Zhong Pingting, Liu Riqian, Zhu Zhuoting, Huang Wenyong, Wang Wei
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, 510000, Guangzhou, China; Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Haikou, 570311, Hainan Province, China.
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, 510000, Guangzhou, China.
Diabetes Metab Syndr. 2024 Jan;18(1):102942. doi: 10.1016/j.dsx.2024.102942. Epub 2024 Jan 5.
To assess the relationship between frailty phenotypes and the risk of MVD among prediabetics in two prospective cohorts.
The study included 66,068 and 226 participants with prediabetes from the UK Biobank (UKB) and Chinese Ocular Imaging Project (COIP) in Guangzhou, China, respectively. Frailty was evaluated using the Fried phenotype, which includes weight loss, fatigue, low grip strength, low physical activity, and slow walking pace. The outcome was incident microvascular diseases, including diabetic retinopathy, nephropathy, and neuropathy in UKB, and decline rate of retinal capillary density in COIP. Cox models were used to calculate hazard ratios (HRs) and 95 % confidential intervals (CIs), and mixed linear model was used to determine the β and 95 % CIs.
At baseline, 27,491 (41.6 %) and 3332 (5.0 %) prediabetics were classified as pre-frail and frail, respectively in UKB. During a median follow-up of 8.9 years, 3784 cases of incident microvascular diseases were identified. Pre-frailty and frailty were significantly associated with a higher risk of microvascular diseases (HR 1.21 [1.12, 1.30] for pre-frailty; HR 1.60 [1.42, 1.81] for frailty). Compared to no frailty, the adjusted HRs for frailty were 1.42 (0.73, 2.76) for retinopathy, 1.49 (1.31, 1.70) for nephropathy, and 2.37 (1.69, 3.33) for neuropathy. Fatigue and walking pace were the strongest mediators of frailty and microvascular diseases. In the COIP, the lowest handgrip strength group exhibited 62%-63 % faster annually decline in retinal capillary density compared with the highest group (all P<0.05).
Each frailty point is important for prediabetics because both pre-frailty and frailty phenotypes are strongly associated with an increased risk of microvascular diseases and its subtypes. Lower handgrip strength presents with faster decline in retinal capillary density.
在两个前瞻性队列中评估糖尿病前期患者的衰弱表型与微血管病变风险之间的关系。
该研究分别纳入了来自英国生物银行（UKB）的66,068例和来自中国广州的中国眼部成像项目（COIP）的226例糖尿病前期患者。使用Fried表型评估衰弱，该表型包括体重减轻、疲劳、握力低下、体力活动不足和步速缓慢。结局指标为微血管疾病的发生，在UKB中包括糖尿病视网膜病变、肾病和神经病变，在COIP中为视网膜毛细血管密度下降率。使用Cox模型计算风险比（HR）和95%置信区间（CI），并使用混合线性模型确定β值和95%CI。
在UKB中，基线时分别有27,491例（41.6%）和3332例（5.0%）糖尿病前期患者被分类为衰弱前期和衰弱。在中位随访8.9年期间，共识别出3784例微血管疾病病例。衰弱前期和衰弱均与微血管疾病风险显著相关（衰弱前期的HR为1.21[1.12,1.30]；衰弱的HR为1.60[1.42,1.81]）。与无衰弱相比，衰弱对视网膜病变的校正HR为1.42（0.73,2.76），对肾病为1.49（1.31,1.70），对神经病变为2.37（1.69,3.33）。疲劳和步速是衰弱与微血管疾病之间最强的中介因素。在COIP中，握力最低组的视网膜毛细血管密度年下降率比最高组快62%-63%（所有P<0.05）。
对于糖尿病前期患者，每个衰弱点都很重要，因为衰弱前期和衰弱表型均与微血管疾病及其亚型风险增加密切相关。握力较低与视网膜毛细血管密度下降较快有关。
