Prevalence of diabetes in the elderly with frailty: a systematic review_Chinese Journal of Evidence-Based Medicine

Authors：

SHANG Yi ¹ , GAO Qianqian ² , CHEN Fei ² , ZHAO Li ² , MEI Fan ² ,  MA Bin ^2,3

1. Lanzhou University Second Hospital, Lanzhou 730000, P.R.China;
2. Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou 730000, P.R.China;
3. Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, P.R.China;

Corresponding author：

MA Bin, Email: kittymb2017@163.com

Keywords：

Elderly; Diabetes; Frailty; Systematic review; Meta-analysis; Cross-sectional study

DOI：

10.7507/1672-2531.202103031

Video：

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Objective To systematically evaluate the prevalence of diabetes in the elderly with frailty.Methods PubMed, EMbase, Web of Science, CNKI, CBM, VIP and WanFang Data databases were electronically searched to collect cross-sectional studies on the prevalence of diabetes in the elderly with frailty from inception to November 2020. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; meta-analysis was then performed by using Stata 15.0 software.Results A total of 21 cross-sectional studies involving 22 403 subjects were included. The pooled prevalence of diabetes in the elderly with frailty was 34% (95%CI 26% to 43%). Subgroup analysis showed that the prevalence of diabetes in patients with frailty in Asia and South America was higher than those in Europe and North America. The prevalence of diabetes in patients with frailty using physical frailty measures to evaluate frailty was higher than using multidimensional frailty measures. The prevalence of diabetes in patients with frailty in outpatient and hospital were higher than those in the community.Conclusions Current evidence suggests that the prevalence of diabetes is high in the elderly with frailty.

Citation： SHANG Yi, GAO Qianqian, CHEN Fei, ZHAO Li, MEI Fan, MA Bin. Prevalence of diabetes in the elderly with frailty: a systematic review. Chinese Journal of Evidence-Based Medicine, 2021, 21(7): 825-831. doi: 10.7507/1672-2531.202103031 Copy

