Frailty Status and Mortality Risk in Older Adults With Diabetes Mellitus: Frailty Status and Mortality

Neslihan Kayahan Satış; Mehmet İlkin Naharcı

doi:10.5281/zenodo.14742100

Authors

Neslihan Kayahan Satış Department of Geriatrics, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkiye https://orcid.org/0000-0002-6802-7926
Mehmet İlkin Naharcı Department of Geriatrics, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkiye https://orcid.org/0000-0003-2730-7144

DOI:

https://doi.org/10.5281/zenodo.14742100

Keywords:

Frailty Syndrome, Risk Factors , Diabetes Mellitus, Mortality

Abstract

Background: Frailty, characterized by decreased physiological reserves and an increased risk of adverse health outcomes, is prevalent among older adults with diabetes mellitus (DM). This study aimed to investigate how frailty status affects mortality in older individuals with diabetes.

Methods: Patients previously diagnosed with DM who presented to a tertiary referral center between March 2020 and March 2022 were selected and followed up for at least two years. The frailty assessment used the Fried frailty phenotype criteria, and patients were categorized as frail, pre-frail, or robust. Multivariate regression models were utilized to identify mortality risk factors.

Results: The study cohort comprised 424 patients with a median age of 75 years, of which 65.8% were female. Among the patients, 28.3% were classified as frail and 66.0% as pre-frail. During the observation period, the overall mortality rate was 6.8%, with a significantly higher mortality rate in frail patients (15%) compared to pre-frail patients (3.9%) (p<0.001). Multivariate analysis identified frailty as a significant predictor of increased mortality risk in the overall population (HR=2.84, 95% CI: 1.20–6.69, p=0.017) and in men (HR=7.35, 95% CI: 1.17–48.35, p=0.033), but not in women (HR=2.70, 95% CI: 0.99–7.30, p=0.051).

Conclusion: Frailty markedly elevates the risk of mortality in older adults with DM, with this effect being particularly pronounced in males. These findings emphasize the significance of early identification and management of frailty in enhancing survival outcomes in this population.

References

King H, Aubert RE, Herman WH. Global burden of diabetes, 1995-2025: prevalence, numerical estimates, and projections. Diabetes Care. 1998;21(9):1414-1431. doi:10.2337/diacare.21.9.1414

Zimmet PZ. Diabetes epidemiology as a tool to trigger diabetes research and care [published correction appears in Diabetologia 1999 Aug;42(8):1032]. Diabetologia. 1999;42(5):499-518. doi:10.1007/s001250051188

Mohammedi K, Woodward M, Marre M, et al. Comparative effects of microvascular and macrovascular disease on the risk of major outcomes in patients with type 2 diabetes. Cardiovasc Diabetol. 2017;16(1):95. Published 2017 Jul 27. doi:10.1186/s12933-017-0574-y

Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people [published correction appears in Lancet. 2013 Oct 19;382(9901):1328]. Lancet. 2013;381(9868):752-762. doi:10.1016/S0140-6736(12)62167-9

Morley JE, Malmstrom TK, Rodriguez-Mañas L, Sinclair AJ. Frailty, sarcopenia and diabetes. J Am Med Dir Assoc. 2014;15(12):853-859. doi:10.1016/j.jamda.2014.10.001

Kalyani RR, Corriere M, Ferrucci L. Age-related and disease-related muscle loss: the effect of diabetes, obesity, and other diseases. Lancet Diabetes Endocrinol. 2014;2(10):819-829. doi:10.1016/S2213-8587(14)70034-8

Chen LK, Chen YM, Lin MH, Peng LN, Hwang SJ. Care of elderly patients with diabetes mellitus: a focus on frailty. Ageing Res Rev. 2010;9 Suppl 1:S18-S22. doi:10.1016/j.arr.2010.08.008

Ida S, Kaneko R, Imataka K, Murata K. Relationship between frailty and mortality, hospitalization, and cardiovascular diseases in diabetes: a systematic review and meta-analysis. Cardiovasc Diabetol. 2019;18(1):81. Published 2019 Jun 18. doi:10.1186/s12933-019-0885-2

Morley JE. Nutritional supplementation and sarcopenia: the evidence grows. J Am Med Dir Assoc. 2015;16(9):717-719. doi:10.1016/j.jamda.2015.06.001

Cadore EL, Izquierdo M. Exercise interventions in polypathological aging patients that coexist with diabetes mellitus: improving functional status and quality of life. Age (Dordr). 2015;37(3):64. doi:10.1007/s11357-015-9800-2

Gnjidic D, Hilmer SN, Blyth FM, et al. Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes. J Clin Epidemiol. 2012;65(9):989-995. doi:10.1016/j.jclinepi.2012.02.018

Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146-M156. doi:10.1093/gerona/56.3.m146

Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189-198. doi:10.1016/0022-3956(75)90026-6

Sachdev PS, Blacker D, Blazer DG, et al. Classifying neurocognitive disorders: the DSM-5 approach. Nat Rev Neurol. 2014;10(11):634-642. doi:10.1038/nrneurol.2014.181

Mahoney FI, Barthel DW. Functional Evaluation: The Bathel Index. Md State Med J. 1965;14:61-65.

