Frailty in elderly diabetes patients

Abstract

Abstract. Frailty is a state of vulnerability and a consequence of cumulative decline in multiple physiological systems over a lifespan. The occurrence of frailty depends on deterioration in muscle and nerve function, declining cardiopulmonary reserve and loss of executive function. Diabetes mellitus (DM) often causes functional impairment in each of the above systems, thus leading to a loss of whole body homeostasis and deterioration in physical function. Inability of self-management in DM patients may also have considerable impact on the development of sarcopenia/frailty. Thus, there may be positive feedback between the progression of diabetic complications and frailty/sarcopenia. While various factors are involved in this process, insulin resistance or insulin depletion may be an important factor in the progression of frailty in diabetes patients since insulin is well known to be an anabolic hormone in muscle. Interestingly, in our study targeting elderly DM patients, low HbA1c was a significant and independent risk factor for frailty, as assessed using a broad sense frailty scale, the Clinical Frailty Scale (CSF), suggesting that reverse metabolism due to malnutrition in elderly type 2 DM patients might be involved. Therefore, an intervention that includes proper nutrition and exercise training may be essential for the prevention of frailty. The pathogenesis of frailty in DM patients is extensively discussed in this review.

Alterations in mitochondrial functions and morphology in muscle and non‐muscle tissues in type 1 diabetes: implications for metabolic health

“…While less understood, studies in humans with T1D also suggest impairments in skeletal muscle mass, function and metabolism (see previous reviews: Krause et al., ; Monaco, Perry, & Hawke, ; Monaco, Gingrich, & Hawke, ). Although these impairments in skeletal muscle are not considered life‐threatening (and as a result are often overlooked clinically), diabetic myopathy is likely the primary reason underlying the greater risk of sarcopenia, exercise intolerance, mobility limitations, physical disability and frailty that has been reported, especially with increasing age, in those with diabetes relative to those without (Yanase, Yanagita, Muta, & Nawata, ). In fact, we recently postulated that T1D recapitulates a condition of accelerated muscle ageing, with many of the deficiencies that occur in aged muscles already being present in individuals with T1D but at a significantly earlier age (Monaco, Gingrich, & Hawke, ).…”

Low serum albumin, aspartate aminotransferase, and body mass are risk factors for frailty in elderly people with diabetes–a cross-sectional study

“…* Frailty was defined using the clinical frailty score ( 5). P values were determined using 1) the unpaired t-test, 2) Fisher's exact test 3) Mann-Whitney test.…”

“…The Clinical Frailty Scale (CFS) is thought to be the most suitable index for the quanti cation of frailty in elderly people because it includes physical, mental, and social scales 3 . We have previously shown, on the basis of a diagnosis of frailty made using the CFS, that 42% of 132 elderly patients with type 2 diabetes (T2DM) were frail and that aging and low circulating concentrations of albumin, high-density lipoproteincholesterol (HDL-C), systolic blood pressure (SBP), HbAlc, and total cholesterol were risk factors for frailty 4,5 . Thus, the traditional risk factors for metabolic syndrome and/or cardiovascular disease in middleaged people may shift from being deleterious to bene cial in old age.…”

Low serum albumin, aspartate aminotransferase, and body mass are risk factors for frailty in elderly people with diabetes – a cross-sectional study

“…The Clinical Frailty Scale (CFS) is thought be the most suitable index for the quantification of frailty in elderly people, because it includes physical, mental, and social scales 3 . We have previously shown, on basis of a diagnosis of frailty made using the CFS, that 42% of 132 elderly patients with type 2 diabetes (T2DM) were frail, and that aging and low circulating concentrations of albumin, high-density lipoprotein-cholesterol (HDL-C), systolic blood pressure (SBP), HbAlc, and total cholesterol were risk factors for frailty 4,5 . Thus, the traditional risk factors for metabolic syndrome and/or cardiovascular disease in middle-aged people may shift from being deleterious to beneficial in old age.…”