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09-11-2019 | Older adults | News

Diabetes linked to increased frailty during aging

medwireNews: Older people with diabetes are frailer throughout aging than those without diabetes, study findings indicate.

Gloria Aguayo (Luxembourg Institute of Health, Strassen) and colleagues report that the frailty levels among people with diabetes at the age of 60 years and over “broadly correspond to levels only reached more than a decade later by their peers without diabetes.”

The findings are based on data from 5377 participants (median age 70 years, 45% men) of the English Longitudinal Study of Ageing who were evaluated with a 36-item frailty index (36-FI) every 2 years for 10 years.

Of these, 12% had diabetes and 35% were frail according to the 36-FI, which takes into account disability, comorbidity (excluding diabetes), physical functioning, and mental health.

After adjustment for sex and birth cohort, the researchers found that participants who had diabetes at baseline had a significantly higher 36-FI score at age 60 years and throughout the trajectory of aging, modeled to age 100 years, than those without diabetes.

For example, they estimated that the level of frailty for a 60-year-old man with baseline diabetes was similar to that for a 74-year-old man without baseline diabetes (36-FI=17 vs 18), with similar results observed for women.

Higher baseline glycated hemoglobin (HbA1c) levels were also associated with greater frailty throughout aging, but fasting glucose levels were not.

And when Aguayo and team took family income, social class, smoking, alcohol, and hemoglobin into account, the association between diabetes and increased frailty index remained significant whereas that for HbA1c did not.

To reduce the potential for reverse causation, the investigators repeated their analysis but excluded the participants who were frail at baseline, with a similar outcome.

However, stratifying the data according to baseline cardiovascular disease (CVD) status revealed that baseline diabetes was only significantly associated with frailty in the 4639 people without CVD.

This “indicates that CVD may be a modifying factor in the association” between diabetes and frailty, Aguayo et al remark.

Writing in Diabetes Care, the researchers say their findings “could reflect a role of diabetes complications in frailty trajectories or earlier shared determinants that contribute to diabetes and frailty risk in later life.”

They conclude that the “results highlight the relevance of a timely diabetes diagnosis because of the likelihood of a faster increasing frailty trajectory than among individuals without diabetes.”

And they add: “Future research should examine the causality and mechanisms of this association.”

By Laura Cowen

medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group

Diabetes Care 2019; doi: 10.2337/dc19-0497

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