scholarly journals Impact of Multidomain Lifestyle Intervention on Frailty Through the Lens of Deficit Accumulation in Adults with Type 2 Diabetes Mellitus

2019 ◽  
Vol 75 (10) ◽  
pp. 1921-1927 ◽  
Author(s):  
Felicia R Simpson ◽  
Nicholas M Pajewski ◽  
Barbara Nicklas ◽  
Stephen Kritchevsky ◽  
Alain Bertoni ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Lifestyle Intervention ◽  
Biological Aging ◽  
Deficit Accumulation ◽  
Dietary Counseling ◽  
Intensive Lifestyle Intervention ◽  
Age Related

Abstract Background Type 2 diabetes and obesity increase the accumulation of health deficits and may accelerate biological aging. Multidomain lifestyle interventions may mitigate against this. Methods Within a large, randomized clinical trial of intensive lifestyle intervention including caloric restriction, increased physical activity, dietary counseling, and risk factor monitoring compared with diabetes support and education, we examined the accumulation of health deficits across 8 years. We used two complementary frailty indices (FIs) based on deficit accumulation, one modeled on work in the Systolic Blood Pressure Intervention Trial and the other including additional deficits related to obesity and type 2 diabetes mellitus. Differences between intervention groups and their consistency among subgroups were assessed with re-randomization tests. Results Data from 4,859 adults (45–76 years at baseline, 59% female) were analyzed. Random assignment to intensive lifestyle intervention was associated with lower FI scores throughout follow-up as captured by areas under curves traced by longitudinal means (p ≤ .001), over which time mean (SE) differences between intervention groups averaged 5.8% (0.9%) and 5.4% (0.9%) for the two indices. At year 8, the percentage of participants classified as frail (FI > 0.21) was lower among intensive lifestyle intervention (39.8% and 54.5%) compared with diabetes support and education (42.7% and 60.9%) for both FIs (both p < .001). Intervention benefits were relatively greater for participants who were older, not obese, and without history of cardiovascular disease at baseline. Conclusions Eight years of multidomain lifestyle intervention create a buffer against the accumulation of age-related health deficits in overweight or obese adults with type 2 diabetes. ClinicalTrials.gov Identifier: NCT00017953

scholarly journals IMPACT OF AN INTENSIVE MULTIDOMAIN LIFESTYLE INTERVENTION ON DEFICIT ACCUMULATION FRAILTY INDICES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S781-S781
Author(s):  
Felicia Simpson ◽  
Nicholas M Pajewski ◽  
Alain M Bertoni ◽  
Frank Ingram ◽  
Barbara M Nicklas ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Lifestyle Intervention ◽  
Frailty Index ◽  
Biological Aging ◽  
Controlled Clinical Trial ◽  
Deficit Accumulation ◽  
Dietary Counseling ◽  
Two Indices ◽  
Over Time

Abstract Background: Type 2 diabetes and obesity increase accumulation of health deficits over time and may accelerate biological aging. It is unknown whether multidomain lifestyle interventions can mitigate against this. Methods: Within a large, randomized controlled clinical trial of intensive lifestyle intervention (ILI) including caloric restriction, increased physical activity, dietary counseling, and risk factor monitoring compared with diabetes support and education (DSE) we examined the trajectory of frailty across 8 years. We used two complementary frailty index (FI) definitions, one modeled on work in the Systolic Blood Pressure Intervention Trial; the other including additional deficits related to aging with obesity and type 2 diabetes mellitus. Differences between intervention groups and the consistency of these across clinical subgroups were assessed with re-randomization tests. Results: Data from 4859 adults (45-76 years at baseline, 59% female) were analyzed. Random assignment to ILI was associated with lower FI scores throughout 8 years of follow-up (p<0.001), over which time mean differences between intervention groups averaged 5.8% and 5.4% for the two indices. At year 8, the percentages of participants categorized as frail (FI>0.21) were lower among ILI (39.8% and 54.5%) compared with DSE (42.7% and 60.9%) for the two indices (both p<0.001). Intervention benefits were relatively greater for individuals who were older, not obese, and without history of cardiovascular disease at baseline. Conclusions: Eight years of multidomain lifestyle intervention slows the accumulation of health deficits over time in overweight or obese adults with type 2 diabetes.

