Frailty as a Major Factor in the Increased Risk of Death and Disability in Older People With Diabetes

Castro-Rodríguez, M.; Carnicero, José Antonio Carranza; García‐García, Francisco José; Walter, Stephan; Morley, John E.; Rodríguez‐Artalejo, Fernando; Sinclair, Alan J.; Rodríguez‐Mañas, Leocadio

doi:10.1016/j.jamda.2016.07.013

Cited by 102 publications

(83 citation statements)

References 32 publications

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“…We also know from long-term follow-up of the major glycaemic intensification studies indicate an enduring survival advantage in the intensive study arms, 23 although another recent follow-up study or a large intensification trial did not observe any survival advantage. 24 Furthermore, in our data we observed limited hazard in relation to glucose lowering therapies, which would be counter to the excess intensification explanation, with only SUs and insulin being associated with modest elevated mortality risk. Huang et al 3 found that the patients in their lower glycaemic group had significantly less exposure to hypoglycaemic agents than those with more elevated levels of glycaemic control.…”

Section: Discussioncontrasting

confidence: 55%

Mean HbA1c, HbA1c variability, and mortality in people with diabetes aged 70 years and older: a retrospective cohort study

Forbes

Murrells

Mulnier

et al. 2018

The Lancet Diabetes & Endocrinology

156

151

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Evidence before this studyWe have searched PubMed and Scopus from 1990-2017, to identify relevant studies that contain terms for older people; all-cause mortality; glycaemic control; glycaemic variability (with synonyms). We also identified current international guidelines for older people. Overall, the data on optimal glycaemic targets for older people are scant, particularly from prospective studies. In terms of the association between glycaemic control and mortality in older populations the finding have suggested a 'J' shaped distribution in that relationship, although the point at which a significant mortality hazard is observed at the lower end of the glycaemic range has varied between studies. In terms of glycaemic variability, it has been identified that longer term variations in glycaemic control are associated with mortality risk. However, these analyses have not been graduated for magnitude or direction of variability. In addition, previous analyses have not considered the impact of low HbA1c levels, which are associated with mortality risk independent of diabetes intervention. Added value of this studyIn this large population study we are the first group to consider both glycaemic control and glycaemic variability together. We have also employed a new metric for variability which considers exposure to clinically significant changes in glycaemic control. This metric enabled us to assess the direction of change as well as the overall variability. Integrating glycaemic control and variability in our modelling enabled us to consider the importance of stability as a potential factor in understanding the mortality hazard in this population. Additional nuances to our analysis include: consideration of low HbA1c values; higher levels of granularity compared to previous studies in terms of glycaemic thresholds, with 0.5%(5.5mmol/l) HbA1c increments; consideration of gender differences; and the distinction between those who develop diabetes in midlife and those who develop it in older age. Implications of all the available evidenceOur data suggest that we may need to rethink how we consider glycaemic targets in the older diabetes population, in a number of ways: firstly, that variability expresses significant hazard in older people; secondly, that variability may be independent of diabetes therapies and may be related to other factors related to aging; thirdly, stability seems to attenuate hazard in medium to higher ranges of glycaemic control; and finally, there may be some important gender differences in relation to glycaemic control and hazard which are not considered in current guidelines. Therefore, while we recognise that observational data can often raise more questions than answers; we would advocate that we reconsider glycaemic control not simply as a target to direct therapeutic management, but as an important piece of information in relation to assessing individual risk. Perhaps in the past we have been too polarised in our view of glycaemia as purely indicative of optimal control, rather than as a p...

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Section: Discussioncontrasting

confidence: 55%

Mean HbA1c, HbA1c variability, and mortality in people with diabetes aged 70 years and older: a retrospective cohort study

Forbes

Murrells

Mulnier

et al. 2018

The Lancet Diabetes & Endocrinology

156

151

View full text Add to dashboard Cite

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“…Frailty is emerging as a high‐impact geriatric syndrome, and according to recent data from the UK Biobank Study, T2DM adds a five‐fold increase in the risk of frailty in middle‐aged and older people (aged 37–73 years) . Frailty is viewed as a generalized loss in physiological reserve capacity associated with functional decline and has an increased risk for negative health outcomes; it is now considered a complication of diabetes that may subsequently account for the unexplained disability excess seen in older diabetic populations . Although the biological processes that underlie frailty are still unclear and likely to be complex and multifactorial, sarcopenia may play an important role in the accelerated decline in leg lean mass, muscle strength, and functional capacity seen in older people with diabetes compared with those without diabetes …”

Section: Introductionmentioning

confidence: 99%

Effectiveness of a multimodal intervention in functionally impaired older people with type 2 diabetes mellitus

