Department of Pharmacy, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Age Ageing. 2023 Jul 1;52(7). doi: 10.1093/ageing/afad128.
Frailty substantially increased the risk of adverse clinical outcomes, which was also critical in diabetes management. This study aimed to investigate the interrelationships between the age of onset, frailty, anti-diabetic medications and clinical outcomes in people with diabetes mellitus (DM).
A total of 123,172 people aged 40 years and older who were newly diagnosed with DM were identified and categorised into four frailty subgroups (robust, mild, moderate and severe) based on the multimorbidity frailty index (mFI). Cox proportional hazards models were used to examine associations between frailty and clinical outcomes at different ages of DM onsets (40-64, 65-74, 75-84 and 85+ years). Outcomes of interest included generic outcomes (mortality and unplanned hospitalisation) and DM-related outcomes (cardiovascular disease-related mortality, major adverse cardiovascular events (MACEs), diabetes-related hospitalisation and hypoglycaemia).
The proportion of frailty increased with age at diagnosis amongst people with incident DM and the mFI scores increased significantly during the 10-year follow-up. Amongst people with diabetes, those with mild, moderate and severe frailty were associated with greater risks of all-cause mortality (mild: adjusted hazard ratio (aHR) 1.69 [95% confidence interval (CI) 1.60-1.80], P < 0.01; moderate: aHR 2.46 [2.29-2.65], P < 0.01; severe frailty: aHR 3.40 [3.16-3.65], P < 0.01) compared with the robust group. Similar results were found in unplanned hospitalisations, cardiovascular disease-related mortality, MACEs and hypoglycaemia.
Our study quantified the prevalence of frailty, captured its dynamic changes and examined its impacts on various clinical outcomes amongst people with diabetes at different ages at onset. Frailty assessment and management should be implemented into routine diabetes care.
虚弱显著增加了不良临床结局的风险，这在糖尿病管理中也至关重要。本研究旨在探讨糖尿病患者发病年龄、虚弱、抗糖尿病药物与临床结局之间的相互关系。
共纳入 123172 名年龄在 40 岁及以上、新诊断为糖尿病的患者，根据多疾病衰弱指数（mFI）将其分为 4 个虚弱亚组（健壮、轻度、中度和重度）。使用 Cox 比例风险模型分析不同发病年龄（40-64、65-74、75-84 和 85+岁）的虚弱与临床结局之间的关系。感兴趣的结局包括一般结局（死亡率和非计划性住院）和糖尿病相关结局（心血管疾病相关死亡率、主要不良心血管事件（MACE）、糖尿病相关住院和低血糖）。
随着新发糖尿病患者发病年龄的增加，虚弱的比例增加，且 mFI 评分在 10 年随访期间显著升高。在糖尿病患者中，与轻度、中度和重度虚弱相比，所有原因死亡率均显著增加（轻度：调整后的危险比（aHR）为 1.69[95%置信区间（CI）为 1.60-1.80]，P<0.01；中度：aHR 为 2.46[2.29-2.65]，P<0.01；重度：aHR 为 3.40[3.16-3.65]，P<0.01）。未计划住院、心血管疾病相关死亡率、MACE 和低血糖也有类似结果。
本研究量化了糖尿病患者不同发病年龄时的虚弱流行率，捕捉了其动态变化，并评估了虚弱对各种临床结局的影响。虚弱评估和管理应纳入糖尿病常规护理。