1.	Lipsitz LA. Dynamics of stability: the physiologic basis of functional health and frailty. J Gerontol A Biol Sci Med Sci, 2002, 57(3): B115-125.
2.	Fried LP, Ferrucci L, Darer J, et al. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci, 2004, 59(3): 255-263.
3.	Woods NF, LaCroix AZ, Gray SL, et al. Frailty: emergence and consequences in women aged 65 and older in the women's health initiative observational study. J Am Geriatr Soc, 2005, 53(8): 1321-1330.
4.	Cho NH, Shaw JE, Karuranga S, et al. IDF diabetes atlas: global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract, 2018, 138: 271-281.
5.	Baena-Díez JM, Peñafiel J, Subirana I, et al. Risk of cause-specific death in individuals with diabetes: a competing risks analysis. Diabetes Care, 2016, 39(11): 1987-1995.
6.	Chen LK, Chen YM, Lin MH, et al. Care of elderly patients with diabetes mellitus: a focus on frailty. Ageing Res Rev, 2010, 9 Suppl 1: S18-22.
7.	Soysal P, Stubbs B, Lucato P, et al. Inflammation and frailty in the elderly: a systematic review and meta-analysis. Ageing Res Rev, 2016, 31: 1-8.
8.	Morley JE, Kim MJ, Haren MT. Frailty and hormones. Rev Endocr Metab Disord, 2005, 6(2): 101-108.
9.	Heuberger RA. The frailty syndrome: a comprehensive review. J Nutr Gerontol Geriatr, 2011, 30(4): 315-368.
10.	Veronese N, Stubbs B, Fontana L, et al. Frailty is associated with an increased risk of incident type 2 diabetes in the elderly. J Am Med Dir Assoc, 2016, 17(10): 902-907.
11.	沈妍交, 曹立, 郝秋奎, 等. 老年病科住院患者衰弱状况及其影响因素. 中国老年学杂志, 2019, 39(24): 6117-6120.
12.	秦丽, 梁珍珍, 葛立宾, 等. 社区老年衰弱综合征的影响因素研究. 中国全科医学, 2020, 23(5): 598-603.
13.	Ricci NA, Pessoa GS, Ferriolli E, et al. Frailty and cardiovascular risk in community-dwelling elderly: a population-based study. Clin Interv Aging, 2014, 9: 1677-1685.
14.	曾宪涛, 刘慧, 陈曦, 等. Meta分析系列之四: 观察性研究的质量评价工具. 中国循证心血管医学杂志, 2012, 4(4): 297-299.
15.	方向阳, 陈清, 侯原平, 等. 社区老年人衰弱相关因素. 中国老年学杂志, 2019, 39(2): 467-470.
16.	卫尹, 曹艳佩, 杨晓莉, 等. 老年住院患者衰弱综合征现状及影响因素. 复旦学报(医学版), 2018, 45(4): 496-502.
17.	孟丽, 谭潇, 石婧, 等. 老年人衰弱分布及其影响因素的初步研究. 中国临床保健杂志, 2017, 20(5): 481-485.
18.	Serra-Prat M, Papiol M, Vico J, et al. Factors associated with frailty in community-dwelling elderly population: a cross-sectional study. Eur Geriatr Med, 2016, 7: 531-537.
19.	Calado LB, Ferriolli E, Moriguti JC, et al. Frailty syndrome in an independent urban population in Brazil (FIBRA study): a cross-sectional populational study. Sao Paulo Med J, 2016, online ahead of print. DOI: 10.1590/1516-3180.2016.0078180516.
20.	Chang SS, Weiss CO, Xue QL, et al. Patterns of comorbid inflammatory diseases in frail older women: the women's health and aging studiesⅠandⅡ. J Gerontol A Biol Sci Med Sci, 2010, 65(4): 407-413.
21.	Bustamante-Ara N, Villarroel L, Paredes F, et al. Frailty and health risks in an agricultural population, Chile 2014-2017. Arch Gerontol Geriatr, 2019, 82: 114-119.
22.	Danon-Hersch N, Rodondi N, Spagnoli J, et al. Prefrailty and chronic morbidity in the youngest old: an insight from the Lausanne cohort Lc65⁺. J Am Geriatr Soc, 2012, 60(9): 1687-1694.
23.	Chen CY, Wu SC, Chen LJ, et al. The prevalence of subjective frailty and factors associated with frailty in Taiwan. Arch Gerontol Geriatr, 2010, 50(Suppl 1): S43-47.
24.	Carneiro JA, Ramos GC, Barbosa AT, et al. Prevalence and factors associated with frailty in non-institutionalized older adults. Rev Bras Enferm, 2016, 69(3): 435-442.
25.	Ma L, Tang Z, Zhang L, et al. Prevalence of frailty and associated factors in the community-dwelling population of China. J Am Geriatr Soc, 2018, 66(3): 559-564.
26.	Merchant RA, Chen MZ, Tan LWL, et al. Singapore healthy older people everyday (HOPE) study: prevalence of frailty and associated factors in older adults. J Am Med Dir Assoc, 2017, 18(8): 734. e9-734. e14.
