Hyperglycemia, Frailty and Disability in Older Women

老年女性的高血糖、虚弱和残疾

• 批准号: 6822736
• 负责人: Caroline S Blaum
• 金额: $ 30.62万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-09-01 至 2007-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6822736
• 关键词: behavioral /social science research tag; blood vessel disorder; body physical activity; cytoskeletal proteins; disease /disorder proneness /risk; exercise; female; frail elderly; functional ability; human old age (65+); human subject; hyperglycemia; inflammation; interleukin 6; longitudinal human study; mathematical model; medical complication; muscle strength; noninsulin dependent diabetes mellitus; obesity; pathologic process; person with disability; phlebotomy; tumor necrosis factor alpha; weight loss; women' s health

DESCRIPTION (provided by applicant): As disability becomes increasingly recognized as a diabetes outcome of major clinical and public health importance, it becomes less clear how diabetes causes disability. The goal of the proposed research is to investigate whether hyperglycemia itself has an independent association with disability in mobility, endurance, strength and activities of daily living. We will test the hypothesis that hyperglycemia contributes to the development of frailty (a syndrome of vulnerability to stressors recently shown to be prevalent in community-dwelling older adults) and through this to disability, via a pathway involving inflammatory mediators. The specific aims are: l) to describe change over time in level of hyperglycemia measured by glycohemoglobin; 2) to evaluate associations of hyperglycemia with inflammatory mediators and how that association is modified by obesity; 3, to evaluate associations of hyperglycemia with characteristics defining frailty (weight loss, weakness, slowness, exhaustion, low exercise tolerance) and the frailty syndrome itself, to determine if hyperglycemia at baseline or its change over time predicts onset or progression of frailty; 4, to evaluate the contribution of hyperglycemia to measures of disability through frailty, and overall, adjusting for comorbidity; 5, to seek evidence for potential critical points in the pathway from hyperglycemia to disability that might be amenable to intervention, such as (a) threshold levels of hyperglycemia; (b) subsets of older people in whom hyperglycemia may be particularly problematic such as those with vascular conditions and obesity; and 6, to evaluate population attributable risk of frailty and disability due to the hyperglycemia frailty pathway. Our research strategy includes: study of women who are both functional and disabled using two complementary studies, the Women's Health and Aging Studies I and II, which have nearly identical measures of relevant variables; and cross sectional and longitudinal data analysis. Analyses will focus on longitudinal change models including random effect growth curves, random-effect change models, and time to event models. This research will link inflammatory disruption in diabetes to that of frailty and disability, help determine the potential impact of hyperglycemia on adverse health outcomes important to older adults, and provide important preliminary data for future studies, observational and interventional, of glycemic control in older adults with diabetes.

描述（由申请人提供）：随着残疾越来越被公认为是主要临床和公共健康重要性的糖尿病结果，糖尿病如何导致残疾变得尚不清楚。拟议的研究的目的是研究高血糖本身是否与流动性，耐力，力量和日常生活中的残疾有独立的联系。我们将检验以下假设：高血糖有助于脆弱的发展（对压力源的脆弱性综合征最近在社区居住的老年人中很普遍），并通过涉及炎症介体的途径通过这种残疾。具体目的是：l）描述通过糖emoglobin测量的高血糖水平随时间变化的变化； 2）评估高血糖与炎症介质的关联，以及如何通过肥胖来改变这种关联； 3，评估高血糖的关联与定义脆弱的特征（体重减轻，弱点，缓慢，疲惫，运动耐受性低）和脆弱的综合征本身，以确定基线时高血糖或其随时间变化的变化是否预测脆弱的发作或进展； 4，以评估高血糖对通过脆弱的残疾度量的贡献，总体上调整合并症； 5，寻求从高血糖到残疾的途径中潜在的关键点的证据，这些途径可能适合干预，例如（a）高血糖的阈值水平； （b）高血糖可能尤其有问题的老年人的子集，例如血管状况和肥胖症的人群；和6，以评估由于高血糖较弱的途径而导致的脆弱和残疾风险。我们的研究策略包括：使用两项互补研究（女性健康和衰老研究I和II）对妇女进行功能和残疾的研究，这些研究与相关变量几乎相同；以及横截面和纵向数据分析。分析将重点放在纵向变化模型上，包括随机效应生长曲线，随机效应变化模型和事件模型的时间。这项研究将将糖尿病的炎症破坏与脆弱和残疾联系起来，有助于确定高血糖对不良健康结果对老年人重要的不良健康结果的潜在影响，并为老年人对糖尿病的老年人的观察性研究和介入，介入的观察性和介入性，对糖尿病的介入，为未来的研究提供重要的初步数据。