Rodríguez‐Mañas

Laosa

Vellas

et al. 2019

J cachexia sarcopenia muscle

Self Cite

118

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Background Type 2 diabetes, a highly prevalent chronic disease, is associated with increasing frailty and functional decline in older people. We aimed to evaluate the effectiveness of a multimodal intervention on functional performance in frail and pre‐frail participants aged ≥70 years with type 2 diabetes mellitus. Methods The MID‐Frail study was a cluster‐randomized multicenter clinical trial conducted in 74 trial sites across seven European countries. The trial recruited 964 participants who were aged >70 years [mean age in intervention group, 78.4 (SD 5.6) years, 49.2% male and 77.6 (SD 5.29) years, 52.4% male in usual care group], with type diabetes mellitus and determined to be frail or pre‐frail using Fried's frailty phenotype. Participants were allocated by trial site to follow either usual care (UCG) or intervention procedures (IG). Intervention group participants received a multimodal intervention composed of (i) an individualized and progressive resistance exercise programme for 16 weeks; (ii) a structured diabetes and nutritional educational programme over seven sessions; and (iii) Investigator‐linked training to ensure optimal diabetes care. Short Physical Performance Battery (SPPB) scores were used to assess change in functional performance at 12 months between the groups. An analysis of the cost‐effectiveness of the intervention was undertaken using the incremental cost‐effectiveness ratio (ICER). Secondary outcomes included mortality, hospitalization, institutionalization, quality of life, burden on caregivers, the frequency and severity of hypoglycaemia episodes, and the cost‐effectiveness of the intervention. Results After 12 months, IG participants had mean SPPB scores 0.85 points higher than those in the UCG (95% CI, 0.44 to 1.26, P < 0.0001). Dropouts were higher in frail participants and in the intervention group, but significant differences in SPPB between treatment groups remained consistent after sensitivity analysis. Estimates suggest a mean saving following intervention of 428.02 EUR (2016) per patient per year, with ICER analysis indicating a consistent benefit of the described health care intervention over usual care. No statistically significant differences between groups were detected in any of the other secondary outcomes. Conclusions We have demonstrated that a 12 month structured multimodal intervention programme across several clinical settings in different European countries leads to a clinically relevant and cost‐effective improvement in the functional status of older frail and pre‐frail participants with type 2 diabetes mellitus.

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“…Irrespective, given the evidence associated with the MedDiet and healthy ageing [50][51][52][53], a pragmatic approach may include adopting a MedDiet pattern to attenuate physical frailty and sarcopenia with advanced age. Moreover, it would be prudent to investigate this causal relationship amongst older adults who are more vulnerable to physical frailty and sarcopenia, such as older adults with T2DM [144][145][146]. In addition to the various micro and macrovascular diseases which contribute to disability amongst patients with T2DM, in older people with diabetes, physical frailty and sarcopenia are now emerging as a third category of complications [144][145][146].…”

Section: Implications For Future Research and Conclusionmentioning

confidence: 99%

“…Moreover, it would be prudent to investigate this causal relationship amongst older adults who are more vulnerable to physical frailty and sarcopenia, such as older adults with T2DM [144][145][146]. In addition to the various micro and macrovascular diseases which contribute to disability amongst patients with T2DM, in older people with diabetes, physical frailty and sarcopenia are now emerging as a third category of complications [144][145][146]. Numerous observational studies have reported that older adults with T2DM are at risk of an accelerated decline SMM, muscle strength and/or higher odds of impaired physical functioning relative to their nondiabetic counterparts [147][148][149][150][151][152][153][154][155][156][157][158].…”

Section: Implications For Future Research and Conclusionmentioning

confidence: 99%

Mediterranean Diet attenuates risk of frailty and sarcopenia: New insights and future directions

McClure

Villani

2017

JCSM Clinical Reports

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Sarcopenia and physical frailty are associated with progressive disability and predictive of negative health outcomes. Dietary interventions are considered the cornerstone in the management of sarcopenic symptomology and physical frailty. However few studies have investigated preventative strategies. Moreover, most studies have focused on the efficacy of individual nutrients or supplements rather than dietary patterns. The Mediterranean Diet (MedDiet) is a dietary pattern that provides evidence for an association between diet quality, healthy ageing and disease prevention. The purpose of this paper was to examine, synthesise and develop a narrative review of the current literature, investigating the potential benefits associated with adherence to a MedDiet and attenuation of physical frailty and sarcopenic symptomology in older adults. We also explored the underlying mechanisms underpinning the potential benefits of the MedDiet on ameliorating physical frailty and sarcopenic symptomology. Synthesis of the reviewed literature is suggestive of a decreased risk of physical frailty and sarcopenic symptomology with greater adherence to a MedDiet. We identified the anti-inflammatory and high antioxidant components of the MedDiet as two potential biological mechanisms involved. Due to a lack of evidence from RCTs to support the proposed physiological mechanisms, we suggest investigating these observations in older adults with type 2 diabetes (T2DM) whom are vulnerable to physical frailty and disability. A number of biological mechanisms describing the pathway to disability in older adults with T2DM have been postulated with many of these mechanisms potentially mitigated with dietary interventions involving the MedDiet. Exploring these mechanisms with the use of well-designed, longer-term dietary intervention studies in older adults with an increased vulnerability to physical frailty and sarcopenia is warranted.

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Frailty as a Major Factor in the Increased Risk of Death and Disability in Older People With Diabetes

Cited by 102 publications

References 32 publications

Mean HbA1c, HbA1c variability, and mortality in people with diabetes aged 70 years and older: a retrospective cohort study

Mean HbA1c, HbA1c variability, and mortality in people with diabetes aged 70 years and older: a retrospective cohort study

Effectiveness of a multimodal intervention in functionally impaired older people with type 2 diabetes mellitus

Mediterranean Diet attenuates risk of frailty and sarcopenia: New insights and future directions

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