Esther García-Esquinas1, Auxiliadora Graciani2, Pilar Guallar-Castillón2, Esther López-García2, Leocadio Rodríguez-Mañas3, Fernando Rodríguez-Artalejo2. 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.
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.
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