Frailty tied to the progression of prediabetes to diabetes and CVD, mortality risk: Study

In middle-aged and older people with prediabetes and diabetes, fragility has been reported to be a common complication or coexisting factor. A clear picture of the impacts of frailty on the long-term outcomes in people with prediabetes and diabetes would yield important clues for effectively managing prediabetes and diabetes.

Characterization of fragility is functional declines in multiple physiological systems and increased stressors. Previous research has found that fragility increases the risk of adverse health outcomes in diabetes patients, such as all-cause mortality and cardiovascular disease. However, some critical knowledge gaps still need to be addressed. No study has assessed the frailty impacts on long-term outcomes in people with diabetes. The effect of fragility on prediabetes to diabetes progression needs to be elucidated.

To address the knowledge gaps, Qing Chen and colleagues from China aimed to evaluate the effects of frailty on the progression of prediabetes to diabetes, CVD and all-cause mortality in people with prediabetes and diabetes.

For this purpose, the authors included 7,933 people with prediabetes and diabetes from two studies (CHARLS, China Health and Retirement Longitudinal Study and ELSA, English Longitudinal Study of Ageing). The frailty index determined frailty status and classified it as pre-frail, robust, and frail. The risks of progression to diabetes, CVD, and all-cause mortality were also calculated.

The authors reported the following findings:

• Frail subjects in prediabetes had remarkably increased risks of progression to diabetes (CHARLS, OR = 1.55; ELSA, OR = 1.86) compared with robust subjects.
• Frail subjects with prediabetes also presented remarkably increased risks of CVD (CHARLS: HR = 1.90; ELSA: HR = 1.94) and all-cause mortality (CHARLS: HR = 2.45; ELSA: HR = 2.13) than robust subjects with prediabetes.
• In diabetes, frailty still increased the risks of CVD (CHARLS, HR = 2.72; ELSA, HR = 2.41) and all-cause mortality (CHARLS, HR = 2.28; ELSA, HR = 2.28).

"In the study with prospective cohorts from UK and China, we found that frailty is tied to the progression of prediabetes to diabetes and increased CVD and all-cause mortality risks in people with prediabetes and diabetes," the authors wrote."Furthermore, frailty and conventional risk factors also improved risk prediction for all-cause mortality and CVD in patients with prediabetes and diabetes."

Reference:

He D, Li J, Li Y, Zhu J, Zhou T, Xu Y, Wu Q, Cheng Z, Chen Q, Liu Z, Zhu Y. Frailty is associated with the progression of prediabetes to diabetes and elevated risks of cardiovascular disease and all-cause mortality in individuals with prediabetes and diabetes: Evidence from two prospective cohorts. Diabetes Res Clin Pract. 2022 Nov 7;194:110145. doi: 10.1016/j.diabres.2022.110145. Epub ahead of print.