Center for Clinical Big Data and Analytics of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Big Data in Health Science School of Public Health, Zhejiang University School of Medicine, Hangzhou, China.
JMIR Public Health Surveill. 2023 May 18;9:e45502. doi: 10.2196/45502.
Compared with adults with normal glucose metabolism, those with prediabetes tend to be frail. However, it remains poorly understood whether frailty could identify adults who are most at risk of adverse outcomes related to prediabetes.
We aimed to systematically evaluate the associations between frailty, a simple health indicator, and risks of multiple adverse outcomes including incident type 2 diabetes mellitus (T2DM), diabetes-related microvascular disease, cardiovascular disease (CVD), chronic kidney disease (CKD), eye disease, dementia, depression, and all-cause mortality in late life among middle-aged adults with prediabetes.
We evaluated 38,950 adults aged 40 years to 64 years with prediabetes using the baseline survey from the UK Biobank. Frailty was assessed using the frailty phenotype (FP; range 0-5), and participants were grouped into nonfrail (FP=0), prefrail (1≤FP≤2), and frail (FP≥3). Multiple adverse outcomes (ie, T2DM, diabetes-related microvascular disease, CVD, CKD, eye disease, dementia, depression, and all-cause mortality) were ascertained during a median follow-up of 12 years. Cox proportional hazards regression models were used to estimate the associations. Several sensitivity analyses were performed to test the robustness of the results.
At baseline, 49.1% (19,122/38,950) and 5.9% (2289/38,950) of adults with prediabetes were identified as prefrail and frail, respectively. Both prefrailty and frailty were associated with higher risks of multiple adverse outcomes in adults with prediabetes (P for trend <.001). For instance, compared with their nonfrail counterparts, frail participants with prediabetes had a significantly higher risk (P<.001) of T2DM (hazard ratio [HR]=1.73, 95% CI 1.55-1.92), diabetes-related microvascular disease (HR=1.89, 95% CI 1.64-2.18), CVD (HR=1.66, 95% CI 1.44-1.91), CKD (HR=1.76, 95% CI 1.45-2.13), eye disease (HR=1.31, 95% CI 1.14-1.51), dementia (HR=2.03, 95% CI 1.33-3.09), depression (HR=3.01, 95% CI 2.47-3.67), and all-cause mortality (HR=1.81, 95% CI 1.51-2.16) in the multivariable-adjusted models. Furthermore, with each 1-point increase in FP score, the risk of these adverse outcomes increased by 10% to 42%. Robust results were generally observed in sensitivity analyses.
In UK Biobank participants with prediabetes, both prefrailty and frailty are significantly associated with higher risks of multiple adverse outcomes, including T2DM, diabetes-related diseases, and all-cause mortality. Our findings suggest that frailty assessment should be incorporated into routine care for middle-aged adults with prediabetes, to improve the allocation of health care resources and reduce diabetes-related burden.
与葡萄糖代谢正常的成年人相比，糖尿病前期患者往往身体虚弱。然而，目前尚不清楚虚弱是否可以识别出与糖尿病前期相关的不良结局风险最高的成年人。
我们旨在系统评估简单健康指标——虚弱与多种不良结局（包括 2 型糖尿病（T2DM）、糖尿病相关微血管疾病、心血管疾病（CVD）、慢性肾脏病（CKD）、眼病、痴呆、抑郁和全因死亡率）风险之间的关联，以评估中年糖尿病前期患者的上述结局。
我们使用英国生物库的基线调查评估了 38950 名年龄在 40 岁至 64 岁之间的糖尿病前期成年人。使用衰弱表型（FP；范围 0-5）评估衰弱，将参与者分为非衰弱（FP=0）、衰弱前期（1≤FP≤2）和衰弱（FP≥3）。在中位随访 12 年期间，确定了多种不良结局（即 T2DM、糖尿病相关微血管疾病、CVD、CKD、眼病、痴呆、抑郁和全因死亡率）。使用 Cox 比例风险回归模型估计关联。进行了几项敏感性分析以检验结果的稳健性。
在基线时，49.1%（19122/38950）和 5.9%（2289/38950）的糖尿病前期成年人分别被确定为衰弱前期和衰弱。衰弱前期和衰弱均与糖尿病前期成年人的多种不良结局风险增加相关（趋势 P<0.001）。例如，与非衰弱组相比，衰弱的糖尿病前期患者发生 T2DM（风险比[HR]=1.73，95%置信区间[CI]1.55-1.92）、糖尿病相关微血管疾病（HR=1.89，95% CI 1.64-2.18）、CVD（HR=1.66，95% CI 1.44-1.91）、CKD（HR=1.76，95% CI 1.45-2.13）、眼病（HR=1.31，95% CI 1.14-1.51）、痴呆（HR=2.03，95% CI 1.33-3.09）、抑郁（HR=3.01，95% CI 2.47-3.67）和全因死亡率（HR=1.81，95% CI 1.51-2.16）的风险显著更高，这些均在多变量调整模型中。此外，FP 评分每增加 1 分，这些不良结局的风险就会增加 10%至 42%。敏感性分析中通常观察到稳健的结果。
在英国生物库的糖尿病前期参与者中，衰弱前期和衰弱均与多种不良结局（包括 T2DM、糖尿病相关疾病和全因死亡率）的风险增加显著相关。我们的研究结果表明，应将衰弱评估纳入中年糖尿病前期患者的常规护理中，以改善医疗资源的分配并减轻糖尿病相关负担。
