老年2型糖尿病住院患者合并衰弱的患病情况及影响因素研究

Study on the prevalence of frailty and influencing factors in hospitalized elderly patients with type 2 diabetes mellitus

目的分析老年2型糖尿病住院患者合并衰弱的患病情况及其影响因素。方法该研究为单中心观察性研究。按入排标准连续入选2017年1月至2021年12月间年龄≥65岁、住院治疗的2型糖尿病患者。运用老年综合评估,评价患者的老年综合征,其中衰弱的评估采用临床衰弱水平量表。采用多因素logistic回归分析,分析老年2型糖尿病患者合并衰弱的影响因素。结果最终入选住院老年2型糖尿病患者343例,其中男性152例(44.3%),年龄69~79岁,中位年龄74岁。所有入选老年2型糖尿病患者中,合并衰弱者108例(31.5%)。与无衰弱的老年2型糖尿病患者相比,合并衰弱患者的年龄更大(79岁比72岁,P<0.001),男性比例(36.1%比48.1%,P=0.038)、BMI水平(24.0±4.2比25.0±3.5,P=0.025)较低;糖尿病病程更长(14年比11年,P=0.008),合并糖尿病靶器官病变的比例(64.8%比39.2%,P<0.001)及Charlson共病指数(3分比2分,P<0.001)更高;长期用药种类(8种比4种,P<0.001)及多重用药的比例(88.9%比74.9%,P=0.003)更高;微营养评估简表(MNA-SF)分值较低(11分比13分,P<0.001),有1年内跌倒史(46.3%比16.6%,P<0.001)、合并尿失禁(45.4%比19.6%,P<0.001)、需要辅助行走(49.1%比3.9%,P<0.001)的比例更高;握力(18.9 kg比26.2 kg,P<0.001)、步速(0.56 m/s比0.97 m/s,P<0.001)较低;5次起坐时间明显延长(21.2 s比11.6 s,P<0.001),不能完成全足距测试的比例明显高于无衰弱的患者(66.7%比11.9%,P<0.001);血清白蛋白(39 g/L比40 g/L,P<0.001)、前白蛋白(211 mg/L比230 mg/L,P<0.001)水平较低,糖化血红蛋白(7.3%比6.9%,P=0.018)、肌酐(83μmol/L比73μmol/L,P<0.001)、尿酸(350 mmol/L比320 mmol/L,P=0.005)、同型半胱氨酸(12.6 mmol/L比11.3 mmol/L,P=0.010)、超敏C反应蛋白(2.24 mg/L比1.16 mg/L,P<0.001)水平较高,空腹血糖、血脂水平差异无统计学意义(P均>0.05)。多因素logistic回归分析显示,握力是老年2型糖尿病患者合并衰弱的显著影响因素(OR0.927,95%CI 0.866~0.993,P=0.030)。结论住院老年2型糖尿病患者合并衰弱的患病率高。对于低握力的老年糖尿病患者,应注意衰弱的筛查并进行相应干预。

Objective To analyze the prevalence of frailty among elderly inpatients with type 2 diabetes(T2DM)and determine related clinical factors.Methods This study was a single center observational study.According to the inclusion criteria,elderly patients hospitalized with T2DM between Jannuary 2017 and December 2021 were enrolled.Geriatric assessment was performed to evaluate existing geriatric syndromes of the patients.Frailty was assessed using the Clinical Frailty Scale.Multivariate logistic regression was used to analyze influencing factors for frailty of elderly patients with T2DM.Results A total of 343 patients were enrolled in the study,and there were 152(44.3%)male patients.The patients were aged 69-79 years with a median age of 74 years.Among all the patients,108 cases(31.5%)were complicated with frailty.Compared with non-frail patients,the frail patients with T2DM were even older(79 ys vs.72 ys,P0.001),had lower male proportion(36.1%vs.48.1%,P=0.038)and BMI(24.0±4.2 vs.25.0±3.5,P=0.025),also had longer duration of diabetes(14 ys vs.11 ys,P=0.008),higher proportion of diabetic target organ lesions(64.8%vs.39.2%,P0.001),as well as higher scores of Charlson Co-Morbidity Index(3 vs.2,P0.001).There were more types of long-term medication(8 vs.4,P0.001)and higher proportion of polypharmacy(88.9%vs.74.9%,P=0.003)in frail than non-frail patients.The MNA-SF scores were lower(11 vs.13,P0.001),and the proportion of patients with history of falls within a year(46.3%vs.16.6%,P0.001),urinary incontinence(45.4%vs.19.6%,P0.001),as well asusing walking-aid(49.1%vs.3.9%,P0.001)were higher infrail patients compared with non-frail patients.Grip strength(18.9 kg vs.26.2 kg,P0.001)and gait speed(0.56 m/s vs.0.97 m/s,P0.001)were significantly lower in frail patients compared with non-frail patients.The five sit-to-stand time was significantly prolonged(21.2 s vs.11.6 s,P0.001),and the proportion of patients unable to accomplish full tandem stance(66.7%vs.11.9%,P0.001)was significantly higher in frail patients compared with non-frail patients.Moreover,lower level of albumin(39 g/L vs.40 g/L,P0.001)and prealubumin(211 mg/L vs.230 mg/L,P0.001),higher level of glycosylated hemoglobin(7.3%vs 6.9%,P=0.018),serum creatinine(83μmol/L vs.73μmol/L,P0.001),uric acid(350mmol/L vs.320 mmol/L,P=0.005),homocysteine(12.6 mmol/L vs.11.3 mmol/L,P=0.010),and high-sensitive C-reactive protein(2.24 mg/L vs.1.16 mg/L,P0.001)were observed in frail patients compared with non-frail patients,while there were no significant difference in fasting blood glucose,total cholesterol,triglycerides,low-density lipoprotein cholesterol,and high-density lipoprotein cholesterol between the two groups(all P0.05).Multivariate Logistic regression analysis showed that grip strength(OR 0.927,95%CI 0.866-0.993,P=0.030)was the influencing factor of frailty in elderly patients with type 2 diabetes.Conclusion The prevalence of frailty in hospitalized elderly patients with type 2 diabetes is high.For the elderly diabetic patients with reduced grip strength,attention should be paid to the screen and corresponding intervention for frailty.