Diabetes Care:不仅糖尿病,糖尿病前期也会导致老年人的功能衰退和残疾

2021-02-21 MedSci原创 MedSci原创

糖尿病前期与更快的功能衰退和残疾有关且独立于糖尿病的未来发展,这种联系可能部分由心血管疾病介导。

糖尿病与功能衰退有关,但糖尿病前期对身体功能的影响尚不清楚。一些评估糖尿病与身体功能之间关系的横断面研究表明,糖尿病患者身体功能障碍的发生率很高。只有少数研究探讨了糖尿病与突发性身体损伤之间的关系。由于糖尿病前期与各种疾病(如血管疾病和肾脏疾病)有关,这部分患者在糖尿病完全发作之前可能会出现功能衰退和残疾。然而,大多数关于功能与糖尿病之间关系的研究都将糖尿病前期患者分为血糖正常组。

此外,在涉及糖尿病前期和身体功能的研究中,大多数是横断面研究迄今为止,还没有基于人群的队列研究专门调查糖尿病前期与身体功能下降和残疾发展的关系。近日,Diabetes Care上发表的新研究就比较了糖尿病前期和糖尿病对身体功能和残疾进展的影响,并探索心血管疾病(CVDs)是否介导了这些关联。

本研究中,瑞典国家研究院(Swedish National Study on Aging and Care in Kungsholmen)对一项基于人群的纵向研究对2013名60岁的参与者进行了长达12年的监测。身体功能用椅立(s)和行走速度(m/s)测试来测量,残疾用日常生活中受损的基本活动和工具活动的总数来测量。通过医学检查或临床记录、用药或糖化血红蛋白(HbA1c) 6.5%确定糖尿病。无糖尿病患者的糖尿病前期被定义为HbA1c 5.7%和6.4%。心血管病是通过临床检查和国家病人登记确定的。采用混合效应模型和中介模型对数据进行分析。

研究结果显示,在基线检查时,650人(32.3%)有糖尿病前期,151人有糖尿病(7.5%)。在多调整混合效应模型中,即使控制了糖尿病的未来发展,糖尿病前期患者的坐姿站立时间增加(β0.33,95%CI 0.05 0.61),步行速度降低(β0.006,95%CI 0.010至0.002),残疾进展加快(β0.05,95%CI 0.01 0.08)。糖尿病导致的功能衰退比糖尿病前期更快。

在12年的随访中,根据血糖状态预测椅立、行走速度和残疾评分(ADL + IADL)的轨迹。

在中介分析中,心血管疾病分别介导了7.1%、7.8%和20.9%的糖尿病前期与坐姿、步行速度和残疾进展之间的关联。糖尿病患者与椅立、行走速度和残疾相关的心血管病累积的相应中介比例分别为13.3%、22.9%和14.4%。

基线糖尿病前期和糖尿病随访期间心血管疾病变化与椅立、行走速度和残疾评分的相关性的中介分析

在瑞典这项以人群为基础的老年人纵向研究中,研究者发现:1)除了糖尿病外,糖尿病前期与老年人更快的身体功能衰退和残疾进展相关,独立于糖尿病的未来发展;2)糖尿病患者的这种联系强于糖尿病前期患者;3)心血管疾病的快速发展可以解释为糖尿病并发症的发展,这在一定程度上调节了糖尿病前期和功能衰退/残疾之间的联系。

这项研究是第一个证明糖尿病前期是身体功能急剧下降和残疾进展更快的独立危险因素。研究强调了在高血糖人群中预防心血管病的重要性,并强调了监测老年人功能的必要性,即使是在糖尿病前驱阶段。

参考文献:Ying Shang, Laura Fratiglioni, Davide Liborio VetranoAbigail Dov,Anna-Karin Welme and Weili Xu.

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    2021-02-21 misszhang

    谢谢MedSci提供最新的资讯

    0

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    2021-02-21 liangying

    抗糖很重要#2型糖尿病#

    0

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对于血糖风险较高的非糖尿病人群,接受预防生活方式干预可降低进展为糖尿病的风险,但医疗参与的强化干预并未使风险进一步降低