Caruso L B, Silliman R A, Demissie S, Greenfield S, Wagner E H
Department of Medicine, School of Medicine, Boston University, Massachusetts, USA.
J Gerontol A Biol Sci Med Sci. 2000 Jul;55(7):M372-7. doi: 10.1093/gerona/55.7.m372.
Older persons with type 2 diabetes are at higher risk for functional impairment than are their age-matched counterparts without-diabetes. We therefore sought to identify factors associated with impaired physical function in older persons with type 2 diabetes by using a cross-sectional study design.
We studied 1238 persons with type 2 diabetes who were 55 years of age or older and enrolled in the Type II Diabetes Patient Outcomes Research Team (PORT) project. Subjects were primary care patients at a large staff model health maintenance organization who had completed a mailed survey that collected information about demographics (age, race, marital status, income, education, gender, and body mass index [BMI]), health behaviors (exercise, smoking, and alcohol), care and control of diabetes (therapy, self-reported glucose control, home glucose monitoring, and disease duration), mood (Center for Epidemiologic Studies--Depression Scale [CES-D]), comorbidity, and the Short-Form-36 health survey (SF-36). We evaluated the bivariate relationships between the PFI- 10, a 10-item measure of physical function from the SF-36, and candidate independent variables from the domains described previously. Variables that were significant at an a level of .10 were entered into a multiple linear regression model.
There were eight independent predictors of impaired physical function (all p < .05, R2 = .40). Factors associated with impaired function in order of their relative importance were as follows: a higher comorbidity score, older age, obesity, lack of regular exercise, CES-D score higher than 20, taking insulin, lower formal education, and abstinence from alcohol.
Increased comorbidity and older age are associated with poorer function, as is the severity of diabetes and less formal education. Exercise, lower BMI, and better mood are associated with better function. Therefore, promoting regular exercise and weight loss, in addition to treating depression, are likely to preserve or even improve the functional status of older persons with type 2 diabetes. Moderate alcohol use may be beneficial as well. The extent to which these relationships persist in prospective studies or clinical trials remains to be evaluated.
与年龄匹配的非糖尿病老年人相比，2型糖尿病老年人发生功能障碍的风险更高。因此，我们采用横断面研究设计，试图确定2型糖尿病老年人身体功能受损的相关因素。
我们研究了1238名年龄在55岁及以上、参加II型糖尿病患者结局研究团队（PORT）项目的2型糖尿病患者。研究对象是一家大型员工模式健康维护组织的初级保健患者，他们完成了一份邮寄调查问卷，该问卷收集了有关人口统计学（年龄、种族、婚姻状况、收入、教育程度、性别和体重指数[BMI]）、健康行为（运动、吸烟和饮酒）、糖尿病的护理和控制（治疗、自我报告的血糖控制、家庭血糖监测和病程）、情绪（流行病学研究中心抑郁量表[CES-D]）、合并症以及简短健康调查36项量表（SF-36）的信息。我们评估了SF-36中10项身体功能测量指标PFI-10与上述领域的候选自变量之间的双变量关系。在α水平为0.10时具有显著性的变量被纳入多元线性回归模型。
有8个身体功能受损的独立预测因素（所有p<0.05，R2 = 0.40）。按相对重要性顺序排列，与功能受损相关的因素如下：合并症评分较高、年龄较大、肥胖、缺乏规律运动、CES-D评分高于20、使用胰岛素、正规教育程度较低以及戒酒。
合并症增加、年龄较大与功能较差有关，糖尿病严重程度和正规教育程度较低也与功能较差有关。运动、较低的BMI和较好的情绪与较好的功能有关。因此，除治疗抑郁症外，促进规律运动和减肥可能有助于维持甚至改善2型糖尿病老年人的功能状态。适度饮酒也可能有益。这些关系在前瞻性研究或临床试验中的持续程度仍有待评估。
