Frailty as a Major Factor in the Increased Risk of Death and Disability in Older People With Diabetes

• Published in: Journal of the American Medical Directors Association Vol. 17; no. 10; pp. 949 - 955
• Main Authors: Castro-Rodríguez, Marta, MD, Carnicero, José A., PhD, Garcia-Garcia, Francisco J., MD, Walter, Stephan, PhD, Morley, John E., MB BCh, Rodríguez-Artalejo, Fernando, MD, Sinclair, Alan J., MD, Rodríguez-Mañas, L., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2016
• Subjects: Activities of Daily Living; Aged; Aged, 80 and over; Diabetes Mellitus, Type 2 - mortality; disability; Female; Frail Elderly; frailty; Homes for the Aged; Humans; Internal Medicine; Male; Medical Education; mortality; Older adults; Proportional Hazards Models; Prospective Studies; Risk Factors; type 2 diabetes; mortality; frailty; risk factors; type 2 diabetes; Older adults; disability
• ISSN: 1525-8610; 1538-9375
• DOI: 10.1016/j.jamda.2016.07.013

Abstract Objectives To assess the role of frailty in predicting death and incident disability in older adults with type 2 diabetes mellitus. Design Prospective cohort study. Setting Community dwelling. Participants A total of 1825 individuals ≥65 years old recruited between June 2006 and September 2009 were followed for a median of 5.5 years for mortality and 4.98 years for incident functional disability in activities of daily living. Self-reported diabetes, comorbidities (Charlson index), cardio- and cerebrovascular diseases, drug treatments, Frailty Trait Score (FTS) and Frailty Index (FI), activities of daily living, heart rate, and blood pressure among others were collected at baseline. Main outcome measures Survival analysis (Kaplan-Meier), adjusted Cox proportional-hazards models, and binary logistic regression were used to assess the relationship between frailty, comorbidity, and vascular diseases and time to death and incident disability. Results A total of 363 people had diabetes. Among them, 83 deaths and 84 cases of incident disability occurred during follow-up. People with diabetes died more frequently than those without diabetes [hazard ratio = 1.36, 95% confidence interval (CI) 1.06–1.75; P  = .002], showing a poorer functional status at baseline. Survival analysis showed a relationship between frailty quartiles and the risk of death. In the adjusted Cox-models, only age and frailty indices, but not comorbidity or cardio/cerebrovascular diseases, were associated with the risk of death and incident disability after adjusting for measures of frailty. The hazard ratio for death was 1.51 (95% CI 1.28–1.77) and 1.83 (95% CI 1.49–2·26) for each 10 points increase in the FTS and FI; odds ratio for incident disability was 1·64 (95% CI 1.22–2.20) and 1·35 (95% CI 1.09–1.67) when using FI and FTS, respectively. Conclusions Frailty is an important risk factor for death and disability in older adults with diabetes, supporting the recent recommendations that frailty status should be routinely assessed in these patients.