TY - JOUR
T1 - Both pre-frailty and frailty increase healthcare utilization and adverse health outcomes in patients with type 2 diabetes mellitus
AU - Chao, Chia Ter
AU - Wang, Jui
AU - Chien, Kuo Liong
AU - Tsai, Hung Bin
AU - Chiang, Chih Kang
AU - Huang, Jenq Wen
AU - Chan, Ding Cheng
AU - Hung, Kuan Yu
N1 - Funding Information:
The study is financially sponsored by National Taiwan University Hospital BeiHu branch, and the Ministry of Science and Technology, Taiwan (MOST 106‑2314‑B‑002‑132‑MY2). The sponsors have no role in the study design, data collection, analysis, and result interpretation of this study.
Publisher Copyright:
© 2018 The Author(s).
PY - 2018/9/27
Y1 - 2018/9/27
N2 - Background: Diabetes mellitus (DM) correlates with accelerated aging and earlier appearance of geriatric phenotypes, including frailty. However, whether pre-frailty or frailty predicts greater healthcare utilization in diabetes patients is unclear. Methods: From the Longitudinal Cohort of Diabetes Patients in Taiwan (n = 840,000) between 2004 and 2010, we identified 560,795 patients with incident type 2 DM, categorized into patients without frailty, or with 1, 2 (pre-frail) and ≥ 3 frailty components, based on FRAIL scale (Fatigue, Resistance, Ambulation, Illness, and body weight Loss). We examined their long-term mortality, cardiovascular risk, all-cause hospitalization, and intensive care unit (ICU) admission. Results: Among all participants (56.4 ± 13.8 year-old, 46.1% female, and 84.8% community-dwelling), 77.8% (n = 436,521), 19.2% (n = 107,757), 2.7% (n = 15,101), and 0.3% (n = 1416) patients did not have or had 1, 2 (pre-frail), and ≥ 3 frailty components (frail), respectively, with Fatigue and Illness being the most common components. After 3.14 years of follow-up, 7.8% patients died, whereas 36.6% and 9.1% experienced hospitalization and ICU stay, respectively. Cox proportional hazard modeling discovered that patients with 1, 2 (pre-frail), and ≥ 3 frailty components (frail) had an increased risk of mortality (for 1, 2, and ≥ 3 components, hazard ratio [HR] 1.05, 1.13, and 1.25; 95% confidence interval [CI] 1.02-1.07, 1.08-1.17, and 1.15-1.36, respectively), cardiovascular events (HR 1.05, 1.15, and 1.13; 95% CI 1.02-1.07, 1.1-1.2, and 1.01-1.25, respectively), hospitalization (HR 1.06, 1.16, and 1.25; 95% CI 1.05-1.07, 1.14-1.19, and 1.18-1.33, respectively), and ICU admission (HR 1.05, 1.13, and 1.17; 95% CI 1.03-1.07, 1.08-1.14, and 1.06-1.28, respectively) compared to non-frail ones. Approximately 6-7% risk elevation in mortality and healthcare utilization was noted for every frailty component increase. Conclusion: Pre-frailty and frailty increased the risk of mortality and cardiovascular events, and entailed greater healthcare utilization in patients with type 2 DM.
AB - Background: Diabetes mellitus (DM) correlates with accelerated aging and earlier appearance of geriatric phenotypes, including frailty. However, whether pre-frailty or frailty predicts greater healthcare utilization in diabetes patients is unclear. Methods: From the Longitudinal Cohort of Diabetes Patients in Taiwan (n = 840,000) between 2004 and 2010, we identified 560,795 patients with incident type 2 DM, categorized into patients without frailty, or with 1, 2 (pre-frail) and ≥ 3 frailty components, based on FRAIL scale (Fatigue, Resistance, Ambulation, Illness, and body weight Loss). We examined their long-term mortality, cardiovascular risk, all-cause hospitalization, and intensive care unit (ICU) admission. Results: Among all participants (56.4 ± 13.8 year-old, 46.1% female, and 84.8% community-dwelling), 77.8% (n = 436,521), 19.2% (n = 107,757), 2.7% (n = 15,101), and 0.3% (n = 1416) patients did not have or had 1, 2 (pre-frail), and ≥ 3 frailty components (frail), respectively, with Fatigue and Illness being the most common components. After 3.14 years of follow-up, 7.8% patients died, whereas 36.6% and 9.1% experienced hospitalization and ICU stay, respectively. Cox proportional hazard modeling discovered that patients with 1, 2 (pre-frail), and ≥ 3 frailty components (frail) had an increased risk of mortality (for 1, 2, and ≥ 3 components, hazard ratio [HR] 1.05, 1.13, and 1.25; 95% confidence interval [CI] 1.02-1.07, 1.08-1.17, and 1.15-1.36, respectively), cardiovascular events (HR 1.05, 1.15, and 1.13; 95% CI 1.02-1.07, 1.1-1.2, and 1.01-1.25, respectively), hospitalization (HR 1.06, 1.16, and 1.25; 95% CI 1.05-1.07, 1.14-1.19, and 1.18-1.33, respectively), and ICU admission (HR 1.05, 1.13, and 1.17; 95% CI 1.03-1.07, 1.08-1.14, and 1.06-1.28, respectively) compared to non-frail ones. Approximately 6-7% risk elevation in mortality and healthcare utilization was noted for every frailty component increase. Conclusion: Pre-frailty and frailty increased the risk of mortality and cardiovascular events, and entailed greater healthcare utilization in patients with type 2 DM.
KW - Diabetes mellitus
KW - Frail phenotype
KW - Frailty
KW - Hospitalization
KW - Mortality
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U2 - 10.1186/s12933-018-0772-2
DO - 10.1186/s12933-018-0772-2
M3 - Article
C2 - 30261879
AN - SCOPUS:85054050172
SN - 1475-2840
VL - 17
JO - Cardiovascular Diabetology
JF - Cardiovascular Diabetology
IS - 1
M1 - 130
ER -
