Table_1_Combined effect of diabetes and frailty on mortality among Chinese older adults: A follow-up study.docx

BackgroundFrailty and diabetes are two important health problems associated with aging in older individuals. This paper seeks to analyze the frailty in older adults suffering from diabetes and the combined effect of diabetes and frailty on mortality risk.
MethodsThe frailty index (FI) model was employed when evaluating frailty among the older adults based on the baseline data conducted in 2009; and death as outcome variables collected in 2020 were analyzed. The influence of diabetes on age-related changes in frailty in the older adults and resulting mortality rates was analyzed. Cox regression and Kaplan-Meier curves were applied to evaluate the influence on the risk of death and the 11-year survival of the older adults with varying diabetes and frailty statuses.
ResultsUltimately, 1,213 older people aged between 60 and 101, with an average age of (74.79 ± 8.58) at baseline, were included in the analysis. By 2020, there had been 447 deaths with mortality at 36.9% (447/1,213); there were 271 cases of diabetes, with a prevalence of 22.3% (271/1,213). The mean FI value for older adults with diabetes was higher than that of those without regardless of age, and the average annual relative growth rate of the FI value for older adults with diabetes was higher than that of those without diabetes (β = 0.039 vs. β = 0.035, t = 8.367, P < 0.001). For all FI value levels, the mortality rate among older adults with diabetes was higher than that of those without. The Cox Regression analysis showed that, compared with those suffering from neither diabetes nor frailty, older adults with both had the higher mortality risk (HR = 1.760. P < 0.001), followed by older adults suffering from frailty alone (HR = 1.594, P = 0.006), and then by older adults suffering from only diabetes (HR = 1.475, P = 0.033). The survival analysis showed that the median survival of those suffering from diabetes and frailty to be the shortest at just 57.23 (95% CI: 54.05 to 60.41) months, lower than the 83.78 (95% CI: 79.33 to 88.23) months in those suffering from frailty alone, and 119.93 (95% CI: 113.84 to 126.02) months in those with only diabetes, and 124.39 (95% CI: 119.76 to 129.02) months in older adults with neither diabetes nor frailty (P < 0.001).
ConclusionFrailty is common among older adults suffering from diabetes, and there is an increased risk of poor health outcomes, such as death, among older adults suffering from diabetes and frailty. When diagnosing, treating, and dealing with older adults with diabetes, attention should be paid to screening and assessing frailty in hopes of identifying it early so that appropriate measures of intervention can be taken to avoid or delay the resulting adverse effects.

背景
衰弱与糖尿病是老年人群中与衰老相关的两类重要健康问题。本研究旨在分析糖尿病老年人群的衰弱状况，以及糖尿病与衰弱的联合作用对死亡风险的影响。

方法
基于2009年收集的基线数据，采用衰弱指数（Frailty Index, FI）模型对老年人群的衰弱程度进行评估；同时以2020年收集的死亡结局作为分析变量，探究糖尿病对老年人群衰弱程度随年龄变化的影响及其所致的死亡率差异。本研究采用Cox回归与Kaplan-Meier生存曲线，评估不同糖尿病与衰弱状态的老年人群的死亡风险及11年生存情况。

结果
最终共纳入1213名年龄介于60至101岁的老年人群作为分析对象，基线时平均年龄为(74.79 ± 8.58)岁。截至2020年，共计447例死亡，总死亡率为36.9%（447/1213）；其中糖尿病患者271例，患病率为22.3%（271/1213）。无论年龄分层如何，糖尿病老年人群的平均衰弱指数得分均高于非糖尿病老年人群；且糖尿病老年人群的衰弱指数年平均相对增长率亦高于非糖尿病人群（β=0.039 vs β=0.035，t=8.367，P<0.001）。在所有衰弱指数水平分层中，糖尿病老年人群的死亡率均高于非糖尿病人群。Cox回归分析显示，与既无糖尿病也无衰弱的老年人群相比，同时罹患糖尿病与衰弱的老年人群死亡风险最高（风险比Hazard Ratio, HR=1.760，P<0.001），其次为仅罹患衰弱的老年人群（HR=1.594，P=0.006），再次为仅罹患糖尿病的老年人群（HR=1.475，P=0.033）。生存分析结果表明，同时罹患糖尿病与衰弱的老年人群中位生存期最短，仅为57.23（95%置信区间Confidence Interval, CI: 54.05~60.41）个月，低于仅罹患衰弱人群的83.78（95%CI:79.33~88.23）个月、仅罹患糖尿病人群的119.93（95%CI:113.84~126.02）个月，以及既无糖尿病也无衰弱人群的124.39（95%CI:119.76~129.02）个月（P<0.001）。

结论
衰弱在糖尿病老年人群中较为常见，同时罹患糖尿病与衰弱的老年人群出现死亡等不良健康结局的风险显著升高。在对糖尿病老年患者进行诊断、治疗与干预时，应重视衰弱的筛查与评估，做到早发现、早干预，以避免或延缓由此引发的不良事件。