南京医科大学学报（自然科学版）2026，Vol.46Issue(6)：840-853,14.DOI:10.7655/NYDXBNSN260215
虚弱状态与成人1型糖尿病死亡和血管并发症风险的关联研究
Frailty and risk of mortality and vascular complications in adults with type 1 diabetes
摘要
Abstract
Objective:To investigate the associations between frailty status and the risks of mortality and vascular complications in adults with type 1 diabetes(T1D).Methods:This prospective cohort study was based on the UK Biobank(UKB)and included participants with T1D at baseline.Frailty status was assessed using physical frailty(PF)and the frailty index(FI).The primary outcomes included all-cause mortality,T1D-related and complication-related mortality,and incident macrovascular and microvascular complications.Cox proportional hazards regression models were used to evaluate the associations between frailty status and each outcome.Dose-response analyses,subgroup analyses,and multiple sensitivity analyses were further conducted.Results:A total of 1 571 participants with T1D at baseline were included in the mortality analyses,with a median follow-up of 13.4 years;among them,1 207 participants without baseline vascular complications were included in the complication analyses.Based on PF and FI,12.7%and 28.5%of participants were classified as frail,respectively.After multivariable adjustment,compared with non-frail participants,frail individuals had a significantly higher risk of all-cause mortality[PF:hazard ratio(HR)=2.76,95%confidence interval(CI):1.92-3.98;FI:HR=2.71,95%CI:1.71-4.31].The risk of T1D-related and complication-related mortality was also markedly increased among frail participants(PF:HR 4.02,95%CI:2.21-7.28;FI:HR 4.14,95%CI:1.73-9.89).Among participants without baseline vascular complications,frailty was significantly associated with higher risks of incident macrovascular complications(PF:HR=2.17,95%CI:1.46-3.22;FI:HR=2.39,95%CI:1.61-3.54)and microvascular complications(PF:HR=1.66,95%CI:1.18-2.32;FI:HR=2.05,95%CI:1.47-2.86).Dose-response analyses showed monotonic increases in the risks of multiple outcomes with increasing frailty severity,whereas a non-linear association was observed between PF scores and the risk of microvascular complications.Subgroup analyses showed that the association between FI and all-cause mortality was more pronounced among participants with lower systolic blood pressure(SBP)or lower body mass index(BMI),whereas the predictive effect of PF was relatively consistent across subgroups.Sensitivity analyses yielded results generally consistent with the main analyses.Conclusion:In adults with T1D,frailty was significantly associated with increased risks of mortality and incident vascular complications.Frailty assessment may help identify individuals at higher risk of poor prognosis and provide additional support for risk stratification and management in this population.关键词
1型糖尿病/虚弱/死亡/糖尿病并发症/UK BiobankKey words
type 1 diabetes/frailty/mortality/diabetes complications/UK Biobank分类
医药卫生引用本文复制引用
周轶雯,李爽,刘静飞,陈启航,杨淳,高天雨,陈阳,顾愹,杨涛..虚弱状态与成人1型糖尿病死亡和血管并发症风险的关联研究[J].南京医科大学学报（自然科学版）,2026,46(6):840-853,14.基金项目
国家自然科学基金(82230028) （82230028）
国家"万人计划"青年拔尖人才支持计划(SQ2024QB05226) （SQ2024QB05226）
江苏省前沿技术研发计划(BF2025612) （BF2025612）
四大慢病重大专项(2023ZD0507400,2023ZD0507403) （2023ZD0507400,2023ZD0507403）