27.	Sousa AC, Dias RC, Maciel ÁC, et al. Frailty syndrome and associated factors in community-dwelling elderly in Northeast Brazil. Arch Gerontol Geriatr, 2012, 54(2): 95-101.
28.	Chang SF, Yang RS, Lin TC, et al. The discrimination of using the short physical performance battery to screen frailty for community-dwelling elderly people. J Nurs Scholarsh, 2014, 46(3): 207-215.
29.	Ramsay SE, Arianayagam DS, Whincup PH, et al. Cardiovascular risk profile and frailty in a population-based study of older British men. Heart, 2015, 101(8): 616-622.
30.	Vaingankar JA, Chong SA, Abdin E, et al. Prevalence of frailty and its association with sociodemographic and clinical characteristics, and resource utilization in a population of Singaporean older adults. Geriatr Gerontol Int, 2017, 17(10): 1444-1454.
31.	Watanabe Y, Hirano H, Arai H, et al. Relationship between frailty and oral function in community-dwelling elderly adults. J Am Geriatr Soc, 2017, 65(1): 66-76.
32.	Wu IC, Shiesh SC, Kuo PH, et al. High oxidative stress is correlated with frailty in elderly chinese. J Am Geriatr Soc, 2009, 57(9): 1666-1671.
33.	Buckley DI, Fu R, Freeman M, et al. C-reactive protein as a risk factor for coronary heart disease: a systematic review and meta-analyses for the U. S. preventive services task force. Ann Intern Med, 2009, 151(7): 483-495.
34.	Cappola AR, Xue QL, Fried LP. Multiple hormonal deficiencies in anabolic hormones are found in frail older women: the women's health and aging studies. J Gerontol A Biol Sci Med Sci, 2009, 64(2): 243-248.
35.	Ding EL, Song Y, Malik VS, et al. Sex differences of endogenous sex hormones and risk of type 2 diabetes: a systematic review and meta-analysis. JAMA, 2006, 295(11): 1288-1299.
36.	Ren J, Anversa P. The insulin-like growth factor I system: physiological and pathophysiological implication in cardiovascular diseases associated with metabolic syndrome. Biochem Pharmacol, 2015, 93(4): 409-417.
37.	Mulero J, Zafrilla P, Martinez-Cacha A. Oxidative stress, frailty and cognitive decline. J Nutr Health Aging, 2011, 15(9): 756-760.
38.	Ashar FN, Moes A, Moore AZ, et al. Association of mitochondrial DNA levels with frailty and all-cause mortality. J Mol Med (Berl), 2015, 93(2): 177-186.
39.	Zaslavsky O, Cochrane BB, Thompson HJ, et al. Frailty: a review of the first decade of research. Biol Res Nurs, 2013, 15(4): 422-432.
40.	Evans JL, Goldfine ID, Maddux BA, et al. Are oxidative stress-activated signaling pathways mediators of insulin resistance and beta-cell dysfunction? Diabetes, 2003, 52(1): 1-8.
41.	D'Mello MJ, Ross SA, Briel M, et al. Association between shortened leukocyte telomere length and cardiometabolic outcomes: systematic review and meta-analysis. Circ Cardiovasc Genet, 2015, 8(1): 82-90.
42.	Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci, 2001, 56(3): M146-156.
43.	向玉萍, 高静, 吴晨曦, 等. 衰弱与糖尿病患者不良结局关系的系统评价. 中国疗养医学, 2018, 27(1): 1-5.
44.	Ida S, Kaneko R, Imataka K, et al. Relationship between frailty and mortality, hospitalization, and cardiovascular diseases in diabetes: a systematic review and meta-analysis. Cardiovasc Diabetol, 2019, 18(1): 81.
45.	Morley JE. Nutritional supplementation and sarcopenia: the evidence grows. J Am Med Dir Assoc, 2015, 16(9): 717-719.
46.	Theou O, Stathokostas L, Roland KP, et al. The effectiveness of exercise interventions for the management of frailty: a systematic review. J Aging Res, 2011, 2011: 569194.
47.	Abdelhafiz AH, Rodríguez-Mañas L, Morley JE, et al. Hypoglycemia in older people - a less well recognized risk factor for frailty. Aging Dis, 2015, 6(2): 156-167.

