title: Diabetes and risk of frailty and its potential mechanisms: a prospective cohort study of older adults.
abstract: BACKGROUND
  There is emerging evidence of the role of diabetes as a risk factor for frailty. However, the mechanisms of this association are uncertain.
  
  
  METHODS
  Prospective cohort study of 1750 noninstitutionalized individuals aged 60 years or older recruited in 2008-2010. At baseline, information was obtained on health behaviors, morbidity, cardiometabolic biomarkers, and antidiabetic treatments. Individuals were considered diabetic if they reported a physician diagnosis or had fasting serum glucose of 126 mg/dL or higher. Study participants were followed through 2012 to assess incident frailty, defined as at least 3 of the 5 Fried criteria.
  
  
  RESULTS
  At baseline, the cohort included 346 individuals with diabetes and 1404 without diabetes. Over a mean 3.5-year follow-up, 115 cases of incident frailty were ascertained. After adjustment for age, sex, and education, participants with diabetes showed an increased risk of frailty (odds ratio [OR] 2.18, 95% confidence interval [CI] 1.42-3.37). Additional adjustment for health behaviors and abdominal obesity yielded a 29.7% reduction in the OR (OR 1.83, 95% CI 1.16-2.90). Subsequent adjustment for morbidity produced an additional 8.4% reduction (OR 1.76, 95% CI 1.10-2.82), and for cardiometabolic biomarkers, a further 44% reduction (OR 1.32, 95% CI 0.70-2.49). In particular, adjustment for HbA1c, lipoproteins, and triglycerides accounted for the greatest reductions. Finally, additional adjustment for oral antidiabetic medication reduced the OR to 1.01 (95% CI 0.46-2.20), whereas adjustment for nutritional therapy increased the OR to 1.64 (95% CI 0.77-3.49).
  
  
  CONCLUSIONS
  Diabetes mellitus is associated with higher risk of frailty; this association is partly explained by unhealthy behaviors and obesity and, to a greater extent, by poor glucose control and altered serum lipid profile among diabetic individuals. Conversely, diabetes nutritional therapy reduces the risk of frailty.
authors.affiliation: Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid / IdiPaz, and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain. Electronic address: esthergge@gmail.com.
authors.forename: Esther
authors.initials: E
authors.lastname: García-Esquinas
authors.affiliation: Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid / IdiPaz, and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
authors.forename: Auxiliadora
authors.initials: A
authors.lastname: Graciani
authors.affiliation: Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid / IdiPaz, and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Guallar-Castillón
authors.affiliation: Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid / IdiPaz, and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: López-García
authors.affiliation: Division of Geriatric Medicine, Hospital Universitario de Getafe, Madrid, Spain.
authors.forename: Leocadio
authors.initials: L
authors.lastname: Rodríguez-Mañas
authors.affiliation: Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid / IdiPaz, and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Rodríguez-Artalejo
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D015897:Comorbidity; D048909:Diabetes Complications / Q000503:physiopathology*; D005260:Female; D016330:Frail Elderly; D015438:Health Behavior; D006801:Humans; D007407:Interviews as Topic; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000503:physiopathology; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain
chemical_list: D015415:Biomarkers
keywords: Diabetes mellitus; Spain; frailty; older adults; walking speed