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)

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.