title: Frailty, Diabetes, and Mortality in Middle-Aged African Americans.
abstract: Older adult frail diabetics have high mortality risk, but data are limited regarding frail late middle-aged diabetics, especially for African-Americans. The aim of this study is to examine the association of diabetes with health outcomes and frailty in the African American Health (AAH) study.
  
  
  
  AAH is a population-based longitudinal cohort study. Participants were African Americans (N=998) ages 49 to 65 years at baseline. Cross-sectional comparisons for diabetes included disability, function, physical performance, cytokines, and frailty. Frailty measures included the International Academy of Nutrition and Aging [FRAIL] frailty scale, Study of Osteoporotic Fractures [SOF] frailty scale, Cardiovascular Health Study [CHS] frailty scale, and Frailty Index [FI]). Longitudinal associations for diabetes included new ADLs ≥ 1 and mortality at 9-year follow-up.
  
  
  
  Diabetics were more likely to be frail using any of the 4 frailty scales than were non-diabetics. Frail diabetics, compared to nonfrail diabetics, reported significantly increased falls in last 1 year, higher IADLs and higher LBFLs. They demonstrated worse performance on the SPPB, one-leg stand, and grip strength; and higher Tumor Necrosis Factor receptors (sTNFR1 and sTNFR2). Mortality and 1 or more new ADLs also were increased among frail compared to nonfrail diabetics when followed for 9 years.
  
  
  
  Frailty in middle-aged African American persons with diabetes is associated with having more disability and functional limitations, worse physical performance, and higher cytokines (sTNFR1 and sTNFR2 only). Middle-aged African Americans with diabetes have an increased risk of mortality and frail diabetics have an even higher risk of death, compared to nonfrail diabetics.
authors.affiliation: John E. Morley, MB, BCh, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Boulevard, M238, St Louis, MO 63104, E-mail address: morley@slu.edu; Phone: 314-977-8462; Fax: 314-771-8571.
authors.forename: S
authors.initials: S
authors.lastname: Chode
authors.forename: T K
authors.initials: TK
authors.lastname: Malmstrom
authors.forename: D K
authors.initials: DK
authors.lastname: Miller
authors.forename: J E
authors.initials: JE
authors.lastname: Morley
mesh_terms: D000203:Activities of Daily Living; D001741:Black or African American; D000368:Aged; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000209:etiology* / Q000401:mortality; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged