Predictors of frailty among Chinese community-dwelling older adults with type 2 diabetes: a cross-sectional survey

Kong, Linglin; Zhao, Huimin; Fan, Jing; Wang, Quan; Li, Jie; Bai, Jinbing; Mao, Jing

doi:10.1136/bmjopen-2020-041578

Cited by 29 publications

(18 citation statements)

References 40 publications

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“…Comparison at baseline in this study showed that older adults, females, individuals with lower education levels, and widowed older adults were associated with a higher proportion of frailty and diabetes with frailty. Among older adults with diabetes and frailty, there was an increased proportion with 3 or more chronic diseases and multiple medications, a significant decrease in the activities of daily living and cognitive functions, and an increase in depression scores, all of which were consistent with previous studies ( 19 – 21 ). Therefore, targeted intervention would be desirable in the management of older adults with diabetes and frailty to delay the course of diseases, relieve harm resulting from comorbidities, reduce the risk of adverse outcomes, and improve the level of diabetes management overall.…”

Section: Discussionsupporting

confidence: 89%

Combined effect of diabetes and frailty on mortality among Chinese older adults: A follow-up study

et al. 2023

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BackgroundFrailty and diabetes are two important health problems associated with aging in older individuals. This paper seeks to analyze the frailty in older adults suffering from diabetes and the combined effect of diabetes and frailty on mortality risk.MethodsThe frailty index (FI) model was employed when evaluating frailty among the older adults based on the baseline data conducted in 2009; and death as outcome variables collected in 2020 were analyzed. The influence of diabetes on age-related changes in frailty in the older adults and resulting mortality rates was analyzed. Cox regression and Kaplan-Meier curves were applied to evaluate the influence on the risk of death and the 11-year survival of the older adults with varying diabetes and frailty statuses.ResultsUltimately, 1,213 older people aged between 60 and 101, with an average age of (74.79 ± 8.58) at baseline, were included in the analysis. By 2020, there had been 447 deaths with mortality at 36.9% (447/1,213); there were 271 cases of diabetes, with a prevalence of 22.3% (271/1,213). The mean FI value for older adults with diabetes was higher than that of those without regardless of age, and the average annual relative growth rate of the FI value for older adults with diabetes was higher than that of those without diabetes (β = 0.039 vs. β = 0.035, t = 8.367, P < 0.001). For all FI value levels, the mortality rate among older adults with diabetes was higher than that of those without. The Cox Regression analysis showed that, compared with those suffering from neither diabetes nor frailty, older adults with both had the higher mortality risk (HR = 1.760. P < 0.001), followed by older adults suffering from frailty alone (HR = 1.594, P = 0.006), and then by older adults suffering from only diabetes (HR = 1.475, P = 0.033). The survival analysis showed that the median survival of those suffering from diabetes and frailty to be the shortest at just 57.23 (95% CI: 54.05 to 60.41) months, lower than the 83.78 (95% CI: 79.33 to 88.23) months in those suffering from frailty alone, and 119.93 (95% CI: 113.84 to 126.02) months in those with only diabetes, and 124.39 (95% CI: 119.76 to 129.02) months in older adults with neither diabetes nor frailty (P < 0.001).ConclusionFrailty is common among older adults suffering from diabetes, and there is an increased risk of poor health outcomes, such as death, among older adults suffering from diabetes and frailty. When diagnosing, treating, and dealing with older adults with diabetes, attention should be paid to screening and assessing frailty in hopes of identifying it early so that appropriate measures of intervention can be taken to avoid or delay the resulting adverse effects.

