| ObjectiveTo evaluate the prevalence of frailty in diabetic patients,and appraise the use of frailty asssssment tools in the prediction of adverse health outcomes in diabetic patients by systematic review.To determine the superiority of one or more frailty assessment tools to other tools in elderly diabetic patients in the community;to investigate the frailty status and influencing factors of elderly diabetic patients in the community,and clarify the mechanism.To provide relevant reference basis for the selection and application of frailty assessment tools for diabetic patients,and provides reference for future treatment and nursing intervention of elderly frailty patients with diabetic mellitus in the community.Methods1.The following electronic bibliographic database were searched from January 2001 to April 2019:PubMed,Embase,Web of Science,PEDro,The Cochrane Library,CINAHL,CNKI,Wanfang database,China Biology Medicine disc and Vip Database.All relevant literatures reporting the predictive value of frailty assessment tools for the adverse health outcomes of diabetic patients were included.Qualitative and quantitative analysis of the literature was performed to compare the predictive power of different tools for the same outcome.2.With multistage stratified random sampling,a total of 719 elder patients aged 60 years and over with diabetes were recruited in five community health service centers from Hengyang City,Hunan Province from May 2019 to December 2019.FRAIL scale,general information questionnaire,Disease Distress Scale,Short Portable Mental State Questionaire,Mini Nutrition Assessment-Short Form,The Geriatric Depression Scale were conducted to investigate the frailty status and influencing factors.SPSS 22.0 software was used for statistical description,x~2 test,analysis of ANOVA variance,multi-factor Logistic regression analysis,Pearson correlation analysis,and AMOS 22.0software was used for establishing a structural equation model to determine the path of influence factors.Results1.44 articles were initially included by searching reviews.After full-text screening,12 articles were finally included for qualitative analysis and 3articles were subjected to quantitative analysis.The prevalence of frailty in diabetic patients ranges from 0.3%to 74%,and the epidemiological differences among assessment tools are large.2.The 12 studies included 8 different types of frailty assessment tools.The frailty defined by the assessment tool is closely related to adverse health outcomes such as death,disability,fall,hospitalization and complications in diabetic patients.Among them,the FRAIL scale is currently the most wide assessment tool in diabetic patients,and it has a good predictive value on the risk of hospitalization and disability in patients with diabetes[HR=1.25(95%CI:1.17,1.33),HR=1.25(95%CI:1.14,1.35)].The Frail Phenotype has the best predictive value on the death outcome of diabetic patients[HR=3.59(95%CI:1.95,6.62)].FRAIL scale is simple and easy to operate,which is more suitable for preliminary screening of frailty conditions in elderly diabetic patients in the community.3.The prevalence of frailty and pre-frailty were 19.2%and 43.3%,respectively.Among the 719 participants,15%participants reported the presence of cognitive impairment,34.8%participants reported the presence of depressive symptoms,39.9%participants reported the presence of diabetes-related distress,and 32.8%participants had the risk of malnutrition or malnutrition.4.Univariate analysis showed statistically significant differences in age,marital status,education level,family monthly income,course of disease,fasting blood glucose,number of complications,number of comorbidities,hypoglycemia in the past year,BMI,cognitive function,depressive symptoms,diabetes-related distress,and nutritional status(P<0.05).5.The statistically significant variables in the univariate analysis were incorporated into the Ordered Multiple Classification Logistic Regression for further multivariate analysis.These results showed that fasting blood glucose,the number of complications,the number of comorbidities,BMI,the history of hypoglycemia in the past year,cognitive function,nutritional status,depressive symptoms,and diabetes-related distress were the influencing factors of the frailty in elderly diabetic patients in the community.(P<0.05)6.Construct a structural equation model based on theoretical model and literature analysis to explore the mechanism and path relationship between cognitive function,depressive symptoms,diabetes-related distress,nutritional status,and frailty in elderly diabetic patients in communities.Model fitting index:x2/df=2.639,RMSEA=0.067,RMR=0.021,GFI=0.975,CFI=0.981,suggesting a good model fit.Diabetes-related distress can positively affect frailty,and also affect frailty positively through the mediating effect of nutritional status scores(mediating effect of nutritional status accounts for 9.3%of the total effect).Depression cannot directly affect frailty,but indirectly positively affects frailty by affect nutritional status and cognition function,with indirect effects of 0.046 and 0.080,respectively.Nutritional status negatively affect frailty,and also negatively affect frailty through the mediating role of cognitive function(mediating effect accounts for 9.1%of the total effect).Conclusion1.The prevalence of fraity surveyed by different assessment tools is quite different.The FRAIL scale is currently widely used in diabetic patients.It has a good predictive effect on the risk of death,hospitalization and disability in diabetic patients,which can be used for the initial screening of frailty in elder diabetic patients in the community.2.The influential factors of frailty in elder diabetic patients in the community include fasting blood glucose,number of complications,number of comorbidities,BMI,the history of hypoglycemia in the past year,cognitive function,nutritional status,depressive symptoms,and diabetes-related distress. |
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