1. Lipsitz LA. Dynamics of stability: the physiologic basis of functional health and frailty. J Gerontol A Biol Sci Med Sci, 2002, 57(3): B115-125.
2. Fried LP, Ferrucci L, Darer J, et al. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci, 2004, 59(3): 255-263.
3. Woods NF, LaCroix AZ, Gray SL, et al. Frailty: emergence and consequences in women aged 65 and older in the women's health initiative observational study. J Am Geriatr Soc, 2005, 53(8): 1321-1330.
4. Cho NH, Shaw JE, Karuranga S, et al. IDF diabetes atlas: global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract, 2018, 138: 271-281.
5. Baena-Díez JM, Peñafiel J, Subirana I, et al. Risk of cause-specific death in individuals with diabetes: a competing risks analysis. Diabetes Care, 2016, 39(11): 1987-1995.
6. Chen LK, Chen YM, Lin MH, et al. Care of elderly patients with diabetes mellitus: a focus on frailty. Ageing Res Rev, 2010, 9 Suppl 1: S18-22.
7. Soysal P, Stubbs B, Lucato P, et al. Inflammation and frailty in the elderly: a systematic review and meta-analysis. Ageing Res Rev, 2016, 31: 1-8.
8. Morley JE, Kim MJ, Haren MT. Frailty and hormones. Rev Endocr Metab Disord, 2005, 6(2): 101-108.
9. Heuberger RA. The frailty syndrome: a comprehensive review. J Nutr Gerontol Geriatr, 2011, 30(4): 315-368.
10. Veronese N, Stubbs B, Fontana L, et al. Frailty is associated with an increased risk of incident type 2 diabetes in the elderly. J Am Med Dir Assoc, 2016, 17(10): 902-907.
11. 沈妍交, 曹立, 郝秋奎, 等. 老年病科住院患者衰弱状况及其影响因素. 中国老年学杂志, 2019, 39(24): 6117-6120.
12. 秦丽, 梁珍珍, 葛立宾, 等. 社区老年衰弱综合征的影响因素研究. 中国全科医学, 2020, 23(5): 598-603.
13. Ricci NA, Pessoa GS, Ferriolli E, et al. Frailty and cardiovascular risk in community-dwelling elderly: a population-based study. Clin Interv Aging, 2014, 9: 1677-1685.
14. 曾宪涛, 刘慧, 陈曦, 等. Meta分析系列之四: 观察性研究的质量评价工具. 中国循证心血管医学杂志, 2012, 4(4): 297-299.
15. 方向阳, 陈清, 侯原平, 等. 社区老年人衰弱相关因素. 中国老年学杂志, 2019, 39(2): 467-470.
16. 卫尹, 曹艳佩, 杨晓莉, 等. 老年住院患者衰弱综合征现状及影响因素. 复旦学报(医学版), 2018, 45(4): 496-502.
17. 孟丽, 谭潇, 石婧, 等. 老年人衰弱分布及其影响因素的初步研究. 中国临床保健杂志, 2017, 20(5): 481-485.
18. Serra-Prat M, Papiol M, Vico J, et al. Factors associated with frailty in community-dwelling elderly population: a cross-sectional study. Eur Geriatr Med, 2016, 7: 531-537.
19. Calado LB, Ferriolli E, Moriguti JC, et al. Frailty syndrome in an independent urban population in Brazil (FIBRA study): a cross-sectional populational study. Sao Paulo Med J, 2016, online ahead of print. DOI: 10.1590/1516-3180.2016.0078180516.
20. Chang SS, Weiss CO, Xue QL, et al. Patterns of comorbid inflammatory diseases in frail older women: the women's health and aging studiesⅠandⅡ. J Gerontol A Biol Sci Med Sci, 2010, 65(4): 407-413.
21. Bustamante-Ara N, Villarroel L, Paredes F, et al. Frailty and health risks in an agricultural population, Chile 2014-2017. Arch Gerontol Geriatr, 2019, 82: 114-119.
22. Danon-Hersch N, Rodondi N, Spagnoli J, et al. Prefrailty and chronic morbidity in the youngest old: an insight from the Lausanne cohort Lc65⁺. J Am Geriatr Soc, 2012, 60(9): 1687-1694.
23. Chen CY, Wu SC, Chen LJ, et al. The prevalence of subjective frailty and factors associated with frailty in Taiwan. Arch Gerontol Geriatr, 2010, 50(Suppl 1): S43-47.
24. Carneiro JA, Ramos GC, Barbosa AT, et al. Prevalence and factors associated with frailty in non-institutionalized older adults. Rev Bras Enferm, 2016, 69(3): 435-442.
25. Ma L, Tang Z, Zhang L, et al. Prevalence of frailty and associated factors in the community-dwelling population of China. J Am Geriatr Soc, 2018, 66(3): 559-564.
26. Merchant RA, Chen MZ, Tan LWL, et al. Singapore healthy older people everyday (HOPE) study: prevalence of frailty and associated factors in older adults. J Am Med Dir Assoc, 2017, 18(8): 734. e9-734. e14.
27. Sousa AC, Dias RC, Maciel ÁC, et al. Frailty syndrome and associated factors in community-dwelling elderly in Northeast Brazil. Arch Gerontol Geriatr, 2012, 54(2): 95-101.
28. Chang SF, Yang RS, Lin TC, et al. The discrimination of using the short physical performance battery to screen frailty for community-dwelling elderly people. J Nurs Scholarsh, 2014, 46(3): 207-215.
29. Ramsay SE, Arianayagam DS, Whincup PH, et al. Cardiovascular risk profile and frailty in a population-based study of older British men. Heart, 2015, 101(8): 616-622.
30. Vaingankar JA, Chong SA, Abdin E, et al. Prevalence of frailty and its association with sociodemographic and clinical characteristics, and resource utilization in a population of Singaporean older adults. Geriatr Gerontol Int, 2017, 17(10): 1444-1454.
31. Watanabe Y, Hirano H, Arai H, et al. Relationship between frailty and oral function in community-dwelling elderly adults. J Am Geriatr Soc, 2017, 65(1): 66-76.
32. Wu IC, Shiesh SC, Kuo PH, et al. High oxidative stress is correlated with frailty in elderly chinese. J Am Geriatr Soc, 2009, 57(9): 1666-1671.
33. Buckley DI, Fu R, Freeman M, et al. C-reactive protein as a risk factor for coronary heart disease: a systematic review and meta-analyses for the U. S. preventive services task force. Ann Intern Med, 2009, 151(7): 483-495.
34. Cappola AR, Xue QL, Fried LP. Multiple hormonal deficiencies in anabolic hormones are found in frail older women: the women's health and aging studies. J Gerontol A Biol Sci Med Sci, 2009, 64(2): 243-248.
35. Ding EL, Song Y, Malik VS, et al. Sex differences of endogenous sex hormones and risk of type 2 diabetes: a systematic review and meta-analysis. JAMA, 2006, 295(11): 1288-1299.
36. Ren J, Anversa P. The insulin-like growth factor I system: physiological and pathophysiological implication in cardiovascular diseases associated with metabolic syndrome. Biochem Pharmacol, 2015, 93(4): 409-417.
37. Mulero J, Zafrilla P, Martinez-Cacha A. Oxidative stress, frailty and cognitive decline. J Nutr Health Aging, 2011, 15(9): 756-760.
38. Ashar FN, Moes A, Moore AZ, et al. Association of mitochondrial DNA levels with frailty and all-cause mortality. J Mol Med (Berl), 2015, 93(2): 177-186.
39. Zaslavsky O, Cochrane BB, Thompson HJ, et al. Frailty: a review of the first decade of research. Biol Res Nurs, 2013, 15(4): 422-432.
40. Evans JL, Goldfine ID, Maddux BA, et al. Are oxidative stress-activated signaling pathways mediators of insulin resistance and beta-cell dysfunction? Diabetes, 2003, 52(1): 1-8.
41. D'Mello MJ, Ross SA, Briel M, et al. Association between shortened leukocyte telomere length and cardiometabolic outcomes: systematic review and meta-analysis. Circ Cardiovasc Genet, 2015, 8(1): 82-90.
42. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci, 2001, 56(3): M146-156.
43. 向玉萍, 高静, 吴晨曦, 等. 衰弱与糖尿病患者不良结局关系的系统评价. 中国疗养医学, 2018, 27(1): 1-5.
44. Ida S, Kaneko R, Imataka K, et al. Relationship between frailty and mortality, hospitalization, and cardiovascular diseases in diabetes: a systematic review and meta-analysis. Cardiovasc Diabetol, 2019, 18(1): 81.
45. Morley JE. Nutritional supplementation and sarcopenia: the evidence grows. J Am Med Dir Assoc, 2015, 16(9): 717-719.
46. Theou O, Stathokostas L, Roland KP, et al. The effectiveness of exercise interventions for the management of frailty: a systematic review. J Aging Res, 2011, 2011: 569194.
47. Abdelhafiz AH, Rodríguez-Mañas L, Morley JE, et al. Hypoglycemia in older people - a less well recognized risk factor for frailty. Aging Dis, 2015, 6(2): 156-167.

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