Chhetri Jagadish Kumar, Zheng Zheng, Xu Xitong, Ma Cuihong, Chan Piu
Department of Geriatrics, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, No. 45 Changchun St., Beijing, Xicheng District, 100053, China.
Department of Neurobiology, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, No. 45 Changchun St., Beijing, Xicheng District, 100053, China.
BMC Geriatr. 2017 Feb 8;17(1):47. doi: 10.1186/s12877-017-0439-y.
Various factors including cardio-metabolic disorders are found to be correlated with frailty. With the increase in age, older adults are likely to have elevated blood glucose level. In this study we intend to investigate the prevalence and incidence of frailty in the pre-diabetic and diabetic community dwelling elderly population and the associated risk factors.
At baseline total of 10,039 subjects with a mean age of 70.51 (±7.82) were included. A total of 6,293 older adults were followed up at 12 months. A Frailty index (FI) with 32 items was developed using Rockwood's cumulative deficits method. Frailty index ≥0.25 was used as cut-off criteria for the diagnosis of frailty. Diagnosis of pre-diabetes and diabetes was set according to the World Health Organization (WHO) criteria for fasting plasma glucose (FPG) level. Chi-square tests were performed to compare percentages by 3 major groups (non-diabetes, pre-diabetes, diabetes), ANOVA and student's t-tests was used to compare means of group for continuous variables. Multiple logistic regression models were performed to estimate the risk factors for frailty in non-diabetic, pre-diabetic and diabetic elderly populations using baseline and longitudinal data.
Diabetic population had a much higher prevalence (19.32%) and incidence (12.32%) of frailty, compared to that of non-diabetic older adults (prevalence of 11.92% and incidence of 7.04%). And pre-diabetics had somewhat similar prevalence of 11.43% and slightly higher incidence of 8.73% for frailty than non-diabetic older adults. Diabetics were at 1.36 (95% CI = 1.18,1.56) and 1.56 (95%CI = 1.32,1.85) fold increase in risk of frailty compared to non-diabetic population for prevalence and incidence, respectively. Being female, urban living, high waist circumference, less house work and need regular anti-diabetic medications were independent risk factors only in pre-diabetic and diabetic older adults.
This study confirms that diabetes is an independent serious chronic condition to increase the risk of frailty in community dwelling older adults in northern China. To effectively delay or avoid frailty, older adults should be advised for taking proper control of blood glucose level and avoiding the associated risk factors and implementing the protective factors in primary-care setting.
包括心脏代谢紊乱在内的多种因素被发现与衰弱相关。随着年龄的增长，老年人的血糖水平可能会升高。在本研究中，我们旨在调查糖尿病前期和糖尿病社区居住老年人群中衰弱的患病率和发病率以及相关危险因素。
基线时纳入了10,039名平均年龄为70.51（±7.82）岁的受试者。共有6,293名老年人在12个月时接受了随访。使用Rockwood的累积缺陷法制定了一个包含32个条目的衰弱指数（FI）。衰弱指数≥0.25被用作衰弱诊断的截断标准。根据世界卫生组织（WHO）的空腹血糖（FPG）水平标准进行糖尿病前期和糖尿病的诊断。进行卡方检验以比较3个主要组（非糖尿病、糖尿病前期、糖尿病）的百分比，使用方差分析和学生t检验比较连续变量组的均值。使用基线和纵向数据进行多元逻辑回归模型，以估计非糖尿病、糖尿病前期和糖尿病老年人群中衰弱的危险因素。
与非糖尿病老年人相比（患病率为11.92%，发病率为7.04%），糖尿病患者的衰弱患病率（19.32%）和发病率（12.32%）要高得多。糖尿病前期患者的衰弱患病率为11.43%，与非糖尿病老年人相似，发病率为8.73%，略高于非糖尿病老年人。糖尿病患者的衰弱患病率和发病率与非糖尿病人群相比，风险分别增加了1.36倍（95%CI = 1.18,1.56）和1.56倍（95%CI = 1.32,1.85）。女性、城市居住、高腰围、较少的家务劳动和需要定期服用抗糖尿病药物是仅在糖尿病前期和糖尿病老年人群中的独立危险因素。
本研究证实，糖尿病是增加中国北方社区居住老年人衰弱风险的一种独立的严重慢性疾病。为了有效延迟或避免衰弱，应建议老年人在初级保健环境中适当控制血糖水平，避免相关危险因素并实施保护因素。
