Department of Geriatrics, Faculty of Health Sciences, Nicolaus Copernicus University in Torun, Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland.
Department of Internal Medicine II, Asklepios Clinic Uckermark, 74-506 Schwedt, Germany.
Int J Environ Res Public Health. 2022 Aug 19;19(16):10327. doi: 10.3390/ijerph191610327.
Introduction: Frailty syndrome occurs more frequently in patients with diabetes than in the general population. The reasons for this more frequent occurrence and the interdependence of the two conditions are not well understood. To date, there is no fully effective method for the diagnosis, prevention, and monitoring of frailty syndrome. This study aimed to assess the degree of metabolic control of diabetes in patients with frailty syndrome and to determine the impact of frailty on the course of diabetes using a retrospective analysis. Materials and Methods: A total of 103 individuals aged 60+ with diabetes were studied. The study population included 65 women (63.1%) and 38 men (36.9%). The mean age was 72.96 years (SD 7.55). The study was conducted in the practice of a general practitioner in Wielkopolska in 2018−2019. The research instrument was the authors’ original medical history questionnaire. The questions of the questionnaire were related to age, education, and sociodemographic situation of the respondents, as well as their dietary habits, health status, and use of stimulants. Other instruments used were: the Mini-Mental State Examination (MMSE), Lawton Scale (IADL—Instrumental Activities of Daily Living), Katz Scale (ADL—Activities of Daily Living), Geriatric Depression Rating Scale (GDS), and SHARE-FI scale (Survey of Health, Aging, and Retirement in Europe). Anthropometric and biochemical tests were performed. Results: In the study, frailty syndrome was diagnosed using the SHARE-FI scale in 26 individuals (25%): 32 (31.1%) were pre-frailty and 45 (43.7%) represented a non-frailty group. Statistical analysis revealed that elevated HbA1c levels were associated with a statistically significant risk of developing frailty syndrome (p = 0.048). In addition, the co-occurrence of diabetes and frailty syndrome was found to be a risk factor for loss of functional capacity or limitation in older adults (p = 0.00) and was associated with the risk of developing depression (p < 0.001) and cognitive impairment (p < 0.001). Conclusions: Concerning metabolic control of diabetes, higher HbA1c levels in the elderly are a predictive factor for the development of frailty syndrome. No statistical significance was found for the other parameters of metabolic control in diabetes. People with frailty syndrome scored significantly higher on the Geriatric Depression Rating Scale and lower on the MMSE cognitive rating scale than the comparison group. This suggests that frailty is a predictive factor for depression and cognitive impairment. Patients with frailty and diabetes have significantly lower scores on the Basic Activities of Daily Living Rating Scale and the Complex Activities of Daily Living Rating Scale, which are associated with loss or limitation of functioning. Frailty syndrome is a predictive factor for loss of functional capacity in the elderly.
与普通人群相比，糖尿病患者更容易出现衰弱综合征。这种更频繁发生的原因以及两种情况的相互依存关系尚不清楚。迄今为止，还没有完全有效的方法来诊断、预防和监测衰弱综合征。本研究旨在评估衰弱综合征患者糖尿病的代谢控制程度，并通过回顾性分析确定衰弱对糖尿病病程的影响。
共研究了 103 名 60 岁以上患有糖尿病的个体。研究人群包括 65 名女性（63.1%）和 38 名男性（36.9%）。平均年龄为 72.96 岁（SD 7.55）。该研究于 2018-2019 年在大波兰省的一名全科医生的诊所进行。研究工具是作者原创的病历问卷。问卷的问题涉及受访者的年龄、教育和社会人口状况，以及他们的饮食习惯、健康状况和兴奋剂的使用情况。其他使用的仪器包括：简易精神状态检查（MMSE）、Lawton 量表（IADL—日常活动的工具性活动）、Katz 量表（ADL—日常生活活动）、老年抑郁量表（GDS）和 SHARE-FI 量表（欧洲健康、老龄化和退休调查）。进行了人体测量学和生物化学测试。
在研究中，使用 SHARE-FI 量表在 26 名个体中诊断出衰弱综合征（25%）：32 名（31.1%）为衰弱前期，45 名（43.7%）为非衰弱组。统计分析表明，HbA1c 水平升高与衰弱综合征发展的风险显著相关（p=0.048）。此外，还发现糖尿病和衰弱综合征的同时存在是老年人功能性能力丧失或受限的危险因素（p=0.00），并与抑郁（p<0.001）和认知障碍（p<0.001）的风险相关。
就糖尿病的代谢控制而言，老年人 HbA1c 水平升高是衰弱综合征发展的预测因素。糖尿病代谢控制的其他参数没有统计学意义。衰弱综合征患者在老年抑郁量表上的得分明显高于对照组，而在简易精神状态检查认知评分量表上的得分较低。这表明衰弱是抑郁和认知障碍的预测因素。患有衰弱和糖尿病的患者在基本日常生活活动评定量表和复杂日常生活活动评定量表上的得分明显较低，这与功能丧失或受限有关。衰弱综合征是老年人功能性能力丧失的预测因素。
