Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, 3 chemin du Pont-Bochet, Thônex, Switzerland.
Diabetes Metab. 2012 Apr;38(2):149-55. doi: 10.1016/j.diabet.2011.10.001. Epub 2011 Nov 23.
To study the specific impact of diabetes on long-term mortality in very old subjects with multiple comorbidities and functional disabilities.
The prevalence of vascular disorders, global comorbidity load (cumulative illness rating scale [CIRS]) and functional disabilities (activities of daily living [ADL] and Lawton's instrumental ADL [IADL] scores) were determined according to diabetes status in a cohort of 444 patients (mean age 85.3±6.7 years; 74.0% women) admitted to our geriatric service. Also, the specific impact of diabetes on 4-year mortality was analyzed using Cox proportional-hazards models.
Diabetic patients had higher BMI scores (27.1±4.9 vs. 23.4±4.7 kg/m(2) in controls; P<0.001), and higher prevalences of hypertension (81.9% vs. 65.1%, respectively; P=0.003) and ischaemic heart disease (33.7% vs. 22.2%, respectively; P=0.033), but not of stroke and renal insufficiency. They also had more comorbidities (CIRS score excluding diabetes: 15.1±4.5 vs. 13.8±4.8, respectively; P=0.016) and functional disabilities. Diabetes was associated with mortality (HR: 1.42, 95% CI: 1.02-1.99; P=0.041) after adjusting for age, gender and BMI, and this persisted after adjusting for individual vascular comorbidities, but disappeared after adjusting for CIRS, ADL or IADL scores.
Diabetes was associated with 4-year mortality after adjusting for the inverse relationship between mortality and BMI. This association was better accounted for by the global comorbidity load and functional disabilities than by the individual vascular comorbidities. These findings suggest that the active management of all--rather than selected--comorbidities is the key to improving the prognosis for older diabetic patients.
研究患有多种合并症和功能障碍的非常高龄患者中糖尿病对长期死亡率的具体影响。
根据糖尿病状态，确定了 444 例（平均年龄 85.3±6.7 岁；74.0%为女性）入住我院老年科患者的血管疾病患病率、总体合并症负担（累积疾病评分量表[CIRS]）和功能障碍（日常生活活动[ADL]和 Lawton 的工具性日常生活活动[IADL]评分）。还使用 Cox 比例风险模型分析了糖尿病对 4 年死亡率的具体影响。
糖尿病患者的 BMI 评分较高（27.1±4.9 与对照组的 23.4±4.7kg/m²；P<0.001），高血压（81.9%与 65.1%；P=0.003）和缺血性心脏病（33.7%与 22.2%；P=0.033）的患病率较高，但脑卒中及肾功能不全的患病率无差异。他们的合并症（不包括糖尿病的 CIRS 评分：15.1±4.5 与 13.8±4.8；P=0.016）和功能障碍更多。在校正年龄、性别和 BMI 后，糖尿病与死亡率相关（HR：1.42，95%CI：1.02-1.99；P=0.041），在校正单个血管合并症后，这种相关性仍然存在，但在校正 CIRS、ADL 或 IADL 评分后，这种相关性消失。
在校正死亡率与 BMI 之间的反比关系后，糖尿病与 4 年死亡率相关。这种相关性可以通过总体合并症负担和功能障碍得到更好的解释，而不是通过单个血管合并症来解释。这些发现表明，积极管理所有合并症（而不是选择管理）是改善老年糖尿病患者预后的关键。
