Eight-Year Changes in Multimorbidity and Frailty in Adults With Type 2 Diabetes Mellitus: Associations With Cognitive and Physical Function and Mortality

Mark A Espeland; Jamie Nicole Justice; Judy Bahnson; Joni K Evans; Medha Munshi; Kathleen M Hayden; Felicia R Simpson; Karen C Johnson; Craig Johnston; Stephen R Kritchevsky

doi:10.1093/gerona/glab342

Eight-Year Changes in Multimorbidity and Frailty in Adults With Type 2 Diabetes Mellitus: Associations With Cognitive and Physical Function and Mortality

J Gerontol A Biol Sci Med Sci. 2022 Aug 12;77(8):1691-1698. doi: 10.1093/gerona/glab342.

Authors

Affiliations

¹ Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
² Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
³ Joslin Geriatric Diabetes Program, Joslin Diabetes Center, Boston, Massachusetts, USA.
⁴ Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
⁵ Department of Mathematics, Winston-Salem State University, Winston-Salem, North Carolina, USA.
⁶ Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
⁷ Department of Health and Human Performance, University of Houston, Houston, Texas, USA.

Abstract

Background: Indices of multimorbidity and deficit accumulation (ie, frailty indices) have been proposed as markers of biological aging. If true, changes in these indices over time should predict downstream changes in cognition and physical function, and mortality.

Methods: We examined associations that 8-year changes in (i) a multimorbidity index comprised of 9 chronic diseases and (ii) a frailty index (FI) based on deficit accumulation in functional, behavioral, and clinical characteristics had with subsequent measures of cognitive and physical function over 10 years. We drew data from 3 842 participants in the Action for Health in Diabetes clinical trial. They were aged 45-76 years at baseline and at risk for accelerated biological aging due to overweight/obesity and type 2 diabetes mellitus.

Results: A total of 1 501 (39%) of the cohort had 8-year increases of 1 among the 9 diseases tracked in the multimorbidity index and 868 (23%) had increases of ≥2. Those with greatest increases in multimorbidity tended to be older individuals, males, and non-Hispanic Whites. Greater FI increases tended to occur among individuals who were older, non-Hispanic White, heavier, and who had more baseline morbidities. Changes in multimorbidity and FI were moderately correlated (r = 0.26; p < .001). Increases in both multimorbidity and FI were associated with subsequently poorer composite cognitive function and 400-m walk speed and increased risk for death (all p < .001).

Conclusions: Accelerated biological aging, as captured by multimorbidity and frailty indices, predicts subsequent reduced function and mortality. Whether intensive lifestyle interventions generally targeting multimorbidity and FI reduce risks for downstream outcomes remains to be seen. Clinical Trials Registration Number: NCT00017953.

Keywords: Aging; Deficit accumulation; Intensive lifestyle intervention.

Publication types

Clinical Trial
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Cognition
Diabetes Mellitus, Type 2* / complications
Diabetes Mellitus, Type 2* / epidemiology
Frail Elderly
Frailty* / epidemiology
Humans
Male
Multimorbidity

Associated data

ClinicalTrials.gov/NCT00017953

Abstract

Publication types

MeSH terms

Associated data

Grants and funding