Helen P Hazuda1, Qing Pan2, Hermes Florez3, José A Luchsinger4, Jill P Crandall5, Elizabeth M Venditti6, Sherita H Golden7, Andrea M Kriska6, George A Bray8. 1. University of Texas Health Science Center at San Antonio. 2. Biostatistics Center, The George Washington University. 3. University of Miami, Florida. 4. Columbia University Irving Medical Center, New York, New York. 5. Albert Einstein College of Medicine, Bronx, New York. 6. University of Pittsburgh, Pennsylvania. 7. Johns Hopkins University, Baltimore, Maryland. 8. Pennington Biomedical Research Center, Baton Rouge, Louisiana.
Abstract
BACKGROUND: Frailty is a geriatric syndrome of decreased physiologic reserve and resistance to stressors that results in increased vulnerability to adverse health outcomes with aging. Diabetes and hyperglycemia are established risk factors for frailty. We sought to examine whether the odds of frailty among individuals at high risk of diabetes randomized to treatment with intensive lifestyle (ILS), metformin, or placebo differed after long-term follow-up. METHOD: The sample comprised participants in the Diabetes Prevention Program (DPP) clinical trial, who continued follow-up in the DPP Outcomes Study (DPPOS) and completed frailty assessments in DPPOS Years 8 (n = 2385) and 10 (n = 2289), approximately 12 and 14 years after DPP randomization. Frailty was classified using Fried Frailty Phenotype criteria. GEE models adjusting for visit year with repeated measures pooled for Years 8 and 10 were used to estimate pairwise odds ratios (ORs) between ILS, metformin, and placebo for the outcomes of frail and prefrail versus nonfrail. RESULTS: Frailty prevalence by treatment group was ILS = 3.0%, metformin = 5.4%, placebo = 5.7% at Year 8, and ILS = 3.6%, metformin = 5.3%, placebo = 5.4% at Year 10. Odds ratios (95% CI) estimated with GEE models were ILS versus placebo, 0.62 (0.42-0.93), p = .022; metformin versus placebo, 0.99 (0.69-1.42), p = .976; and ILS versus metformin, 0.63 (0.42-0.94), p = .022. Odds of being frail versus nonfrail were 37% lower for ILS compared to metformin and placebo. CONCLUSIONS: Early ILS intervention, at an average age of about 50 years, in persons at high risk of diabetes may reduce frailty prevalence in later life. Metformin may be ineffective in reducing frailty prevalence. CLINICAL TRIALS REGISTRATION NUMBERS: NCT00004992 (DPP) and NCT00038727 (DPPOS).
BACKGROUND: Frailty is a geriatric syndrome of decreased physiologic reserve and resistance to stressors that results in increased vulnerability to adverse health outcomes with aging. Diabetes and hyperglycemia are established risk factors for frailty. We sought to examine whether the odds of frailty among individuals at high risk of diabetes randomized to treatment with intensive lifestyle (ILS), metformin, or placebo differed after long-term follow-up. METHOD: The sample comprised participants in the Diabetes Prevention Program (DPP) clinical trial, who continued follow-up in the DPP Outcomes Study (DPPOS) and completed frailty assessments in DPPOS Years 8 (n = 2385) and 10 (n = 2289), approximately 12 and 14 years after DPP randomization. Frailty was classified using Fried Frailty Phenotype criteria. GEE models adjusting for visit year with repeated measures pooled for Years 8 and 10 were used to estimate pairwise odds ratios (ORs) between ILS, metformin, and placebo for the outcomes of frail and prefrail versus nonfrail. RESULTS: Frailty prevalence by treatment group was ILS = 3.0%, metformin = 5.4%, placebo = 5.7% at Year 8, and ILS = 3.6%, metformin = 5.3%, placebo = 5.4% at Year 10. Odds ratios (95% CI) estimated with GEE models were ILS versus placebo, 0.62 (0.42-0.93), p = .022; metformin versus placebo, 0.99 (0.69-1.42), p = .976; and ILS versus metformin, 0.63 (0.42-0.94), p = .022. Odds of being frail versus nonfrail were 37% lower for ILS compared to metformin and placebo. CONCLUSIONS: Early ILS intervention, at an average age of about 50 years, in persons at high risk of diabetes may reduce frailty prevalence in later life. Metformin may be ineffective in reducing frailty prevalence. CLINICAL TRIALS REGISTRATION NUMBERS: NCT00004992 (DPP) and NCT00038727 (DPPOS).
Authors: Andrea M Kriska; Sharon L Edelstein; Richard F Hamman; Amy Otto; George A Bray; Elizabeth J Mayer-Davis; Rena R Wing; Edward S Horton; Steven M Haffner; Judith G Regensteiner Journal: Med Sci Sports Exerc Date: 2006-05 Impact factor: 5.411
Authors: William C Knowler; Elizabeth Barrett-Connor; Sarah E Fowler; Richard F Hamman; John M Lachin; Elizabeth A Walker; David M Nathan Journal: N Engl J Med Date: 2002-02-07 Impact factor: 91.245
Authors: Christine G Lee; Ann V Schwartz; Kristine Yaffe; Teresa A Hillier; Erin S LeBlanc; Peggy M Cawthon Journal: J Am Geriatr Soc Date: 2013-10-28 Impact factor: 5.562
Authors: Oleg Zaslavsky; Rod L Walker; Paul K Crane; Shelly L Gray; Eric B Larson Journal: J Gerontol A Biol Sci Med Sci Date: 2016-03-01 Impact factor: 6.053
Authors: Joshua I Barzilay; Caroline Blaum; Tisha Moore; Qian Li Xue; Calvin H Hirsch; Jeremy D Walston; Linda P Fried Journal: Arch Intern Med Date: 2007-04-09
Authors: Mercedes Sotos-Prieto; Ellen A Struijk; Teresa T Fung; Eric B Rimm; Fernando Rodriguez-Artalejo; Walter C Willett; Frank B Hu; Esther Lopez-Garcia Journal: Age Ageing Date: 2022-02-02 Impact factor: 10.668
Authors: Ivan Aprahamian; Marcus K Borges; Denise J C Hanssen; Hans W Jeuring; Richard C Oude Voshaar Journal: Clin Interv Aging Date: 2022-06-22 Impact factor: 3.829
Authors: Sara E Espinoza; Robyn L Woods; A R M Saifuddin Ekram; Michael E Ernst; Galina Polekhina; Rory Wolfe; Raj C Shah; Stephanie A Ward; Elsdon Storey; Mark R Nelson; Christopher M Reid; Jessica E Lockery; Suzanne G Orchard; Ruth Trevaks; Sharyn M Fitzgerald; Nigel P Stocks; Andy Chan; John J McNeil; Anne M Murray; Anne B Newman; Joanne Ryan Journal: J Gerontol A Biol Sci Med Sci Date: 2022-10-06 Impact factor: 6.591
Authors: Scott R Bauer; Louise C Walter; Kristine E Ensrud; Anne M Suskind; John C Newman; William A Ricke; Teresa T Liu; Kevin T McVary; Kenneth Covinsky Journal: JAMA Netw Open Date: 2021-11-01