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Diabetes could be partially responsible for increased frailty with age
Among a cohort of adults aged at least 60 years, participants with diabetes or high HbA1c became frailer more quickly than those without either condition, particularly if cardiovascular disease also was present, according to findings published in Diabetes Care.
“There is evidence that frailty progression can be slowed or reverted by treatment, highlighting the need to detect it at early stages to minimize potential health consequences,” Gloria A. Aguayo, MD, MSc, PhD, of the population health department of Luxembourg Institute of Health in Strassen, Luxembourg, and colleagues wrote. “Diabetes and frailty share some pathophysiological mechanisms, such as low-grade inflammation, insulin resistance and sarcopenia.”
Aguayo and colleagues conducted a prospective study using data from 5,377 adults aged at least 60 years (median age, 70 years; 55% women) in the English Longitudinal Study of Ageing. From 2004 to 2015, participants completed the 36-item Frailty Index questionnaire biennially. The index items were binary responses and were used to calculate a frailty score between 0 and 1, with a mark of 0.2 indicating a participant was frail. The researchers also calculated overall frailty scores out of 100 by incorporating Edmonton Frail Scale and phenotype of frailty scores into estimates. Higher scores on this 100-point scale equated to more frailty.
At baseline, 12% of the participants had diabetes and 35% were frail. After adjustments for sex, birth year, family income, social class, smoking and alcohol history, HbA1c and diabetes medication use, men with diabetes were expected to have an average frailty score of 16 at age 60 years, which would rise to a score of 47 at age 90 years. For men without diabetes, the expected scores increased from an average of nine at age 60 years to an average of 38 at age 90 years. Among women with diabetes, the average expected score was 42 at age 60 years and 72 at age 90 years vs. average scores of 21 and 49 at ages 60 years and 90 years, respectively, for women without diabetes.
Despite these findings, the researchers noted that the association between diabetes at baseline and frailty was observed only among participants without cardiovascular disease. In addition, in adjusted models, having higher HbA1c amplified initial frailty scores and led to a similarly aggressive increase over time, but the association was weaker when adjustments were included for income and social class, smoking and alcohol consumption, and the interaction of HbA1c and diabetes, according to the researchers.
“Our finding of an association between diabetes and frailty in a longitudinal setting, even after adjustment for potential confounders, indicates that people with diabetes experience higher levels of frailty during aging,” the researchers wrote. “These results highlight the relevance of a timely diabetes diagnosis because of the likelihood of a faster increasing frailty trajectory than among individuals without diabetes.” – by Phil Neuffer
Disclosures: The authors report no relevant financial disclosures.
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