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Frailty is associated with the progression of prediabetes to diabetes and elevated risks of cardiovascular disease and all-cause mortality in individuals with prediabetes and diabetes: Evidence from two prospective cohorts

  • Author Footnotes
    1 Equal contribution.
    Di He
    Footnotes
    1 Equal contribution.
    Affiliations
    Department of Epidemiology & Biostatistics, and Department of Respiratory Diseases of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310058, Zhejiang, China
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  • Author Footnotes
    1 Equal contribution.
    Jun Li
    Footnotes
    1 Equal contribution.
    Affiliations
    Department of Epidemiology & Biostatistics, and Department of Respiratory Diseases of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310058, Zhejiang, China
    Search for articles by this author
  • Author Footnotes
    1 Equal contribution.
    Yuhao Li
    Footnotes
    1 Equal contribution.
    Affiliations
    Department of Epidemiology & Biostatistics, and Department of Respiratory Diseases of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310058, Zhejiang, China
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  • Jinghan Zhu
    Affiliations
    The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, Guangdong, China
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  • Tianjing Zhou
    Affiliations
    Department of Epidemiology & Biostatistics, and Department of Respiratory Diseases of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310058, Zhejiang, China
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  • Yuying Xu
    Affiliations
    Department of Epidemiology & Biostatistics, and Department of Respiratory Diseases of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310058, Zhejiang, China
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  • Qiong Wu
    Affiliations
    Department of Epidemiology & Biostatistics, and Department of Respiratory Diseases of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310058, Zhejiang, China
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  • Zongxue Cheng
    Affiliations
    Department of Epidemiology & Biostatistics, and Department of Respiratory Diseases of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310058, Zhejiang, China
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  • Qing Chen
    Correspondence
    Corresponding authors at: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, 310051, Zhejiang, China (Q. Chen). Center for Clinical Big Data and Analytics of the Second Affiliated Hospital and Department of Big Data in Health Science, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, 310058, Zhejiang, China (Z. Liu). Department of Epidemiology & Biostatistics, and Department of Respiratory Diseases of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310058, Zhejiang, China (Y. Zhu).
    Affiliations
    Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, Zhejiang, China
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  • Zuyun Liu
    Correspondence
    Corresponding authors at: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, 310051, Zhejiang, China (Q. Chen). Center for Clinical Big Data and Analytics of the Second Affiliated Hospital and Department of Big Data in Health Science, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, 310058, Zhejiang, China (Z. Liu). Department of Epidemiology & Biostatistics, and Department of Respiratory Diseases of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310058, Zhejiang, China (Y. Zhu).
    Affiliations
    Center for Clinical Big Data and Analytics of the Second Affiliated Hospital and Department of Big Data in Health Science, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou 310058, Zhejiang, China
    Search for articles by this author
  • Yimin Zhu
    Correspondence
    Corresponding authors at: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, 310051, Zhejiang, China (Q. Chen). Center for Clinical Big Data and Analytics of the Second Affiliated Hospital and Department of Big Data in Health Science, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, 310058, Zhejiang, China (Z. Liu). Department of Epidemiology & Biostatistics, and Department of Respiratory Diseases of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310058, Zhejiang, China (Y. Zhu).
    Affiliations
    Department of Epidemiology & Biostatistics, and Department of Respiratory Diseases of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310058, Zhejiang, China

    Cancer Center, Zhejiang University, Hangzhou 310058, Zhejiang, China
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  • Author Footnotes
    1 Equal contribution.
Published:November 07, 2022DOI:https://doi.org/10.1016/j.diabres.2022.110145

      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

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