Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.
Geriatr Gerontol Int. 2019 May;19(5):423-428. doi: 10.1111/ggi.13637. Epub 2019 Feb 20.
Evidence is limited on how frailty affects the association between diabetes and adverse outcomes at the population level. The present community-based study aimed to clarify the relative risks of death and disability in older Japanese adults with diabetes, frailty, both or neither.
The present prospective study analyzed data from 1271 Japanese residents aged ≥65 years in Kusatsu town in Gunma Prefecture, Japan, who participated in annual health checkups carried out between 2002 and 2011, and were initially free of disability. A Cox proportional hazards regression model was used to identify associations of diabetes and frailty with all-cause mortality and incident disability.
Among the 1271 participants, 176 (14%) had diabetes (mean hemoglobin A1c 7.5%, body mass index 24.2 kg/m , 45% using diabetes medications) and 151 (12%) had frailty at baseline. Compared with non-frail participants without diabetes, those with diabetes and frailty had higher risks of mortality (multivariable hazard ratio 5.0, 95% CI 2.4-10.3) and incident disability (hazard ratio 3.9, 95% CI 2.1-7.3). In contrast, non-frail participants with diabetes did not have a significantly increased risk of mortality, although they had a higher tendency for the incidence of disability, as compared with non-frail participants without diabetes.
At the population level, the risks of death and disability in persons with mild diabetes were strongly affected by the presence of frailty. From a community-based perspective, diabetes-related mortality and disability incidence might be reduced by preventing or improving frailty in conjunction with glycemic control. Geriatr Gerontol Int 2019; 19: 423-428.
关于衰弱在人群水平上如何影响糖尿病与不良结局之间的关系，现有证据有限。本基于社区的研究旨在明确患有糖尿病、衰弱、两者兼有或两者均无的日本老年成年人的死亡和残疾相对风险。
本前瞻性研究分析了日本群马县草津町 1271 名年龄≥65 岁的日本居民的数据，这些居民参加了 2002 年至 2011 年间进行的年度健康检查，且最初无残疾。使用 Cox 比例风险回归模型来确定糖尿病和衰弱与全因死亡率和新发残疾的相关性。
在 1271 名参与者中，176 人（14%）患有糖尿病（平均血红蛋白 A1c7.5%，体重指数 24.2kg/m ，45%使用糖尿病药物），151 人（12%）在基线时衰弱。与无糖尿病的非衰弱参与者相比，同时患有糖尿病和衰弱的参与者死亡风险更高（多变量风险比 5.0，95%CI2.4-10.3），残疾发生率更高（风险比 3.9，95%CI2.1-7.3）。相比之下，无糖尿病的非衰弱参与者的死亡风险无显著增加，但残疾发生率更高，与无糖尿病的非衰弱参与者相比有更高的趋势。
在人群水平上，轻度糖尿病患者的死亡和残疾风险受衰弱的严重程度影响很大。从社区角度来看，通过预防或改善衰弱并结合血糖控制，可能会降低与糖尿病相关的死亡率和残疾发生率。
