进行系统回顾和荟萃分析,以估计社区老年糖尿病患者中衰弱和衰弱前期的总体患病率,并检查与该人群中衰弱相关的危险因素。
摘要
背景
衰弱和慢性疾病(包括糖尿病)并存与不良健康结果的高风险相关。人们对糖尿病和衰弱的交叉点越来越感兴趣。了解老年糖尿病患者衰弱的患病率是非常重要的。然而,在相关文献中,对这些人群中衰弱患病率的估计差异很大。
目标
进行系统回顾和荟萃分析,以估计社区老年糖尿病患者中衰弱和衰弱前期的总体患病率,并检查与该人群中衰弱相关的危险因素。
方法
从建库到2020年5月30日,检索PubMed、Web of Science、Embase、Wiley Cochrane图书馆和CINAHL。研究人员评估合格性、提取数据并评估方法学质量。用随机效应模型计算衰弱和衰弱前期的合并患病率。采用Meta回归分析和亚组分析探讨异质性的来源。
结果
共有32项研究符合纳入标准,涉及14450人。老年糖尿病患者衰弱和衰弱前期的合并患病率分别为20.1%(95%CI=16.0–24.2%)和49.1%(95%CI=45.1–53.1%),研究中存在显著的异质性。老年糖尿病患者比无糖尿病患者更易出现衰弱(OR=1.61,95%CI=1.47-1.77,p<0.001)。在使用衰弱表型定义衰弱的研究中(16.3%)和在亚洲进行的研究中(14.3%),衰弱的总患病率较低。女性性别和未婚状况是该人群衰弱的危险因素。
结论
在社区居住的老年糖尿病患者中,衰弱是很常见的。对老年人衰弱的早期筛查和干预应纳入到老年人糖尿病护理中,以预防和减少社区层面的衰弱的负面影响。需要更高质量的纵向研究来检验糖尿病和衰弱之间的时间关系。
Abstract
Coexistence of frailty and chronic diseases including diabetes is related to a higher risk of adverse health outcomes. There is an increasing interest in the intersection of diabetes and frailty. Understanding the prevalence of frailty in older adults with diabetes is of great importance. However, estimates of the prevalence of frailty among this population varied widely in the relevant literature.
To conduct a systematic review and meta-analysis to estimate the overall prevalence of frailty and prefrailty among community-dwelling older adults with diabetes, and examine the risk factors associated with frailty in this population.
PubMed, Web of Science, Embase, Wiley Cochrane Library, and Cumulative Index of Nursing and Allied Health were searched from inception to May 30th, 2020. Investigators assessed eligibility, extracted data and evaluated methodological quality. The pooled prevalence of frailty and prefrailty was calculated using the random-effects model. Meta-regression analysis and subgroup analysis were conducted to explore sources of heterogeneity.
A total of 32 studies met the inclusion criteria, involving 14,450 individuals. The pooled prevalence of frailty and prefrailty in older adults with diabetes was 20.1% (95% CI = 16.0–24.2%) and 49.1% (95%CI = 45.1–53.1%), respectively, with significant heterogeneity across the studies. Frailty was more prevalent in older adults with diabetes than those without diabetes (OR = 1.61, 95%CI = 1.47–1.77, p < 0.001). The pooled prevalence of frailty was lower in studies using Frailty Phenotype to define frailty (16.3%) and conducted in Asia (14.3%). Female gender and unmarried status were risk factors of frailty among this population.
Frailty and prefrailty are common in community-dwelling older adults with diabetes. Early screening of frailty and interventions should be integrated into diabetes care for older adults to prevent and reduce the negative effects of frailty at the community level. Better quality longitudinal research is required to examine the temporal relationship between diabetes and frailty.
原文链接:
https://www.sciencedirect.com/science/article/pii/S002074892100095X
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