclusion of this article is that nutritional management in diabetes mellitus requires social support that will change the behavior of the patient to pay attention to the intake of nutrients, vitamins, minerals and reduce carbohydrate levels in providing daily food.

2. Conduct a comprehensive assessment 3 .
Monitoring indications for drug and food administration (Sesti et al., 2018) 4. Maintaining health quality (self-care ability, physical and functional status (T.L. Chen et al., Diabetics also provide counseling related to indications and complications of the disease they are suffering from and avoid psychological problems (James et al., 2021; Leung et al., 2018; Naito et al., 2019).Lifestyle changes will affect the behavior and mood of people with diabetes mellitus (García-Molina et al., 2020).Nutrition performed on patients must be individualized by considering eating habits, metabolism, physical activity, and the presence of comorbidities (Tumiwa & Langi, 2013).During the Covid-19 pandemic, nutritional needs are a top priority for comorbidities such as diabetes mellitus (James et al., 2021; Raveendran & Misra, 2021).Several studies say that over the age of 40, DM patients should maintain a healthy lifestyle that can prevent complications of diabetes due to high blood sugar levels.(Masruroh, 2018).

Table 1
Inclusion and exclusion criteria using the PICOS format

d. Study screening and selection A search study using keywords namely nutrition management, elderly with diabetes mellitus
f.

Extraction and synthesis of data
Full-text articles excluded, with main reasons (n =2 ) Not focusing management nutrition elderly (n =8) Not Diabetes Mellitus (n = 5) Studies included in qualitative synthesis (narrative-analysis) (n =8 ) Identification Screening Eligibility Included author's name, year, study design, method and results.

Table 2
Articles reviewed