scholarly journals Association of Intensive Lifestyle Intervention, Fitness, and Body Mass Index With Risk of Heart Failure in Overweight or Obese Adults With Type 2 Diabetes Mellitus

Circulation ◽  
2020 ◽  
Vol 141 (16) ◽  
pp. 1295-1306 ◽  
Author(s):  
Ambarish Pandey ◽  
Kershaw V. Patel ◽  
Judy L. Bahnson ◽  
Sarah A. Gaussoin ◽  
Corby K. Martin ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Body Mass Index ◽  
Type 2 Diabetes Mellitus ◽  
Ejection Fraction ◽  
Lifestyle Intervention ◽  
Body Mass ◽  
Hazard Ratio ◽  
Intensive Lifestyle Intervention

Background: Type 2 diabetes mellitus (T2DM) is associated with a higher risk for heart failure (HF). The impact of a lifestyle intervention and changes in cardiorespiratory fitness (CRF) and body mass index on risk for HF is not well established. Methods: Participants from the Look AHEAD trial (Action for Health in Diabetes) without prevalent HF were included. Time-to-event analyses were used to compare the risk of incident HF between the intensive lifestyle intervention and diabetes support and education groups. The associations of baseline measures of CRF estimated from a maximal treadmill test, body mass index, and longitudinal changes in these parameters with risk of HF were evaluated with multivariable adjusted Cox models. Results: Among the 5109 trial participants, there was no significant difference in the risk of incident HF (n=257) between the intensive lifestyle intervention and the diabetes support and education groups (hazard ratio, 0.96 [95% CI, 0.75–1.23]) over a median follow-up of 12.4 years. In the most adjusted Cox models, the risk of HF was 39% and 62% lower among moderate fit (tertile 2: hazard ratio, 0.61 [95% CI, 0.44–0.83]) and high fit (tertile 3: hazard ratio, 0.38 [95% CI, 0.24–0.59]) groups, respectively (referent group: low fit, tertile 1). Among HF subtypes, after adjustment for traditional cardiovascular risk factors and interval incidence of myocardial infarction, baseline CRF was not significantly associated with risk of incident HF with reduced ejection fraction. In contrast, the risk of incident HF with preserved ejection fraction was 40% lower in the moderate fit group and 77% lower in the high fit group. Baseline body mass index also was not associated with risk of incident HF, HF with preserved ejection fraction, or HF with reduced ejection fraction after adjustment for CRF and traditional cardiovascular risk factors. Among participants with repeat CRF assessments (n=3902), improvements in CRF and weight loss over a 4-year follow-up were significantly associated with lower risk of HF (hazard ratio per 10% increase in CRF, 0.90 [95% CI, 0.82–0.99]; per 10% decrease in body mass index, 0.80 [95% CI, 0.69–0.94]). Conclusions: Among participants with type 2 diabetes mellitus in the Look AHEAD trial, the intensive lifestyle intervention did not appear to modify the risk of HF. Higher baseline CRF and sustained improvements in CRF and weight loss were associated with lower risk of HF. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT00017953.

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

2021 ◽  
Author(s):  
Mark A Espeland ◽  
Jamie Nicole Justice ◽  
Judy Bahnson ◽  
Joni K Evans ◽  
Medha Munshi ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Physical Function ◽  
Frailty Index ◽  
Biological Aging ◽  
Older Individuals ◽  
Deficit Accumulation ◽  
Increased Risk

Abstract Background Indices of multimorbidity and deficit accumulation (i.e. 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 1) a multimorbidity index comprised of nine chronic diseases and 2) 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 3841 participants in the Look AHEAD 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 1501 (39%) of the cohort had 8-year increases of one among the nine 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<0.001). Increases in both multimorbidity and FI were associated with subsequently poorer composite cognitive function and 400m walk speed and increased risk for death (all p<0.001). 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.

scholarly journals Effect of Intensive Lifestyle Intervention on the Association between Weight Variability and Mortality and Cardiovascular Events in Overweight or Obese Adults with Type 2 Diabetes Mellitus

