Frailty measurement, prevalence, incidence, and clinical implications in people with diabetes: a systematic review and study-level meta-analysis.
Frailty measurement, prevalence, incidence, and clinical implications in people with diabetes: a systematic review and study-level meta-analysis.
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DOI：
10.1016/s2666-7568(20)30014-3
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发表时间：
2020-12
期刊：
影响因子：
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通讯作者：
Mair FS
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作者：
Hanlon P;Fauré I;Corcoran N;Butterly E;Lewsey J;McAllister D;Mair FS
虚弱是一种易受不良健康后果影响的状态，在糖尿病管理中很重要。我们的目的是量化糖尿病患者虚弱的患病率，并总结虚弱与一般结局（如死亡率）和糖尿病特异性结局（如低血糖）之间的相关性。在这项系统性综述和研究级荟萃分析中，我们检索了MEDLINE、Embase和Web of Science，以查找2001年1月1日（Fried虚弱表型最初发表的年份）至2019年11月26日期间发表的观察性研究。我们纳入了评估和量化18岁及以上糖尿病成年人虚弱程度的研究;并排除了会议摘要、灰色文献和未以英语发表的研究。使用试点数据提取表提取合格研究的数据。我们的主要结果是糖尿病患者虚弱的患病率。次要结局是虚弱的发生率和一般和糖尿病特异性结局。在可能的情况下，通过随机效应荟萃分析评估数据，在人群异质性太大而无法进行荟萃分析的情况下，通过叙述综合评估数据。本研究在PROSPERO注册，CRD 42020163109。在我们确定的3038项研究中，有118项研究使用了20种不同的脆弱性指标，符合纳入条件（n=1 375 373）。 最常用的虚弱指标是虚弱表型（118项研究中的69项[58%]）、虚弱（16项[14%]）和脆弱量表（10项[8%]）。研究在环境（88项研究基于社区，18项基于门诊，10项基于住院，2项基于住宿护理机构）、人口统计学和纳入标准方面具有异质性;因此，我们无法对主要结局进行荟萃分析，而是使用叙述性综合总结患病率数据。使用虚弱表型的中位社区虚弱患病率为13%（IQR 9-21）。在评估该结局的14项研究中，有13项（93%）虚弱与死亡率一致相关（合并风险比1.51 [95%CI 1.30 - 1.76]），7项研究中有7项（100%）虚弱与住院相关，5项研究中有5项（100%）虚弱与残疾相关。在1项研究中，虚弱与低血糖事件相关（<1%），在11项评估并发症的研究中，9项（82%）与微血管和大血管并发症相关，在3项评估生活质量的研究中，3项（100%）与生活质量降低相关，在3项评估认知损害的研究中，3项（100%）与认知损害相关。118项研究中有13项（11%）评估了糖化血红蛋白，发现与虚弱无一致关系。虚弱的识别和评估应该成为糖尿病护理的常规方面。需要更好地了解虚弱和高血糖之间的关系，以及虚弱对特定人群（例如，中年[年龄<65岁]的人以及低收入和中低收入国家的人）的影响，以使糖尿病指南能够针对虚弱个体进行调整。医学研究理事会。
Frailty, a state of increased vulnerability to adverse health outcomes, is important in diabetes management. We aimed to quantify the prevalence of frailty in people with diabetes, and to summarise the association between frailty and generic outcomes (eg, mortality) and diabetes-specific outcomes (eg, hypoglycaemia). In this systematic review and study-level meta-analysis, we searched MEDLINE, Embase, and Web of Science for observational studies published between Jan 1, 2001 (the year of the original publication of the Fried frailty phenotype), to Nov 26, 2019. We included studies that assessed and quantified frailty in adults with diabetes, aged 18 years and older; and excluded conference abstracts, grey literature, and studies not published in English. Data from eligible studies were extracted using a piloted data extraction form. Our primary outcome was the prevalence of frailty in people with diabetes. Secondary outcomes were incidence of frailty and generic and diabetes-specific outcomes. Data were assessed by random-effects meta-analysis where possible and by narrative synthesis where populations were too heterogeneous to allow meta-analysis. This study is registered with PROSPERO, CRD42020163109. Of the 3038 studies we identified, 118 studies using 20 different frailty measures were eligible for inclusion (n=1 375 373). The most commonly used measures of frailty were the frailty phenotype (69 [58%] of 118 studies), frailty (16 [14%]), and FRAIL scale (10 [8%]). Studies were heterogenous in setting (88 studies were community-based, 18 were outpatient-based, ten were inpatient-based, and two were based in residential care facilities), demographics, and inclusion criteria; therefore, we could not do a meta-analysis for the primary outcome and instead summarised prevalence data using a narrative synthesis. Median community frailty prevalence using frailty phenotype was 13% (IQR 9–21). Frailty was consistently associated with mortality in 13 (93%) of 14 studies assessing this outcome (pooled hazard ratio 1·51 [95% CI 1·30–1·76]), with hospital admission in seven (100%) of seven, and with disability in five (100%) of five studies. Frailty was associated with hypoglycaemia events in one study (<1%), microvascular and macrovascular complications in nine (82%) of 11 studies assessing complications, lower quality of life in three (100%) of three studies assessing quality of life, and cognitive impairment in three (100%) of three studies assessing cognitive impairment. 13 (11%) of 118 studies assessed glycated haemoglobin finding no consistent relationship with frailty. The identification and assessment of frailty should become a routine aspect of diabetes care. The relationship between frailty and glycaemia, and the effect of frailty in specific groups (eg, middle-aged [aged <65 years] people and people in low-income and lower-middle-income countries) needs to be better understood to enable diabetes guidelines to be tailored to individuals with frailty. Medical Research Council.