Rubenstein LZ, Harker JO, Salvà A, Guigoz Y, Vellas B. Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF). J Gerontol A Biol Sci Med Sci. 2001;56(6):M366-M372. doi:10.1093/gerona/56.6.m366

Chao CT, Wang J, Chien KL; COhort of GEriatric Nephrology in NTUH (COGENT) study group. Both pre-frailty and frailty increase healthcare utilization and adverse health outcomes in patients with type 2 diabetes mellitus. Cardiovasc Diabetol. 2018;17(1):130. Published 2018 Sep 27. doi:10.1186/s12933-018-0772-2

Miao Z, Zhang Q, Yin J, Li L, Feng Y. Impact of frailty on mortality, hospitalization, cardiovascular events, and complications in patients with diabetes mellitus: a systematic review and meta-analysis. Diabetol Metab Syndr. 2024;16(1):116. Published 2024 May 28. doi:10.1186/s13098-024-01352-6

Kojima G, Taniguchi Y, Iliffe S, Jivraj S, Walters K. Transitions between frailty states among community-dwelling older people: A systematic review and meta-analysis. Ageing Res Rev. 2019;50:81-88. doi:10.1016/j.arr.2019.01.010

Leng SX, Xue QL, Tian J, Walston JD, Fried LP. Inflammation and frailty in older women. J Am Geriatr Soc. 2007;55(6):864-871. doi:10.1111/j.1532-5415.2007.01186.x

Soysal P, Stubbs B, Lucato P, et al. Inflammation and frailty in the elderly: A systematic review and meta-analysis [published correction appears in Ageing Res Rev. 2017 May;35:364-365. doi: 10.1016/j.arr.2016.12.007]. Ageing Res Rev. 2016;31:1-8. doi:10.1016/j.arr.2016.08.006

Blanc JJ, L'Her C, Touiza A, Garo B, L'Her E, Mansourati J. Prospective evaluation and outcome of patients admitted for syncope over a 1 year period. Eur Heart J. 2002;23(10):815-820. doi:10.1053/euhj.2001.2975

DeFronzo RA. Pathogenesis of type 2 diabetes mellitus. Med Clin North Am. 2004;88(4):787-ix. doi:10.1016/j.mcna.2004.04.013

Goisser S, Schrader E, Singler K, et al. Malnutrition According to Mini Nutritional Assessment Is Associated With Severe Functional Impairment in Geriatric Patients Before and up to 6 Months After Hip Fracture. J Am Med Dir Assoc. 2015;16(8):661-667. doi:10.1016/j.jamda.2015.03.002

Haffner SM, Lehto S, Rönnemaa T, Pyörälä K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med. 1998;339(4):229-234. doi:10.1056/NEJM199807233390404

Urban P. The veteran and the rookie. Eur Heart J. 2005;26(1):1-2. doi:10.1093/eurheartj/ehi062

Freire LB, Brasil-Neto JP, da Silva ML, et al. Risk factors for falls in older adults with diabetes mellitus: systematic review and meta-analysis. BMC Geriatr. 2024;24(1):201. Published 2024 Feb 28. doi:10.1186/s12877-024-04668-0

Chittrakul J, Siviroj P, Sungkarat S, Sapbamrer R. Physical Frailty and Fall Risk in Community-Dwelling Older Adults: A Cross-Sectional Study. J Aging Res. 2020;2020:3964973. Published 2020 Jul 4. doi:10.1155/2020/3964973

Zaslavsky O, Walker RL, Crane PK, Gray SL, Larson EB. Glucose Levels and Risk of Frailty. J Gerontol A Biol Sci Med Sci. 2016;71(9):1223-1229. doi:10.1093/gerona/glw024

Gadsby R, Hope S, Hambling C, Carnegie A. Frailty, older people and type 2 diabetes. J Diabetes Nurs. 2017;21(4):138-142.

Li Y, Zou Y, Wang S, et al. A Pilot Study of the FRAIL Scale on Predicting Outcomes in Chinese Elderly People With Type 2 Diabetes. J Am Med Dir Assoc. 2015;16(8):714.e7-714.e12. doi:10.1016/j.jamda.2015.05.019

Cano-Escalera G, Graña M, Irazusta J, Labayen I, Gonzalez-Pinto A, Besga A. Mortality Risks after Two Years in Frail and Pre-Frail Older Adults Admitted to Hospital. J Clin Med. 2023;12(9):3103. Published 2023 Apr 24. doi:10.3390/jcm12093103

Cacciatore F, Testa G, Galizia G, et al. Clinical frailty and long-term mortality in elderly subjects with diabetes. Acta Diabetol. 2013;50(2):251-260. doi:10.1007/s00592-012-0413-2

Mitnitski A, Song X, Skoog I, et al. Relative fitness and frailty of elderly men and women in developed countries and their relationship with mortality. J Am Geriatr Soc. 2005;53(12):2184-2189. doi:10.1111/j.1532-5415.2005.00506.x

Syddall H, Roberts HC, Evandrou M, Cooper C, Bergman H, Aihie Sayer A. Prevalence and correlates of frailty among community-dwelling older men and women: findings from the Hertfordshire Cohort Study. Age Ageing. 2010;39(2):197-203. doi:10.1093/ageing/afp204

Hubbard RE, Rockwood K. Frailty in older women. Maturitas. 2011;69(3):203-207. doi:10.1016/j.maturitas.2011.04.006

Puts MT, Lips P, Deeg DJ. Sex differences in the risk of frailty for mortality independent of disability and chronic diseases. J Am Geriatr Soc. 2005;53(1):40-47. doi:10.1111/j.1532-5415.2005.53008.x

Verbrugge LM. Gender and health: an update on hypotheses and evidence. J Health Soc Behav. 1985;26(3):156-182.

Frailty Status and Mortality Risk in Older Adults With Diabetes Mellitus