Prospective Association Among Diabetes Diagnosis, HbA1c, Glycemia, and Frailty Trajectories in an Elderly Population

Abstract

Frailty is a dynamic state of vulnerability in the elderly. We examined whether individuals with overt diabetes or higher levels of HbA 1c or fasting plasma glucose (FG) experience different frailty trajectories with aging. RESEARCH DESIGN AND METHODS Diabetes, HbA 1c , and FG were assessed at baseline, and frailty status was evaluated with a 36-item frailty index every 2 years during a 10-year follow-up among participants from the English Longitudinal Study of Ageing (ELSA). Mixed-effects models with age as time scale were used to assess whether age trajectories of frailty differed as a function of diabetes, HbA 1c , and FG. RESULTS Among 5,377 participants (median age [interquartile range] 70 [65, 77] years, 45% men), 35% were frail at baseline. In a model adjusted for sex, participants with baseline diabetes had an increased frailty index over aging compared with those without diabetes. Similar findings were observed with higher levels of HbA 1c , while FG was not associated with frailty. In a model additionally adjusted for income, social class, smoking, alcohol, and hemoglobin, only diabetes was associated with an increased frailty index. Among nonfrail participants at baseline, both diabetes and HbA 1c level were associated with a higher increased frailty index over time. CONCLUSIONS People with diabetes or higher HbA 1c levels at baseline had a higher frailty level throughout later life. Nonfrail participants with diabetes or higher HbA 1c also experienced more rapid deterioration of frailty level with aging. This observation could reflect a role of diabetes complications in frailty trajectories or earlier shared determinants that contribute to diabetes and frailty risk in later life. Life expectancy is increasing worldwide. However, the aging process is heterogeneous with a large interindividual variability in health status and disability (1). This heterogeneity in aging can also affect people with diabetes, who are also living longer than before. Although the age-specific prevalence of diabetic complications is lower now than in the past, the cumulative lifetime prevalence of complications in older adults with diabetes and the co-occurrence of multiple medical conditions are higher (2).

Association of weight loss and weight loss maintenance following diabetes diagnosis by screening and incidence of cardiovascular disease and all‐cause mortality: An observational analysis of the ADDITION‐Europe trial

“…Furthermore, we do not know in which component (bone, fat, muscle) the weight loss is occurring when we consider weight change. Loss of muscle mass and bone mass are components of frailty, and people with diabetes experience more frailty with ageing compared with the general population 6 . Our finding of less marked effects in analyses focused on waist circumference compared with weight support that weight loss in the cohort may have occurred in the non‐fat components.…”

Frailty measurement, prevalence, incidence, and clinical implications in people with diabetes: a systematic review and study-level meta-analysis

“…15 Three (3%) of 118 studies used both the frailty index and frailty phenotype. [16][17][18] In each of these studies, the percentage of people identified as frail was higher using the frailty index (53%, 30%, and 32%) [16][17][18] compared to using the frailty phenotype (23%, 26%, and 24%), [16][17][18] highlighting the sensitivity of frailty prevalence to the measure used. Frailty prevalence was also notably high in some ethnic groups (eg, African Americans and Aboriginal Australians) and lower in others (eg, Mexican Americans).…”

“…Heterogeneity between study estimates was low (I²=0%) despite variation in the length of follow-up and the variables in each model. The only study 16 assessing the association between HbA 1c and changes in frailty status showed that a higher HbA 1c at baseline was associated with worsening frailty over a 10-year period measured using the frailty index. Three studies (3%) of 118 assessed transitions between frailty phenotype states and found that people with diabetes were less likely to improve from a frail to a pre-frail or robust state compared to people without diabetes.…”

Applications of physical performance measures to routine diabetes care for frailty prevention concept: fundamental data with grip strength, gait speed, timed chair stand speed, standing balance, and knee extension strength

“…[11][12][13][14] Thus, the prevention of disability and frailty conditions is important because these conditions severely reduce the quality of life of individuals and are economically burdening for public health. [15][16][17][18] Diabetes per se was reported to be associated with a marked increase in the risks of physical disability and frailty. 15 16 It is also known that a decrease in muscle strength is accelerated by aging, especially in people with diabetes compared with those without diabetes.…”