N. Veronese, B. Stubbs, L. Fontana, C. Trevisan, F. Bolzetta, M. De Rui, L. Sartori, E. Musacchio, S. Zambon, S. Maggi, E. Perissinotto, M.C. Corti, G. Crepaldi, E. Manzato, G. Sergi
J Am Med Dir Assoc. 2016;17(10):902-7
This longitudinal study (follow-up of 4.4 years) aimed to investigate whether frailty is associated with an increased risk of incident type 2 diabetes mellitus (T2DM) in a prospective cohort of community-dwelling older people.
1754 men and women older than 65 years without T2DM at baseline were studied.
Frailty status was defined according to Fried criteria and categorized as frailty (≥3 criteria), prefrailty (1-2 criteria), or no frailty (0 criterion). Incident T2DM was defined as fasting plasma glucose (FPG) ≥7.0 mmol/L, or glycosylated hemoglobin ≥6.5%, the use of glucose-lowering drugs, or FPG ≥11.1 mmol/L on a 2-hour oral glucose tolerance test during the follow-up. All T2DM diagnoses were confirmed by endocrinologists.
At baseline, frail participants (n = 174) were significantly (a) more obese and had higher waist circumference, (b) experienced a higher rate of cardiovascular disease (including hypertension), and (c) presented with higher, but not pathologic, values of glycosylated hemoglobin and FPG than prefrail (n = 830) and nonfrail participants (n = 750). Over a 4.4-year follow-up, 265 individuals developed T2DM. In a logistic regression analysis, adjusted for potential baseline confounders, frailty [odds ratio (OR) = 1.87, 95% confidence interval (CI) = 1.31-2.13, P < .0001] and prefrailty (OR = 1.60, 95% CI = 1.27-2.00, P < .0001) were associated with a significantly higher incidence of T2DM than in nonfrail individuals.




Comment: This is the first study to assess the impact of frailty on incident T2DM. In this cohort study of community-living elderly men and women, frailty and prefrailty were significant predictors of incident T2DM in both men and women. Specifically, data demonstrate that frailty is associated with an 87% increased risk of T2DM, whereas prefrailty is associated with a 60% increased risk, independent of several clinical and metabolic risk factors at baseline. More specifically, authors were able to identify that several Fried criteria were able to predict incident T2DM, highlighting that the risk was higher when physical activity was impaired.