老年糖尿病患者衰弱发生率的系统评价

doi:10.3761/j.issn.0254-1769.2021.05.007

摘要/Abstract

摘要：

目的系统评价老年糖尿病患者衰弱的发生率,为制订适宜的护理干预措施提供依据。方法计算机检索PubMed、Embase、Web of Science、中国生物医学文献数据库、中国知网、维普和万方数据库,检索时限为建库至2020年8月,收集老年糖尿病患者衰弱发生率的观察性研究。由2名研究员根据纳入和排除标准独立筛选文献、提取资料,依据乔安娜布里格斯研究所（Joanna Briggs Institute,JBI）文献质量评价工具和纽尔卡斯-渥太华量表（Newcastle-Ottawa Quality Scale,NOS）对纳入文献进行质量评价,应用Stata 15.0软件进行系统评价,采用固定效应或随机效应模型进行数据合并,Egger秩相关检验和漏斗图判断发表偏倚。结果最终纳入27篇文献,共8 127例患者。系统评价结果显示,老年糖尿病患者衰弱的总体发生率为30%[95%CI（0.24~0.37）],衰弱前期的总体发生率为44%[95%CI（0.38~0.51）]。亚组分析结果显示,女性老年糖尿病患者衰弱的发生率（31%）高于男性（24%）;医院发生率（31%）高于社区（30%）;采用综合性衰弱筛查工具评估衰弱时,其发生率（43%）高于躯体性衰弱筛查工具（27%）;北美洲地区发生率（41%）高于亚洲地区（28%）和欧洲地区（27%）。结论老年糖尿病患者衰弱的发生率较高,衰弱前期的发生率更高。护理人员不仅要重视对该人群进行衰弱的早期筛查,更要加强对衰弱前期的识别,制订合理的干预措施以改善老年糖尿病患者预后并提高其生活质量。

关键词: 老年人, 糖尿病, 衰弱, 系统评价, 护理

Abstract:

Objective To systematically evaluate the prevalence of frailty in older patients with diabetes and provide evidence for nursing interventions.Methods Systematic review of the literature was conducted in electronic databases,namely PubMed,Embase,Web of Science,CBM,CNKI,VIP and Wan fang Data,and observational studies about the prevalence of frailty in older patients with diabetes published before August 2020 were included. 2 researchers independently screened the literature,extracted the data,and assessed the quality of included studies using Critical Appraisal Tools published by JBI and NOS. The meta-analysis was performed by Stata 15.0 software. Fixed-effect or random-effect models were used to pool data. Egger rank correlation and funnel plot were used to determine publication bias.Results 27 studies were finally included with a total of 8 127 patients. The pooled prevalence of frailty in older patients with diabetes was 30%[95%CI（0.24~0.37）],and it was 44%[95%CI（0.38~0.51）] for pre-frailty. Subgroup analysis showed that the prevalence of frailty in patients with diabetes in female was higher than that in male;the prevalence of frailty in patients with diabetes in hospital was higher than that in community;the prevalence of frailty in patients with diabetes using multidimensional frailty measures to evaluate frailty was higher than that using physical frailty measures;the prevalence of frailty in patients with diabetes in North America was higher than that in Asia and Europe.Conclusion There is a higher prevalence of frailty/pre-frailty in older patients with diabetes. In the future,nursing staff should not only pay attention to the early screening of the frailty of this population,but also strengthen the identification of the pre-frailty,and develop reasonable interventions to improve the prognosis and quality of life of the elderly diabetic patients.

Key words: The Aged, Diabetes Mellitus, Frail Elderly, Systematic Review, Nursing Care

高倩倩,梅凡,赵黎,陈飞,胡凯燕,尚轶,马玉霞,马彬. 老年糖尿病患者衰弱发生率的系统评价[J]. 中华护理杂志, 2021, 56(5): 686-693.

GAO Qianqian,MEI Fan,ZHAO Li,CHEN Fei,HU Kaiyan,SHANG Yi,MA Yuxia,MA Bin. Prevalence of frailty in older patients with diabetes：a systematic review[J]. Chinese Journal of Nursing, 2021, 56(5): 686-693.

图/表 5

图1 文献检索流程图

Figure 1 Flow chart of literature selection

表1 纳入文献的基本特征

Table 1 Characteristics of the included studies

表2 横断面研究质量评价结果

Table 2 Risk of bias assessment in cross-sectional studies

表3 队列研究质量评价结果（分）

Table 3 Risk of bias assessment in cohort studies（scores）

表4 老年糖尿病患者衰弱发生率亚组分析结果

Table 4 Subgroup analyses of the prevalence of frailty in older patients with diabetes

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