Toyoshima Kenji, Tamura Yoshiaki, Murao Yuji, Kodera Remi, Oba Kazuhito, Ishikawa Joji, Chiba Yuko, Araki Atsushi
Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
Department of Cardiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
Geriatr Gerontol Int. 2024 Oct;24(10):1030-1038. doi: 10.1111/ggi.14969. Epub 2024 Aug 29.
This observational longitudinal study aimed to explore the risk factors for disabilities in older Japanese individuals with diabetes at a frailty clinic, an outpatient clinic specializing in comprehensive geriatric assessments for older patients.
The outcome was the onset of disability as a new certification of long-term care needs in outpatients aged ≥65 years. Multivariable Cox regression analyses examined the independent associations between the onset of disability and the variables that reached significance in the bivariate analysis, after adjusting for age and sex, years of education, and certification of need for support.
A total of 182 participants (mean age 77.8 years, 59.9% female) were included in the study. During a mean follow-up period of 1070 days, 28 patients (15.4%) developed disabilities. Multivariable analysis showed that poor glycemic control (higher levels of glycosylated albumin and HbA1c), frailty as measured by the Clinical Frailty Scale (CFS), cognitive decline as assessed by the revised Hasegawa Dementia Scale (especially "5 object recall" and verbal fluency as assessed by the number of "vegetable names"), poor adherence to medications, and reduced muscle mass were significantly associated with the development of disability. Multivariable Cox regression analyses revealed independent and significant associations between the development of disability and HbA1c ≥7.5%, CFS ≥4, and generating vegetable names≤9.
In identifying older patients with diabetes who are at risk of developing disabilities, it may be useful to evaluate glycemic control, CFS, cognition, and medication adherence. Verbal fluency tests using vegetable names may serve as simple tools for assessing the risk of disability. Geriatr Gerontol Int 2024; 24: 1030-1038.
本观察性纵向研究旨在探讨在一家衰弱诊所（一家专门为老年患者进行综合老年评估的门诊诊所）中，日本老年糖尿病患者出现残疾的风险因素。
研究结果为≥65岁门诊患者出现残疾并获得新的长期护理需求认证。多变量Cox回归分析在调整年龄、性别、受教育年限和支持需求认证后，检验了残疾发生与双变量分析中具有显著意义的变量之间的独立关联。
共有182名参与者（平均年龄77.8岁，女性占59.9%）纳入研究。在平均1070天的随访期内，28名患者（15.4%）出现残疾。多变量分析显示，血糖控制不佳（糖化白蛋白和糖化血红蛋白水平较高）、临床衰弱量表（CFS）测量的衰弱、修订版长谷川痴呆量表评估的认知功能下降（尤其是“5项物体回忆”以及通过“蔬菜名称”数量评估的语言流畅性）、药物依从性差和肌肉量减少与残疾的发生显著相关。多变量Cox回归分析揭示了残疾发生与糖化血红蛋白≥7.5%、CFS≥4以及生成蔬菜名称≤9之间存在独立且显著的关联。
在识别有残疾风险的老年糖尿病患者时，评估血糖控制、CFS、认知和药物依从性可能会有所帮助。使用蔬菜名称进行语言流畅性测试可作为评估残疾风险的简单工具。《老年医学与老年病学国际杂志》2024年；24: 1030 - 1038。
