title: Glucose Levels and Risk of Frailty.
abstract: The association between glucose levels and incident frailty in older persons remains unclear. We examined the extent to which higher glucose levels in older adults with and without diabetes are related to risk of frailty.
  
  
  
  The data are from the Adult Changes in Thought study. We identified 1,848 individuals aged 65+ without dementia for whom glucose levels from laboratory measurements of glucose and glycated hemoglobin were available. Physical frailty using modified Fried's criteria was determined from biennial assessments. Frailty hazard was modeled as a function of time-varying measures of diabetes and average glucose levels using Cox regression.
  
  
  
  A total of 578 incident frailty cases (94 with diabetes, 484 without) occurred during a median follow-up of 4.8 years. The adjusted hazard ratio for frailty comparing those with and without diabetes was 1.52 (95% confidence interval = 1.19-1.94). In participants without diabetes, modeling suggested elevated frailty risk with greater average glucose levels (p = .019); for example, a glucose level of 110mg/dL compared with 100mg/dL yielded a hazard ratio of 1.32 (95% confidence interval = 1.09-1.59). In participants with diabetes, glucose levels less than 160mg/dL and greater than 180mg/dL were related to increased risk of frailty (p = .001).
  
  
  
  Higher glucose levels may be a risk factor for frailty in older adults without diabetes. The apparent U-shape association between glucose levels and frailty in people with diabetes is consistent with the literature on glycemia and mortality and deserves further examination.
authors.affiliation: Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle. ozasl@uw.edu.
authors.forename: Oleg
authors.initials: O
authors.lastname: Zaslavsky
authors.affiliation: Group Health Research Institute, Group Health Cooperative, Washington, Seattle.
authors.forename: Rod L
authors.initials: RL
authors.lastname: Walker
authors.affiliation: Group Health Research Institute, Group Health Cooperative, Washington, Seattle. Department of Medicine, University of Washington, Seattle.
authors.forename: Paul K
authors.initials: PK
authors.lastname: Crane
authors.affiliation: School of Pharmacy, University of Washington, Seattle.
authors.forename: Shelly L
authors.initials: SL
authors.lastname: Gray
authors.affiliation: Group Health Research Institute, Group Health Cooperative, Washington, Seattle. Department of Medicine, University of Washington, Seattle.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Larson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis*; D015992:Body Mass Index; D015331:Cohort Studies; D003704:Dementia / Q000209:etiology; D003920:Diabetes Mellitus / Q000175:diagnosis; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly / Q000706:statistics & numerical data; D015577:Geriatric Assessment; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000150:complications* / Q000175:diagnosis* / Q000453:epidemiology; D015994:Incidence; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: Diabetes; Frailty; Glucose levels; Older adults; Prospective