Diabetes and Risk of Frailty and Its Potential Mechanisms: A Prospective Cohort Study of Older Adults
Diabetes and Risk of Frailty and Its Potential Mechanisms: A Prospective Cohort Study of Older Adults
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DOI：
10.1016/j.jamda.2015.04.008
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发表时间：
2015-09-01
影响因子：
7.6
通讯作者：
Rodriguez-Artalejo, Fernando
中科院分区：
文献类型：
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作者：
Garcia-Esquinas, Esther;Graciani, Auxiliadora;Rodriguez-Artalejo, Fernando
背景：有新的证据表明糖尿病是虚弱的一个危险因素。然而，这种关联的机制尚不明确。方法：前瞻性队列研究的1750年非机构的个人年龄在60岁或以上的招募在2008-2010年。在基线时，获得有关健康行为、发病率、心脏代谢生物标志物和抗糖尿病治疗的信息。如果个人报告医生诊断或空腹血清葡萄糖为126 mg/dL或更高，则认为他们是糖尿病患者。研究参与者随访至2012年，以评估事件脆弱性，定义为至少3个5弗里德criteria.Results：在基线，队列包括346例糖尿病患者和1404例非糖尿病患者。在平均3.5年的随访中，确定了115例事件虚弱。在对年龄、性别和教育进行调整后，糖尿病患者的虚弱风险增加（比值比[OR] 2.18，95%置信区间[CI] 1.42-3.37）。对健康行为和腹部肥胖进行额外调整后，OR降低了29.7%（OR 1.83，95%CI 1.16-2.90）。随后对发病率进行调整，结果进一步降低8.4%（OR 1.76，95% CI 1.10-2.82），对心脏代谢生物标志物进行调整，结果进一步降低44%（OR 1.32，95% CI 0.70-2.49）。特别是，调整HbA 1c，脂蛋白和甘油三酯的降幅最大。最后，口服降糖药的额外调整将OR降至1.01（95%CI 0.46-2.20），而调整营养治疗后OR增加至1.64结论：糖尿病患者易发生身体虚弱;这种关联部分是由于不健康的行为和肥胖，在更大程度上是由于糖尿病患者中血糖控制不良和血脂谱改变。相反，糖尿病营养治疗可以降低虚弱的风险。(C)2015年AMDA -急性后和长期护理医学协会。
Background: There is emerging evidence of the role of diabetes as a risk factor for frailty. However, the mechanisms of this association are uncertain.Methods: Prospective cohort study of 1750 noninstitutionalized individuals aged 60 years or older recruited in 2008-2010. At baseline, information was obtained on health behaviors, morbidity, cardiometabolic biomarkers, and antidiabetic treatments. Individuals were considered diabetic if they reported a physician diagnosis or had fasting serum glucose of 126 mg/dL or higher. Study participants were followed through 2012 to assess incident frailty, defined as at least 3 of the 5 Fried criteria.Results: At baseline, the cohort included 346 individuals with diabetes and 1404 without diabetes. Over a mean 3.5-year follow-up, 115 cases of incident frailty were ascertained. After adjustment for age, sex, and education, participants with diabetes showed an increased risk of frailty (odds ratio [OR] 2.18, 95% confidence interval [CI] 1.42-3.37). Additional adjustment for health behaviors and abdominal obesity yielded a 29.7% reduction in the OR (OR 1.83, 95% CI 1.16-2.90). Subsequent adjustment for morbidity produced an additional 8.4% reduction (OR 1.76, 95% CI 1.10-2.82), and for cardiometabolic biomarkers, a further 44% reduction (OR 1.32, 95% CI 0.70-2.49). In particular, adjustment for HbA1c, lipoproteins, and triglycerides accounted for the greatest reductions. Finally, additional adjustment for oral antidiabetic medication reduced the OR to 1.01 (95% CI 0.46-2.20), whereas adjustment for nutritional therapy increased the OR to 1.64 (95% CI 0.77-3.49).Conclusions: Diabetes mellitus is associated with higher risk of frailty; this association is partly explained by unhealthy behaviors and obesity and, to a greater extent, by poor glucose control and altered serum lipid profile among diabetic individuals. Conversely, diabetes nutritional therapy reduces the risk of frailty. (C) 2015 AMDA - The Society for Post-Acute and Long-Term Care Medicine.