Highlights
- •Frailty promotes the progression of prediabetes to diabetes.
- •Frailty increases the risks of cardiovascular disease and all-cause mortality in prediabetes and diabetes.
- •Frailty improves the risk predictions for cardiovascular disease and all-cause mortality in prediabetes and diabetes.
Abstract
Aims
To investigate the impacts of frailty on the progression of prediabetes to diabetes,
cardiovascular disease (CVD) and all-cause mortality in individuals with prediabetes
and diabetes.
Methods
7,933 subjects with prediabetes and diabetes were included from the China Health and
Retirement Longitudinal Study (CHARLS) and English Longitudinal Study of Ageing (ELSA).
Frailty status was assessed by frailty index and classified as robust, pre-frail,
and frail. Logistic regression was used to calculate risks of progression to diabetes.
Cox regression was used to calculate risks of CVD and all-cause mortality.
Results
In prediabetes, frail subjects had significantly increased risks of progression to
diabetes (CHARLS, OR = 1.55, 95 %CI: 1.09–2.20; ELSA, OR = 1.86, 95 %CI: 1.02–3.37)
compared with robust subjects. Frail subjects with prediabetes also presented significantly
increased risks of CVD (CHARLS: HR = 1.90, 95 %CI: 1.45–2.48; ELSA: HR = 1.94, 95 %CI:
1.31–2.88) and all-cause mortality (CHARLS: HR = 2.45, 95 %CI: 1.79–3.36; ELSA: HR = 2.13,
95 %CI: 1.46–3.10) than robust subjects with prediabetes. In diabetes, frailty still
increased risks of CVD (CHARLS, HR = 2.72, 95 %CI: 1.97–3.77; ELSA, HR = 2.41, 95 %CI:
1.43–4.06) and all-cause mortality (CHARLS, HR = 2.28, 95 %CI: 1.56–3.33; ELSA, HR = 2.28,
95 %CI: 1.47–3.53).
Conclusions
Frailty is associated with the progression of prediabetes to diabetes and elevated
risks of CVD and all-cause mortality in individuals with prediabetes and diabetes.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Diabetes Research and Clinical PracticeAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Trends in Prevalence of Diabetes and Control of Risk Factors in Diabetes Among US Adults, 1999–2018.JAMA. 2021; 326: 704
- Prevalence and Treatment of Diabetes in China, 2013–2018.JAMA. 2021; 326: 2498
- Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9(th) edition.Diabetes Res Clin Pract. 2019; 157: 107843
- Association between prediabetes and risk of cardiovascular disease and all cause mortality: systematic review and meta-analysis.BMJ (Clin Res ed). 2016; 355i5953
- Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies.Lancet (London, England). 2010; 375: 2215-2222
- Prediabetes, Diabetes, and the Risk of All-Cause and Cause-Specific Mortality in a Japanese Working Population: Japan Epidemiology Collaboration on Occupational Health Study.Diabetes Care. 2021; 44: 757-764
- Type 2 diabetes mellitus in older adults: clinical considerations and management.Nat Rev Endocrinol. 2021; 17: 534-548
- Frailty measurement, prevalence, incidence, and clinical implications in people with diabetes: a systematic review and study-level meta-analysis.Lancet Healthy Longevity. 2020; 1: e106-e116
- The prevalence and incidence of frailty in Pre-diabetic and diabetic community-dwelling older population: results from Beijing longitudinal study of aging II (BLSA-II).BMC Geriatrics. 2017; 17: 47
- Frailty in elderly people.Lancet (London, England). 2013; 381: 752-762
- Frailty: implications for clinical practice and public health.Lancet (London, England). 2019; 394: 1365-1375
- Both pre-frailty and frailty increase healthcare utilization and adverse health outcomes in patients with type 2 diabetes mellitus.Cardiovasc Diabetol. 2018; 17: 130
- Relationship between frailty and mortality, hospitalization, and cardiovascular diseases in diabetes: a systematic review and meta-analysis.Cardiovasc Diabetol. 2019; 18: 81
- Cohort profile: the China Health and Retirement Longitudinal Study (CHARLS).Int J Epidemiol. 2014; 43: 61-68
- Cohort profile: the English longitudinal study of ageing.Int J Epidemiol. 2013; 42: 1640-1648
Classification and Diagnosis of Diabetes. Diabetes care 2017; 40: S11-s24.