2020 ◽  
Author(s):  
Menghui Liu ◽  
Xiaohong Chen ◽  
Shaozhao Zhang ◽  
Daya Yang ◽  
Yifen Lin ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Lifestyle Intervention ◽  
Cardiovascular Events ◽  
Risk Of Death ◽  
Intensive Lifestyle Intervention ◽  
All Cause Mortality ◽  
Quartile Group

Abstract Background: The association among intensive lifestyle intervention (ILI), weight variability and the risks of death and cardiovascular events have limited data. We aimed to examine whether the weight variability is associated with all-cause mortality and cardiovascular events, and whether the intensive lifestyle intervention (ILI) will affect these associations in overweight or obese individuals with type 2 diabetes mellitus (T2DM).Methods: Individuals from the Action for Health in Diabetes (Look AHEAD) trial who measured the weight variability based on 5 equally spaced medical measurements of within 4 years were enrolled. A multivariate-adjusted Cox regression models were used to evaluate the associations between weight variability and adverse outcomes including the all-cause mortality and primary cardiovascular disease (CVD) outcome, and the effects of ILI on these associations.Results: Among the 3,859 participants with a median follow-up of 9.6 years, those with the highest quartile of weight variability experienced a double higher risk of death compared with those the lowest quartile (HR 2.25; 95% CI 1.44-3.52), but no difference was found in primary CVD outcome (HR 1.02; 95% CI 0.78-1.33). Moreover, the restricted cubic splines revealed that the risk of death grew with the increased weight variability. Of note, the association between weight variability and all-cause mortality was not observed in ILI arm (the highest vs. lowest quartile group, [HR 1.30; 95% CI 0.67-2.50]) and was just found in diabetes support and education (DSE) arm (the highest vs. lowest quartile group, [HR 3.31; 95% CI 1.84-5.95]).Conclusions: Among the overweight or obese individuals with T2DM, the weight variability was independently associated with increased risks of all-cause mortality, but this association might be removed by ILI.Trial registrations ClinicalTrials.gov identifiers: NCT00017953.

scholarly journals A Narrative Review on Sarcopenia in Type 2 Diabetes Mellitus: Prevalence and Associated Factors

Nutrients ◽  
2021 ◽  
Vol 13 (1) ◽  
pp. 183
Author(s):  
Anna Izzo ◽  
Elena Massimino ◽  
Gabriele Riccardi ◽  
Giuseppe Della Pepa
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Elderly Population ◽  
The Elderly ◽  
Narrative Review ◽  
Macrovascular Complications ◽  
Diabetic Patients ◽  
Age Related

Type 2 diabetes mellitus (T2DM) represents a major health burden for the elderly population, affecting approximately 25% of people over the age of 65 years. This percentage is expected to increase dramatically in the next decades in relation to the increased longevity of the population observed in recent years. Beyond microvascular and macrovascular complications, sarcopenia has been described as a new diabetes complication in the elderly population. Increasing attention has been paid by researchers and clinicians to this age-related condition—characterized by loss of skeletal muscle mass together with the loss of muscle power and function—in individuals with T2DM; this is due to the heavy impact that sarcopenia may have on physical and psychosocial health of diabetic patients, thus affecting their quality of life. The aim of this narrative review is to provide an update on: (1) the risk of sarcopenia in individuals with T2DM, and (2) its association with relevant features of patients with T2DM such as age, gender, body mass index, disease duration, glycemic control, presence of microvascular or macrovascular complications, nutritional status, and glucose-lowering drugs. From a clinical point of view, it is necessary to improve the ability of physicians and dietitians to recognize early sarcopenia and its risk factors in patients with T2DM in order to make appropriate therapeutic approaches able to prevent and treat this condition.

scholarly journals Three-Year Outcomes of Bariatric Surgery vs Lifestyle Intervention for Type 2 Diabetes Mellitus Treatment

JAMA Surgery ◽  
2015 ◽  
Vol 150 (10) ◽  
pp. 931 ◽  
Author(s):  
Anita P. Courcoulas ◽  
Steven H. Belle ◽  
Rebecca H. Neiberg ◽  
Sheila K. Pierson ◽  
Jessie K Eagleton ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Type 2 Diabetes Mellitus ◽  
Lifestyle Intervention ◽  
Diabetes Mellitus Treatment
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