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Section: Discussionsupporting

confidence: 89%

Combined effect of diabetes and frailty on mortality among Chinese older adults: A follow-up study

et al. 2023

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“…However, studies reporting an association of low glycaemia with frailty demonstrated common features of participants, which included lower body weight and malnutrition compared with non-frail patients, suggesting an AM phenotype [ 147 ]. On the other hand, other studies reporting an association of high glycaemia with frailty demonstrated common features of participants, which included higher body weight, higher waist circumference and higher cholesterol compared to non-frail patients, suggesting a SO phenotype [ 148 , 149 , 150 , 151 ]. The association of frailty with both low and high glycaemia can be explained by the presence of two metabolic rather than one phenotype of frailty, which needs future confirmation [ 152 ].…”

Section: Future Perspectivesmentioning

confidence: 99%

Metabolic Impact of Frailty Changes Diabetes Trajectory

Sinclair

Abdelhafiz

2023

Metabolites

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Diabetes mellitus prevalence increases with increasing age. In older people with diabetes, frailty is a newly emerging and significant complication. Frailty induces body composition changes that influence the metabolic state and affect diabetes trajectory. Frailty appears to have a wide metabolic spectrum, which can present with an anorexic malnourished phenotype and a sarcopenic obese phenotype. The sarcopenic obese phenotype individuals have significant loss of muscle mass and increased visceral fat. This phenotype is characterised by increased insulin resistance and a synergistic increase in the cardiovascular risk more than that induced by obesity or sarcopenia alone. Therefore, in this phenotype, the trajectory of diabetes is accelerated, which needs further intensification of hypoglycaemic therapy and a focus on cardiovascular risk reduction. Anorexic malnourished individuals have significant weight loss and reduced insulin resistance. In this phenotype, the trajectory of diabetes is decelerated, which needs deintensification of hypoglycaemic therapy and a focus on symptom control and quality of life. In the sarcopenic obese phenotype, the early use of sodium-glucose transporter-2 inhibitors and glucagon-like peptide-1 receptor agonists is reasonable due to their weight loss and cardio–renal protection properties. In the malnourished anorexic phenotype, the early use of long-acting insulin analogues is reasonable due to their weight gain and anabolic properties, regimen simplicity and the convenience of once-daily administration.

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“…Approximately 1 in 6 community-dwelling people > 65 years old is frail [6], a percentage that increases with age. In elderly people with diabetes, the reported prevalence of prefrailty and frailty can be as high as 51.5% and 19.2%, respectively [7].…”

Section: Knowledge Transfer Of Dr Zoe Pafili (Athens)mentioning

confidence: 99%

Age and Frailty as Key Determinants for Nutritional Therapy Individualization in Elderly Adults with Diabetes

Pafili¹

2021

Komp Nutr Diet

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The increasing prevalence of older adults with diabetes has become a major social burden. Diabetes, frailty, and cognitive dysfunction are closely related to the mechanisms of aging. Insulin resistance, arteriosclerosis, chronic inflammation, oxidative stress, and mitochondrial dysfunction may be common mechanisms shared by frailty and cognitive impairment. Hyperglycemia, hypoglycemia, obesity, vascular factors, physical inactivity, and malnutrition are important risk factors for cognitive impairment and frailty in older adults with diabetes. The impact of nutrients on health outcomes varies with age; thus, shifting diet therapy strategies from the treatment of obesity/metabolic syndrome to frailty prevention may be necessary in patients with diabetes who are over 75 years of age, have frailty or sarcopenia, and experience malnutrition. For the prevention of frailty, optimal energy intake, sufficient protein and vitamin intake, and healthy dietary patterns should be recommended. The treatment of diabetes after middle age should include the awareness of proper glycemic control aimed at extending healthy life expectancy with proper nutrition, exercise, and social connectivity. Nutritional therapy in combination with exercise, optimal glycemic and metabolic control, and social participation/support for frailty prevention can extend healthy life expectancy and maintain quality of life in older adults with diabetes mellitus.

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Predictors of frailty among Chinese community-dwelling older adults with type 2 diabetes: a cross-sectional survey

Cited by 29 publications

References 40 publications

Combined effect of diabetes and frailty on mortality among Chinese older adults: A follow-up study

Combined effect of diabetes and frailty on mortality among Chinese older adults: A follow-up study

Metabolic Impact of Frailty Changes Diabetes Trajectory

Age and Frailty as Key Determinants for Nutritional Therapy Individualization in Elderly Adults with Diabetes

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