In a study of people with prediabetes, it was found that those who were pre-fragile (49.1%) or fragile (5.9%) had significantly higher risks of developing various serious diseases.
Fragile and pre-fragile participants showed distinct characteristics compared to non-fragile participants.
For example, the frail were older, more often women, and had higher rates of cardiovascular disease, depression, and a higher BMI.
Fragile people also have lower levels of occupational participation and a higher proportion with low levels of education.
To simplify, here are the 5 criteria of the frailty phenotype in the UK Biobank study:
Involuntary weight loss: participants were asked, “Compared to a year ago, has your weight changed?”
1: “Yes, I've lost weight”.
0: Other answers
Exhaustion: Participants were asked the question: “In the last 2 weeks, how often have you felt tired or lacked energy?”
1: “More than half of the days or almost every day”
0 : Other answers
Weakness: Strength was measured using a Jamar J00105 hydraulic hand dynamometer (Lafayette Instrument). Participants were asked to perform a grip test for both hands, and the maximum value for the right and left hand was used.
1: (1) Men: ≤29 kg for a BMI ≤24 kg/m²; ≤30 kg for a BMI of 24.1-26 kg/m²; ≤30 kg for a BMI of 26.1-28 kg/m²; or ≤32 kg for a BMI >28 kg/m²; (2) Women: ≤17 kg for a BMI ≤23 kg/m²; ≤17.3 kg for a BMI of 23.1-26 kg/m²; ≤18 kg for a BMI of 26.1-29 kg/m²; or ≤21 kg for a BMI >29 kg/m².
0 : Other answers
Slow walking speed: Participants were asked the question, “How would you describe your usual walking pace?”
1: “Slow pace
0: Other answers
Low physical activity: Participants were asked: “In the last 4 weeks, have you spent any time doing light DIY activities, intensive DIY activities or intense sports?”
1: “No activity or light activity with a frequency of once a week or less”
0 : Other answers
Both pre-fragility and frailty were associated with increased risks of various adverse outcomes (P for trend <.001). For example, frail participants had a significantly higher risk of developing type 2 diabetes (HR=1.73), diabetes-related microvascular disease (HR=1.89), cardiovascular disease (HR=1.66), chronic kidney disease (HR=1.76), eye disease (HR=1.31), dementia (HR=2.03), depression (HR=3.01) and all-cause mortality (HR=1.81).
The “HR” (Hazard Ratio) is a measure used to compare the risk of an event (such as developing a disease) between two groups. For example, an HR of 1.73 means that frail people have a 73% increased risk compared to non-fragile people. If the HR is 2.03, it means that frail people have a 103% greater risk of developing the condition in question than non-fragile people, more than double the baseline risk. If the HR is 3.01, this means that frail people have a 201% higher risk of developing the disease or condition in question than non-fragile people. In other words, they have more than three times the baseline risk.
The “P” indicates the probability that these results are due to chance. Here, very low values (P < 0.001) show that the results are very reliable and that there's a very small chance that it's just a coincidence.
These results underline the importance of closer monitoring and preventive measures in people showing early signs of frailty in order to reduce the risk of Prediabetes-related complications.
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Sources:
Associations Between Frailty and the Increased Risk of Adverse Outcomes Among 38,950 UK Biobank Participants With Prediabetes: Prospective Cohort Study.
Cao X, Li X, Zhang J, Sun X, Yang G, Zhao Y, Li S, Hoogendijk EO, Wang X, Zhu Y, Allore H, Gill TM, Liu Z.
JMIR Public Health Surveill. 2023 May 18;9:e45502. doi: 10.2196/45502.