衰弱与糖尿病患者不良结局关系的系统评价

Systematic evaluation between frailty and adverse health outcomes among diabetic patients

目的系统评价衰弱与糖尿病患者不良结局的关系。方法计算机检索PubMed、Embase、CINAHL、CENTRAL、Web of Science、Wiley、AMED、wanfang data、CBM、CNKI和VIP数据库,搜集国内外发表的衰弱与糖尿病关系的前瞻性队列研究,检索时限均从建库至2017年1月。由两名研究者独立筛选文献、提取资料并进行质量评价,采用Rev Man 5.3软件进行Meta分析,对不能合并的数据进行描述性分析。结果最终纳入7个队列研究,共2 631例糖尿病患者。(1)Meta分析结果显示:衰弱与糖尿病患者不良结局关系,衰弱可增加糖尿病患者失能风险[OR=4.45,95%CI(1.95~10.17),P=0.000 4];衰弱前期、衰弱均可增加糖尿病患者入院风险[O R=2.39,95%CI(1.21~4.74),P=0.01],[O R=5.09,95%CI(2.19~11.87),P=0.000 2];衰弱较非衰弱糖尿病患者死亡风险增加65%[HR=1.65,95%CI(1.36~2.01),P<0.000 01]。(2)描述性分析结果显示:衰弱可增加糖尿病患者失能、死亡、跌倒、损伤风险。结论衰弱可能是糖尿病患者不良结局的危险因素,建议临床医护人员在糖尿病管理中应常规开展衰弱筛查、评估并采取有效干预措施。因本研究纳入研究数量较少,上述结论尚需更多大样本、多中心的队列研究加以验证。

Objective To systematically evaluate the association between frailty and adverse outcomes among dia-betes mellitus.Methods Data were collected through 11 electronic databases （PubMed,Embase,CINAHL,CENTRAL, Web of Science, Wiley, AMED, wanfang data, CBM, CNKI and VIP） on studies of the association between frailty and diabetes mellitus published before January 2017.Two authors independently screened the literature, extracted the data, and assessed their quality.A Meta-analysis was conducted by RevMan 5.3 software.Results 7 studies incorporating 2 631 diabetes patients were analyzed.①Meta-analysis showed that frailty was associated with risk of disability[OR = 4.45,95%CI （1.95±10.17）,P= 0.000 4].Prefi-ailty and frailty were associated with risk of hospitalization [OR=2.39,95% CI（1.21±4.74）, P = 0.01], [OR = 5.09,95% CI（2.19 - 11.87）, P = 0.000 2].Frail diabetic pa- tients have higher mortality risks than non-frail diabetic patients by 65%[HR = 1.65,95%CI（1.36-2.01）,P 〈 0.000 01 ].②Desciptive analysis results showed that frailty could increase the risks of disability, death, fall, and injury among the diabetic patients.Conclusion Frailty is associated with an increased risks of adverse health outcomes.It is advised that frailty screening, assessment and intervention measures should be strengthened in the management of these diabetic patients.Due to the small number of patients in the study, large-scale, multicentral studies are needed to con- firm the conclusion.