- A standard procedure for creating a frailty index.BMC Geriatrics. 2008; 8: 24
- Frailty index and all-cause and cause-specific mortality in Chinese adults: a prospective cohort study.Lancet Public health. 2020; 5: e650-e660
- Association between sarcopenia and cardiovascular disease among middle-aged and older adults: Findings from the China health and retirement longitudinal study.EClinicalMedicine. 2022; 44101264
- Longitudinal associations between loneliness, social isolation and cardiovascular events.Heart (British Cardiac Society). 2020; 106: 1394-1399
- Links Between Mortality and Socioeconomic Characteristics, Disease Burden, and Biological and Physical Functioning in the Aging Chinese Population.J Gerontol Series B, Psychol Sci Soc Sci. 2022; 77: 365-377
- Population-based estimates of healthy working life expectancy in England at age 50 years: analysis of data from the English Longitudinal Study of Ageing.The Lancet Public health. 2020; 5: e395-e403
International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes care 2009; 32: 1327–34.
WHO Guidelines Approved by the Guidelines Review Committee. Use of Glycated Haemoglobin (HbA1c) in the Diagnosis of Diabetes Mellitus: Abbreviated Report of a WHO Consultation. Geneva: World Health Organization Copyright © World Health Organization 2011; 2011.
- Discrimination ability of comorbidity, frailty, and subjective health to predict mortality in community-dwelling older people: Population based prospective cohort study.Eur J Int Med. 2017; 42: 29-38
- Incorporating Frailty Into the Pooled Cohort Equations to Predict Cardiovascular Disease Among Persons With HIV.J Acquir Immune Defic Syndr. 1999; 2021: 971-977
- Sarcopenia Is Associated With a Risk of Mortality in People With Type 2 Diabetes Mellitus.Front Endocrinol. 2021; 12783363
- Effect of Sarcopenia on Mortality in Type 2 Diabetes: A Long-Term Follow-Up Propensity Score-Matched Diabetes Cohort Study.J Clin Med. 2022; 11
Nishikawa H, Fukunishi S, Asai A, Yokohama K, Ohama H, Nishiguchi S, et al. Sarcopenia, frailty and type 2 diabetes mellitus (Review). Mol Med Reports 2021; 24.
Sanz-Cánovas J, López-Sampalo A, Cobos-Palacios L, Ricci M, Hernández-Negrín H, Mancebo-Sevilla JJ, et al. Management of Type 2 Diabetes Mellitus in Elderly Patients with Frailty and/or Sarcopenia. International journal of environmental research and public health. 2022; 19.
- Dysglycaemia and Other Predictors for Progression or Regression from Impaired Fasting Glucose to Diabetes or Normoglycaemia.J Diabetes Res. 2015; 2015373762
- Prevalence of Diabetes, Prediabetes, and Associated Factors in an Adult Chinese Population: Baseline of a Prediabetes Cohort Study.Int J Endocrinol. 2020; 2020: 8892176
- What protects against pre-diabetes progressing to diabetes? Observational study of integrated health and social data.Diabetes Res Clin Pract. 2019; 148: 119-129
- Risk of Progression to Diabetes Among Older Adults With Prediabetes.JAMA Int Med. 2021; 181: 511-519
- Risk of progression to diabetes and mortality in older people with prediabetes: The English longitudinal study on ageing.Age Ageing. 2022; 51
Older Adults: Standards of Medical Care in Diabetes-2021. Diabetes care. 2021; 44: S168-s79.
- Joint British Diabetes Societies for Inpatient Care (JBDS-IP) Clinical Guideline Inpatient care of the frail older adult with diabetes: an Executive Summary.Diabetic Med: J Br Diabetic Assoc. 2020; 37: 1981-1991
- Treatment of Diabetes in Older Adults: An Endocrine Society* Clinical Practice Guideline.J Clin Endocrinol Metabolism. 2019; 104: 1520-1574
Article info
Publication history
Published online: November 07, 2022
Accepted:
November 1,
2022
Received in revised form:
October 11,
2022
Received:
July 28,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
