Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, 430030, China.
Department of Clinical Nutrition, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
BMC Med. 2022 Dec 8;20(1):473. doi: 10.1186/s12916-022-02675-9.
Cross-sectional studies found that frailty was associated with prevalent diabetic microvascular complications (DMC). Longitudinal evidence in this regard is inconclusive and insufficient. We aimed to prospectively evaluate the association of pre-frailty and frailty with DMC in patients with type 2 diabetes (T2D).
We included 18,062 adults (mean age 59.4 ± 7.2 years, 37.4% female) with T2D at baseline in the UK Biobank. Frailty was defined using the frailty phenotype according to five components (weight loss, exhaustion, low physical activity, slow gait speed, and low grip strength). DMC, defined as diabetic nephropathy, diabetic neuropathy, or diabetic retinopathy, was identified using hospital inpatient records and death registries. Cox proportional hazard regression models considering competing risks were used to evaluate the associations of frailty phenotype with overall DMC events and subtypes.
Among all participants, 6101 (33.8%) were classified as non-frail, 10,073 (55.8%) were classified as pre-frail, and 1888 (10.4%) were classified as frail. During a median follow-up of 12.0 years, 3678 DMC cases were documented, including 2213 diabetic nephropathy, 1520 diabetic retinopathy, and 673 diabetic neuropathy events. In the multivariable-adjusted model, compared with participants with non-frail, both pre-frailty and frailty were significantly associated with increased risk of overall DMC (HR 1.10, 95% CI: [1.02, 1.18] for pre-frailty and HR 1.52 [95% CI: 1.36, 1.69] for frailty). Similar results were observed in the subtypes of DMC. For each one-point increase in frailty phenotype score, the risk of overall DMC, diabetic nephropathy, diabetic retinopathy, and diabetic neuropathy event increased by 13%, 16%, 10%, and 20%, respectively.
Both pre-frailty and frailty were associated with an increased risk of DMC in patients with T2D. These findings have important implications for integrating early assessment and surveillance of frailty in diabetes and may favor the identification of at-risk patients.
横断面研究发现，衰弱与常见的糖尿病微血管并发症（DMC）有关。这方面的纵向证据尚无定论且不充分。我们旨在前瞻性评估预衰弱和衰弱与 2 型糖尿病（T2D）患者 DMC 的关系。
我们在英国生物库中纳入了 18062 名基线时患有 T2D 的成年人（平均年龄 59.4±7.2 岁，37.4%为女性）。根据五个组成部分（体重减轻、疲惫、体力活动少、步态缓慢和握力低）来定义衰弱表型。使用医院住院记录和死亡登记册确定 DMC，定义为糖尿病肾病、糖尿病神经病变或糖尿病视网膜病变。考虑竞争风险的 Cox 比例风险回归模型用于评估衰弱表型与总体 DMC 事件和亚型的关系。
在所有参与者中，6101 人（33.8%）被归类为非衰弱，10073 人（55.8%）被归类为衰弱前期，1888 人（10.4%）被归类为衰弱。在中位随访 12.0 年期间，记录了 3678 例 DMC 病例，包括 2213 例糖尿病肾病、1520 例糖尿病视网膜病变和 673 例糖尿病神经病变事件。在多变量调整模型中，与非衰弱者相比，衰弱前期和衰弱均与 DMC 总体风险增加显著相关（衰弱前期 HR 1.10，95%CI：[1.02，1.18]，衰弱 HR 1.52 [95%CI：1.36，1.69]）。在 DMC 的各个亚型中也观察到了类似的结果。衰弱表型评分每增加 1 分，DMC 总体、糖尿病肾病、糖尿病视网膜病变和糖尿病神经病变事件的风险分别增加 13%、16%、10%和 20%。
预衰弱和衰弱均与 T2D 患者的 DMC 风险增加相关。这些发现对于在糖尿病中整合衰弱的早期评估和监测具有重要意义，并可能有利于识别高危患者。
