Prospective Association Among Diabetes Diagnosis, HbA1c, Glycemia, and Frailty Trajectories in an Elderly Population
Prospective Association Among Diabetes Diagnosis, HbA1c, Glycemia, and Frailty Trajectories in an Elderly Population
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老年人群中糖尿病诊断、HbA1c、血糖和虚弱轨迹之间的前瞻性关联
DOI：
10.2337/dc19-0497
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发表时间：
2019-10-01
期刊：
影响因子：
16.2
通讯作者：
Witte, Daniel R.
中科院分区：
文献类型：
--
作者：
Aguayo, Gloria A.;Hulman, Adam;Witte, Daniel R.
目的脆弱是老年人脆弱的一种动态状态。我们研究了患有显性糖尿病或HbA（1c）或空腹血糖（FG）水平较高的个体是否会随着年龄的增长而经历不同的脆弱轨迹。研究设计和方法糖尿病、HbA（1c）和FG在基线时进行评估，虚弱状态在10年随访期间每2年用36项虚弱指数对来自英国老龄化纵向研究（艾尔莎）的参与者进行评估。使用以年龄为时间尺度的混合效应模型来评估虚弱的年龄轨迹是否随糖尿病、HbA（1c）和FG而不同。结果：在5,377名参与者中（中位年龄[四分位距] 70 [65，77]岁，45%为男性），35%在基线时虚弱。在一个调整了性别的模型中，与没有糖尿病的人相比，基线糖尿病的参与者随着年龄的增长虚弱指数增加。HbA（1c）水平较高时观察到类似结果，而FG与虚弱无关。在一个额外调整了收入、社会阶层、吸烟、酒精和血红蛋白的模型中，只有糖尿病与虚弱指数增加相关。在基线时的非虚弱受试者中，糖尿病和HbA（1c）水平均与虚弱指数随时间的增加相关。结论：糖尿病患者或基线HbA（1c）水平较高的人在以后的生活中有更高的虚弱水平。患有糖尿病或HbA（1c）较高的非虚弱参与者也经历了随着年龄增长的虚弱水平更快的恶化。这一观察结果可能反映了糖尿病并发症在虚弱轨迹中的作用，或者是导致糖尿病和晚年虚弱风险的早期共同决定因素。
OBJECTIVE Frailty is a dynamic state of vulnerability in the elderly. We examined whether individuals with overt diabetes or higher levels of HbA(1c) or fasting plasma glucose (FG) experience different frailty trajectories with aging. RESEARCH DESIGN AND METHODS Diabetes, HbA(1c), and FG were assessed at baseline, and frailty status was evaluated with a 36-item frailty index every 2 years during a 10-year follow-up among participants from the English Longitudinal Study of Ageing (ELSA). Mixed-effects models with age as time scale were used to assess whether age trajectories of frailty differed as a function of diabetes, HbA(1c), and FG. RESULTS Among 5,377 participants (median age [interquartile range] 70 [65, 77] years, 45% men), 35% were frail at baseline. In a model adjusted for sex, participants with baseline diabetes had an increased frailty index over aging compared with those without diabetes. Similar findings were observed with higher levels of HbA(1c), while FG was not associated with frailty. In a model additionally adjusted for income, social class, smoking, alcohol, and hemoglobin, only diabetes was associated with an increased frailty index. Among nonfrail participants at baseline, both diabetes and HbA(1c) level were associated with a higher increased frailty index over time. CONCLUSIONS People with diabetes or higher HbA(1c) levels at baseline had a higher frailty level throughout later life. Nonfrail participants with diabetes or higher HbA(1c) also experienced more rapid deterioration of frailty level with aging. This observation could reflect a role of diabetes complications in frailty trajectories or earlier shared determinants that contribute to diabetes and frailty risk in later life.