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, Feb 2017

Background Various factors including cardio-metabolic disorders are found to be correlated with frailty. With the increase in age, older adults are likely to have elevated blood glucose level. In this study we intend to investigate the prevalence and incidence of frailty in the pre-diabetic and diabetic community dwelling elderly population and the associated risk factors. Methods At baseline total of 10,039 subjects with a mean age of 70.51 (±7.82) were included. A total of 6,293 older adults were followed up at 12 months. A Frailty index (FI) with 32 items was developed using Rockwood’s cumulative deficits method. Frailty index ≥0.25 was used as cut-off criteria for the diagnosis of frailty. Diagnosis of pre-diabetes and diabetes was set according to the World Health Organization (WHO) criteria for fasting plasma glucose (FPG) level. Chi-square tests were performed to compare percentages by 3 major groups (non-diabetes, pre-diabetes, diabetes), ANOVA and student’s t-tests was used to compare means of group for continuous variables. Multiple logistic regression models were performed to estimate the risk factors for frailty in non-diabetic, pre-diabetic and diabetic elderly populations using baseline and longitudinal data. Results Diabetic population had a much higher prevalence (19.32%) and incidence (12.32%) of frailty, compared to that of non-diabetic older adults (prevalence of 11.92% and incidence of 7.04%). And pre-diabetics had somewhat similar prevalence of 11.43% and slightly higher incidence of 8.73% for frailty than non-diabetic older adults. Diabetics were at 1.36 (95% CI = 1.18,1.56) and 1.56 (95%CI = 1.32,1.85) fold increase in risk of frailty compared to non-diabetic population for prevalence and incidence, respectively. Being female, urban living, high waist circumference, less house work and need regular anti-diabetic medications were independent risk factors only in pre-diabetic and diabetic older adults. Conclusion This study confirms that diabetes is an independent serious chronic condition to increase the risk of frailty in community dwelling older adults in northern China. To effectively delay or avoid frailty, older adults should be advised for taking proper control of blood glucose level and avoiding the associated risk factors and implementing the protective factors in primary-care setting.

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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)

Chhetri et al. BMC Geriatrics 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) Jagadish Kumar Chhetri 0 Zheng Zheng 0 1 Xitong Xu Cuihong Ma 0 Piu Chan 0 1 0 Department of Geriatrics, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University , No. 45 Changchun St., Beijing, Xicheng District 100053 , China 1 Department of Neurobiology, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University , No. 45 Changchun St., Beijing, Xicheng District 100053 , China Background: Various factors including cardio-metabolic disorders are found to be correlated with frailty. With the increase in age, older adults are likely to have elevated blood glucose level. In this study we intend to investigate the prevalence and incidence of frailty in the pre-diabetic and diabetic community dwelling elderly population and the associated risk factors. Methods: At baseline total of 10,039 subjects with a mean age of 70.51 (±7.82) were included. A total of 6,293 older adults were followed up at 12 months. A Frailty index (FI) with 32 items was developed using Rockwood's cumulative deficits method. Frailty index ≥0.25 was used as cut-off criteria for the diagnosis of frailty. Diagnosis of pre-diabetes and diabetes was set according to the World Health Organization (WHO) criteria for fasting plasma glucose (FPG) level. Chi-square tests were performed to compare percentages by 3 major groups (non-diabetes, pre-diabetes, diabetes), ANOVA and student's t-tests was used to compare means of group for continuous variables. Multiple logistic regression models were performed to estimate the risk factors for frailty in non-diabetic, pre-diabetic and diabetic elderly populations using baseline and longitudinal data. Results: Diabetic population had a much higher prevalence (19.32%) and incidence (12.32%) of frailty, compared to that of non-diabetic older adults (prevalence of 11.92% and incidence of 7.04%). And pre-diabetics had somewhat similar prevalence of 11.43% and slightly higher incidence of 8.73% for frailty than non-diabetic older adults. Diabetics were at 1. 36 (95% CI = 1.18,1.56) and 1.56 (95%CI = 1.32,1.85) fold increase in risk of frailty compared to non-diabetic population for prevalence and incidence, respectively. Being female, urban living, high waist circumference, less house work and need regular anti-diabetic medications were independent risk factors only in pre-diabetic and diabetic older adults. Conclusion: This study confirms that diabetes is an independent serious chronic condition to increase the risk of frailty in community dwelling older adults in northern China. To effectively delay or avoid frailty, older adults should be advised for taking proper control of blood glucose level and avoiding the associated risk factors and implementing the protective factors in primary-care setting. Frailty; Elderly diabetes; Pre-diabetes; Elevated- blood glucose - Background Ageing is associated with multisystem functional decline, which could lead to future frailty [1, 2]. Various factors including cardio-metabolic disorders are found to be correlated with frailty, among which diabetes in the elderly population cannot be excluded. With the increase in age, older adults are likely to have alteration in glucose metabolism which may be due to decrease in insulin sensitivity and resistance, islet cell dysfunction or reduced beta-cell sensitivity leading to elevated glucose level [3]. Diabetes now a very common chronic disease in the elderly population, itself affects all major organs, therefore affecting multisystem function, which in turn could aid in facilitating acceleration of frailty [4, 5]. Impaired fasting glucose (IFG) or pre-diabetes is a transitional state of diabetes which could also be an associated risk factor for frailty. Previous studies have shown that older diabetic adults are at higher risk of being frail [6– 8], however, these study did not examine the risks for frailty in other elevated blood glucose older population. Frailty is a geriatric condition which is known to be reversed or at least delayed, if suitable interventions are implemented on time [9–11]. Moreover, for such interventions to be implemented, the at-risk population and the risk factors should be identified. In this study, we intend to investigate the prevalence and incidence of frailty in community dwelling subjects more than 55 years old with elevated blood glucose (pre-diabetes, diabetes), and if these population shared the common risk factors as normal blood glucose frail population. Methods Study population This study is a secondary analyses based on Beijing Longitudinal study of ageing II (BLSA II) [12]. The baseline study was started from July till November 2009 and a follow-up study was performed after a year from August 2010 to January 2011. A multi-stage cluster random samplin (...truncated)


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Jagadish Chhetri, Zheng Zheng, Xitong Xu, Cuihong Ma, Piu Chan. 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, pp. 47, 17, DOI: 10.1186/s12877-017-0439-y