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J Am Med Dir Assoc. 2015 Sep 1;16(9):748-54. doi: 10.1016/j.jamda.2015.04.008. Epub 2015 May 16.

Diabetes and risk of frailty and its potential mechanisms: a prospective cohort study of older adults.

Author information

1
Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid / IdiPaz, and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain. Electronic address: esthergge@gmail.com.
2
Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid / IdiPaz, and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
3
Division of Geriatric Medicine, Hospital Universitario de Getafe, Madrid, Spain.

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.

KEYWORDS:

Diabetes mellitus; Spain; frailty; older adults; walking speed

PMID:
25986874
DOI:
10.1016/j.jamda.2015.04.008
[Indexed for MEDLINE]

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