Original Study
Diabetes and Risk of Frailty and Its Potential Mechanisms: A Prospective Cohort Study of Older Adults

https://doi.org/10.1016/j.jamda.2015.04.008Get rights and content

Abstract

Background

There is emerging evidence of the role of diabetes as a risk factor for frailty. However, the mechanisms of this association are uncertain.

Methods

Prospective cohort study of 1750 noninstitutionalized individuals aged 60 years or older recruited in 2008–2010. At baseline, information was obtained on health behaviors, morbidity, cardiometabolic biomarkers, and antidiabetic treatments. Individuals were considered diabetic if they reported a physician diagnosis or had fasting serum glucose of 126 mg/dL or higher. Study participants were followed through 2012 to assess incident frailty, defined as at least 3 of the 5 Fried criteria.

Results

At baseline, the cohort included 346 individuals with diabetes and 1404 without diabetes. Over a mean 3.5-year follow-up, 115 cases of incident frailty were ascertained. After adjustment for age, sex, and education, participants with diabetes showed an increased risk of frailty (odds ratio [OR] 2.18, 95% confidence interval [CI] 1.42–3.37). Additional adjustment for health behaviors and abdominal obesity yielded a 29.7% reduction in the OR (OR 1.83, 95% CI 1.16–2.90). Subsequent adjustment for morbidity produced an additional 8.4% reduction (OR 1.76, 95% CI 1.10–2.82), and for cardiometabolic biomarkers, a further 44% reduction (OR 1.32, 95% CI 0.70–2.49). In particular, adjustment for HbA1c, lipoproteins, and triglycerides accounted for the greatest reductions. Finally, additional adjustment for oral antidiabetic medication reduced the OR to 1.01 (95% CI 0.46–2.20), whereas adjustment for nutritional therapy increased the OR to 1.64 (95% CI 0.77–3.49).

Conclusions

Diabetes mellitus is associated with higher risk of frailty; this association is partly explained by unhealthy behaviors and obesity and, to a greater extent, by poor glucose control and altered serum lipid profile among diabetic individuals. Conversely, diabetes nutritional therapy reduces the risk of frailty.

Section snippets

Study Participants and Design

We analyzed data from the Seniors-ENRICA cohort, whose methods have been reported elsewhere.13 This cohort was established in 2008–2010 with 2614 noninstitutionalized individuals aged 60 years or older. At baseline, computer-assisted telephone interviews were used to obtain information on sociodemographic factors, health behaviors, and morbidity. Additionally, home visits were performed to conduct a physical examination, obtain 12-hour fasting blood samples, and record usual diet and prescribed

Results

Table 1 shows the sociodemographic, lifestyle, clinical, and biochemical variables of the study participants, according to diabetic status. Compared with the nondiabetic individuals, those with diabetes were on average 1 year older, were more frequently men, had lower educational level, and showed a higher prevalence of tobacco consumption, obesity, and sedentary behavior. Also, they were less frequently moderate drinkers, showed a higher frequency of cardiovascular disease, a lower level of

Discussion

In this study of community-dwelling older adults in Spain, diabetes was associated with an increased risk of frailty over 3.5 years of follow-up. This increased risk was partly explained by unhealthy behaviors and obesity and, to a greater extent, by poor glucose control and altered serum lipid profile among diabetic individuals. Conversely, nutritional therapy modulated the increased risk of frailty observed among individuals with diabetes.

Patients with type 2 diabetes have an increased

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    Baseline data collection was funded by Sanofi-Aventis. Data collection during follow-up was funded by the Spanish Government FIS grants 09/1626 and 09/0104 (Instituto de Salud Carlos III). Funding specific for this analysis was obtained from the Spanish Government FIS grant 12/1166 (Instituto de Salud Carlos III) and the FP7-HEALTH-2012-Proposal No: 305483–2 (FRAILOMIC Initiative). Funders had no role in data analyses, preparation of the manuscript, or in the decision to submit it for publication.

    The authors declare no conflicts of interest.

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