Frailty predictors identified in older people with type 2 diabetes
medwireNews: Older individuals with type 2 diabetes have a high risk for frailty, and risk predictors include poor glycemic control, depressive symptoms, and lifestyle factors, suggest findings from a Chinese cross-sectional study.
Jie Li (Huazhong University of Science and Technology, Wuhan, China) and colleagues report that out of 291 study participants (52.9% women), 56 were considered frail, 150 were prefrail, and 85 were robust, indicating a prevalence of frailty and prefrailty of 19.2% and 51.5%, respectively. Frailty was measured using the modified frailty phenotype criteria, which take into account unintentional weight loss, exhaustion, slowness, weakness, and low physical activity.
Individuals included in the study were community-dwelling older adults between 65 and 85 years of age (median 69 years) from two community health centers in China, who had been diagnosed with type 2 diabetes at least 6 months before joining the study.
Li et al used a multivariate logistic regression model to identify predictors of frailty, finding that ex-drinkers were significantly more likely to be frail than non-drinkers (odds ratio [OR]=4.46), but there was no significant association between current drinking and frailty risk. They suggest that these findings could be explained by the “sick quitter” effect, with people in poorer health stopping alcohol consumption.
The researchers also found that glycated hemoglobin (HbA1c) levels were higher among frail than non-frail individuals (6.97 vs 6.74%; 53 vs 50 mmol/mol), and HbA1c predicted frailty risk with a significant OR of 1.43.
“Hyperglycaemi[a] could contribute to physical frailty through several potential mechanisms, such as increasing microvascular damage or causing skeletal muscle mitochondrial dysfunction,” comment the authors, adding that “optimal glycaemic control needs to be individually determined for older adults with type 2 diabetes.”
Overall, 35.1% of the participants had malnutrition risk or were malnourished, and of these 69.6% were frail and 10.6% robust. In the multivariate analysis, older people with malnutrition were more likely to be physically frail than those without (OR=8.06). Having depressive symptoms was also associated with frailty risk (OR=1.44).
Conversely, the researchers write in BMJ Open that exercise behavior was a protective factor against frailty, as higher exercise scores were associated with a significantly lower risk for both prefrailty (OR=0.91) and frailty (OR=0.80).
The investigators note that the generalizability of the findings might be limited as the study was conducted only in one city in China. Nevertheless, “[t]he findings of this study could help guide future studies to implement targeted and suitable interventions for preventing frailty among community-dwelling diabetic older adults,” they conclude.
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