Physical frailty and cognitive impairment is associated with diabetes and adversely impact functional status and mortality

ABSTRACT

Objectives: We investigated whether there was a higher prevalence of cognitive impairment (CI) and/or physical frailty (PF) in persons with diabetes compared to their non-diabetic counterparts, and the individual and combined impact of CI and PF on functional and mortality outcomes among diabetic older persons.

Method: Community-living diabetic and non-diabetic participants (N = 2696) aged 55 and above were assessed on CI (MMSE) and PF (CHS criteria) status. Among 486 diabetic persons, we estimated the odds ratio and 95% confidence intervals (OR, 95% CI) of association of CI and/or PF with prevalent IADL and ADL disability and mortality from 11 years of follow up.

Results: Diabetes was associated with significantly higher prevalence of CI and/or PF. Adjusted for sex, age, education, smoking, alcohol intake, physical activity, and BMI, diabetes was associated with higher prevalence of PF alone (OR = 2.24, 1.16–4.34) and PF with CI (OR = 2.01, 1.12–3.60), but not with CI alone (OR = 1.02, 0.73–1.44). In multivariable analyses of 486 diabetic older adults, compared to non-frail (NF) and cognitive normal (CN), CI alone was not significantly associated with IADL (OR = 1.06, 0.53–2.10), but PF alone was associated with considerably higher prevalence of IADL (OR = 6.72, 1.84–24.5). PF with CI was associated with the highest prevalence of IADL (OR = 17.8, 3.66–8.68) and ADL disability (OR = 93.8, 23.6–372.4). Whether singly or in combination, PF and/or CI were associated with worse hazard (HR) ratio for mortality outcomes: CI alone (HR = 2.72, 1.48–5.01), PF alone (HR = 4.30, 1.88–9.82) and CI with PF (HR = 8.41, 3.95–17.9).

Conclusion: Cognitive impairment and/or physical frailty are powerful prognostic factors identifying people with diabetes at high risk of mortality.

KEYWORDS:

• Frailty
• cognitive impairment
• type 2
• disability and mortality

Acknowledgments

We thank the following voluntary welfare organizations for their support: Geylang East Home for the Aged, Presbyterian Community Services, St Luke’s Eldercare Services, Thye Hua Kwan Moral Society (Moral Neighbourhood Links), Yuhua Neighbourhood Link, Henderson Senior Citizens’ Home, NTUC Eldercare Co-op Ltd, Thong Kheng Seniors Activity Centre (Queenstown Centre) and Redhill Moral Seniors Activity Centre.

Declaration of interest

None reported. PGM peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

TPN had full access to all data in the study and has primary responsibility for final content. TPN formulated the hypothesis, designed the study, supervised and reviewed the data analysis, and reviewed and revised the manuscript. FST reviewed the literature, interpreted the results, and drafted and reviewed the manuscript. SLW and YL contributed to the study design, reviewed the literature, interpreted the results, drafted and reviewed the manuscript. MSZN and QG contributed to the study design and data collection, reviewed the results and drafts of the manuscript. All authors read and approved the final manuscript.

Additional information

Funding

The study was supported by research grants from the Agency for Science Technology and Research (A*STAR) Biomedical Research Council (BMRC) [Grant: 08/1/21/19/567] and from the National Medical Research Council [Grant: NMRC/1108/2007]. The sponsors had no role in the conduct of the study or preparation of this manuscript.