The study’s findings go somewhat against the stereotype of type 2 diabetes as a condition affecting mostly obese people, and serves as a reminder than even thinner and weaker people are affected by the condition. To look at the link between risk factors for frailty, researchers followed 291 people with type 2 who lived in their community (not any type of long-term healthcare facility) in central China. Each participant was at least 65 years old and had type 2 diabetes, and got their healthcare through one of two community health centers through which the study was based.
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Link discovered between frailty and glucose control
As part of the study, participants completed a number of different surveys, body measurements and lab tests. A designation of frailty was based on a number of different criteria such as low levels of physical activity, unintentional weight loss, exhaustion, muscle weakness and slowness when walking. Participants were also categorized as having prefrailty, based on less severe measurements in these areas, when appropriate — an indication that a person may be at increased risk of developing frailty, similar to the way prediabetes is often used to indicate an elevated diabetes risk.
Overall, 19.2% of the participants were categorized as having frailty, while 51.5% had prefrailty. The strongest predictor of frailty that the researchers found was malnutrition, with participants’ answers to questions about their diet showing that a high risk for malnutrition was linked to over eight times the likelihood of frailty, compared with those at lowest risk for malnutrition. But A1c level (a measure of long-term blood glucose control) was also a significant predictor of frailty, with participants in the top category for A1c (indicating poorer glucose control) 43% more likely to be frail than those in the bottom category for A1c. A history of drinking alcohol was also a major predictor of frailty, with those in the top category of past alcohol use almost 4.5 times as likely to be frail as those in the bottom category. Depressive symptoms were similarly linked to a 44% higher risk for frailty, while regular physical activity was linked to a 20% lower risk for frailty.
It’s worth noting that these numbers, as part of an observational study, don’t show that A1c level, alcohol use, malnutrition or anything else caused a person to be more or less likely to be frail — they can only suggest a connection. And it’s possible that some of the factors linked to frailty could be part of a relationship that runs in more than one direction. People who are frail, for example, may be unable to exercise as much, which could account for some or all of the lower level of physical activity linked to frailty. The same thing could be said about depressive symptoms, since people who are frail may be more prone to isolation and depression — while at the same time, depressive symptoms may lead to power eating habits and contribute to frailty.
But regardless of the causes, it’s clear that frailty is a significant problem among older adults with type 2 diabetes, and that blood glucose control — among other factors — is tied to the risk of being frail. “Frailty identification and multifaceted interventions should be developed for this population,” the researchers wrote, “taking into consideration proper glycemic control, nutritional instruction, depressive symptoms improvement and enhancement of self-care behaviors.”
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