Combined effect of diabetes and frailty on mortality and incident disability in older Japanese adults.

Kitamura, Akihiko; Taniguchi, Yu; Seino, Satoshi; Yokoyama, Yuri; Amano, Hidenori; Fujiwara, Yoshinori; Shinkai, Shoji

Aim: Evidence is limited on how frailty affects the association between diabetes and adverse outcomes at the population level. The present community‐based study aimed to clarify the relative risks of death and disability in older Japanese adults with diabetes, frailty, both or neither. Methods: The present prospective study analyzed data from 1271 Japanese residents aged ≥65 years in Kusatsu town in Gunma Prefecture, Japan, who participated in annual health checkups carried out between 2002 and 2011, and were initially free of disability. A Cox proportional hazards regression model was used to identify associations of diabetes and frailty with all‐cause mortality and incident disability. Results: Among the 1271 participants, 176 (14%) had diabetes (mean hemoglobin A1c 7.5%, body mass index 24.2 kg/m2, 45% using diabetes medications) and 151 (12%) had frailty at baseline. Compared with non‐frail participants without diabetes, those with diabetes and frailty had higher risks of mortality (multivariable hazard ratio 5.0, 95% CI 2.4–10.3) and incident disability (hazard ratio 3.9, 95% CI 2.1–7.3). In contrast, non‐frail participants with diabetes did not have a significantly increased risk of mortality, although they had a higher tendency for the incidence of disability, as compared with non‐frail participants without diabetes. Conclusions: At the population level, the risks of death and disability in persons with mild diabetes were strongly affected by the presence of frailty. From a community‐based perspective, diabetes‐related mortality and disability incidence might be reduced by preventing or improving frailty in conjunction with glycemic control. Geriatr Gerontol Int 2019; 19: 423–428.

JAPAN; DIABETES risk factors; MORTALITY risk factors; CONFIDENCE intervals; GERIATRIC assessment; FRAIL elderly; GLYCOSYLATED hemoglobin; LONGITUDINAL method; MEDICAL screening; MULTIVARIATE analysis; REGRESSION analysis; BODY mass index; RELATIVE medical risk; DISEASE incidence; PROPORTIONAL hazards models; ODDS ratio; GLYCEMIC control; OLD age

Geriatrics & Gerontology International, 2019, Vol 19, Issue 5, p423

1444-1586

Academic Journal

10.1111/ggi.13637