12th November 2019
2 min read
Discovery of a link between diabetes and frailty in elderly people
New study results
A new study carried out by LIH, in collaboration with international research teams, has shown that people with diabetes aged more than 60 are frailer than people without diabetes. This could mean that patients suffering from diabetes age more quickly. The study was published in July 2019 in Diabetes Care, a renowned scientific journal in the field of diabetes research.
Diabetes is a public health issue...
The life expectancy of the world population continues to rise. According to statistics of the World Health Organisation (WHO), about one third of the European population will be aged over 60 by 2050. As mostly elderly people suffer from diabetes, the prevalence of diabetes and the complications associated with the disorder will also increase.
According to the European Health Examination Survey (EHES), conducted in Luxembourg between 2013 and 2015 with more than 1,500 residents, approximately 5% of the population suffer from diabetes and a quarter show signs of prediabetes. Men are more affected by glucose metabolism disorders than women. Among the 55-64 year olds, 18.5% have diabetes.
...and makes us frail
LIH recently evaluated the data of a large English cohort with the aim of better understanding the consequences of chronic disease on ageing. The results clearly show that diabetes and frailty are associated: At a same age, people with diabetes are generally frailer than people without diabetes. Frailty is an essentially age-related condition of vulnerability. Among other things, it affects the posture and sense of balance of elderly people and increases the risk of falling.
At the start of the study, 12% of the participants had diabetes and 35% were considered frail. Participants were subsequently monitored over a period of 10 years. The researchers found that frailty increased more rapidly in people with diabetes than in people without diabetes regardless the degree of frailty at the beginning of the study. A 60-year-old man with diabetes therefore displays the same frailty index as a 72-year-old man without diabetes.
'In simple terms, diabetes lets us age by 12 years. Diabetes increases the risk of rapid health decline. We become frail earlier, meaning that we have a higher risk of falls leading to injuries or fractures, lose our independence earlier and may need healthcare in hospitals.,
explains Dr Gloria Aguayo from LIH’s Department of Population Health who led the study.
Prediabetes is also a concern
Remarkably, the study also indicated a link between prediabetes and frailty. Prediabetes can be detected by measuring glycated haemoglobin HbA1c in blood samples. HbA1c is a marker that is used to assess blood glucose levels over several months. The results show that people with slightly elevated levels of HbA1c at the beginning of the study developed more rapidly towards frailty than people with a normal level. This result is highly relevant, underlining the importance of taking care of elevated blood glucose levels as early as possible.
Causality needs to be determined
The observations of the study may indicate that the complications resulting from diabetes play a role in frailty trajectories. Another possibility could be that common earlier determinants contribute to the development of diabetes and the risk of frailty later in life.
Future research should investigate the causes and mechanisms of the relationship between diabetes (or prediabetes) and frailty. At present, the possibility of the reverse phenomenon - that frailty could be a factor contributing to the development of diabetes - cannot be ruled out.
Slowing the progression of frailty
The results of the study underline the relevance of early diagnosis of diabetes to prevent accelerated progression of frailty in the elderly. ‘Our research suggests that diabetes and the signs of prediabetes affect the frailty of people over 60,’ explains Dr Aguayo. ‘In an ageing population, it is particularly important that metabolic disorders are diagnosed as early as possible to prevent complications. In addition, the population could be made more aware of better lifestyles with a healthier diet and more exercise through increased preventive measures, thus rising their chances of healthy ageing,’ she states.
The present study was conducted with data from around 5,400 individuals aged 60 or more from the English Longitudinal Study of Ageing (ELSA). Participants were asked to complete a 36-point questionnaire every two years between 2004 and 2015 on the condition of their frailty, and this over a period of 10 years. In addition, they underwent a medical check-up every four years including physical ability tests and blood sampling. From all the collected information, a frailty index between 0 and 1 was determined for each person. An index of 0.2 was considered as threshold for frailty.
> International cooperation
For this research project, the epidemiology and statistics specialists of LIH’s Department of Population Health worked closely with researchers from the Universities of Aarhus (Denmark), Liège (Belgium), Western Ontario (Canada) and INSERM in Paris (France).
Dr Gloria Aguayo