Frailty, diabetes, and mortality in middle-aged African Americans

• Published in: The Journal of nutrition, health & aging Vol. 20; no. 8; pp. 854 - 859
• Main Authors: Chode, S., Malmstrom, T. K., Miller, D. K., Morley, John E.
• Format: Journal Article
• Language: English
• Published: Paris Springer Paris 01-10-2016; Springer Nature B.V
• Subjects: Activities of Daily Living; African Americans; Aged; Aging; Black or African American; Cohort Studies; Cross-Sectional Studies; Diabetes Mellitus - etiology; Diabetes Mellitus - mortality; Female; Frail Elderly; Frailty; Geriatric Assessment; Geriatrics/Gerontology; Humans; Longitudinal Studies; Male; Medicine; Medicine & Public Health; Middle Aged; Neurosciences; Nutrition; Primary Care Medicine; Quality of Life Research; St Louis Missouri; United States > US; mortality; African Americans; Frailty; diabetes; disability
• ISSN: 1279-7707; 1760-4788
• DOI: 10.1007/s12603-016-0801-3

Background
Older adult frail diabetics have high mortality risk, but data are limited regarding frail late middle-aged diabetics, especially for African-Americans. The aim of this study is to examine the association of diabetes with health outcomes and frailty in the African American Health (AAH) study.
Methods
AAH is a population-based longitudinal cohort study. Participants were African Americans (N=998) ages 49 to 65 years at baseline. Cross-sectional comparisons for diabetes included disability, function, physical performance, cytokines, and frailty. Frailty measures included the International Academy of Nutrition and Aging [FRAIL] frailty scale, Study of Osteoporotic Fractures [SOF] frailty scale, Cardiovascular Health Study [CHS] frailty scale, and Frailty Index [FI]). Longitudinal associations for diabetes included new ADLs ≥ 1 and mortality at 9-year follow-up.
Results
Diabetics were more likely to be frail using any of the 4 frailty scales than were non-diabetics. Frail diabetics, compared to nonfrail diabetics, reported significantly increased falls in last 1 year, higher IADLs and higher LBFLs. They demonstrated worse performance on the SPPB, one-leg stand, and grip strength; and higher Tumor Necrosis Factor receptors (sTNFR1 & sTNFR2). Mortality and 1 or more new ADLs also were increased among frail compared to nonfrail diabetics when followed for 9 years.
Conclusions
Frailty in middle-aged African American persons with diabetes is associated with having more disability and functional limitations, worse physical performance, and higher cytokines (sTNFR1 & sTNFR2 only). Middle-aged African Americans with diabetes have an increased risk of mortality and frail diabetics have an even higher risk of death, compared to nonfrail diabetics.