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

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.

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

The Journals of Gerontology Series A ◽

10.1093/gerona/glz197 ◽

2019 ◽

Vol 75 (10) ◽

pp. 1921-1927 ◽

Cited By ~ 7

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

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

The Journals of Gerontology Series A ◽

10.1093/gerona/glab342 ◽

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.

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Is There an Association Between Metformin Exposure and Frailty?

Gerontology and Geriatric Medicine ◽

10.1177/2333721420924956 ◽

2020 ◽

Vol 6 ◽

pp. 233372142092495

Author(s):

Dhanya Baskaran ◽

Raquel Aparicio-Ugarriza ◽

Juliana Ferri-Guerra ◽

Raneem Milyani ◽

Hermes Florez ◽

...

Keyword(s):

Type 2 Diabetes ◽

Logistic Regression ◽

Lower Risk ◽

Frailty Index ◽

Community Dwelling ◽

Outcome Variable ◽

Deficit Accumulation ◽

Binomial Logistic Regression ◽

Multiple Variables

Frailty is a state of vulnerability to stressors resulting in higher morbidity, mortality, and utilization in older adults. Frailty and type 2 diabetes mellitus share similar pathophysiological mechanisms which metformin may target. The purpose of this study was to determine whether exposure to metformin is associated with frailty in veterans. This is a cross-sectional study of veterans 65 years and older with type 2 diabetes who were screened for frailty between January 2016 and August 2017. We constructed a 44-item Frailty Index including multiple variables using a deficit accumulation framework. After adjustment for covariates, the association was calculated using binomial logistic regression models with frailty status as the outcome variable, and metformin exposure as the independent variable. Patients were 98.3% male and 56.7% White with a mean age of 72.9 ( SD = 6.8) years. The proportion of robust, prefrail and frail patients was 2.9% ( n = 22), 46.7 % ( n = 356) and 50.5% ( n = 385), respectively. In binomial logistic regression, exposure to metformin was associated with lower risk for frailty, adjusted odds ratio (OR) = .55 (95% confidence interval [CI] = .39–.77), p ≤ .001. This study shows that exposure to metformin was associated with lower risk for frailty in community-dwelling veterans.

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Association between frailty and risk of fall among diabetic patients

Endocrine Connections ◽

10.1530/ec-20-0405 ◽

2020 ◽

Vol 9 (10) ◽

pp. 1057-1064

Author(s):

Xiaojie Wang ◽

Zhiyuan Chen ◽

Ziyi Li ◽

Bo Chen ◽

Yong Qi ◽

...

Keyword(s):

Type 2 Diabetes ◽

Frailty Index ◽

Epidemiological Studies ◽

Vulnerable Groups ◽

Diabetic Patients ◽

Balance Performance ◽

Deficit Accumulation ◽

Increased Risk ◽

Risk Of Fall

Background Several epidemiological studies have demonstrated the risk factors for fall, while few studies investigated the association between frailty and risk of fall in diabetic patients aged ≥45 years. Methods In this multicity observational study, participants with type 2 diabetes aged ≥45 years were enrolled. Frailty status was measured by a frailty index (FI) of deficit accumulation. We used multivariable regression models to examine the relationship between frailty and fall in diabetic patients, and further investigated the associations between frailty and fall in varied subgroups. Results A total of 2049 participants with type 2 diabetes were identified in our study. Our results showed a per-s.d. and a per-0.01 increment of FI were associated with an increased risk of fall, with a fully adjusted OR of 1.89 (95% CI: 1.50, 2.38), 1.06 (95% CI: 1.04, 1.09), respectively. The effects were magnified when frailty was considered as dichotomous, with an OR of 3.08 (95% CI: 2.18, 4.34). In further subgroup analyses, we found that the females, the older, rural residents, individuals with no sitting toilet, people with poor balance performance and those in poor health status were susceptible to fall. Especially, for the risk of fall in the older, a per-s.d. increase of FI corresponded to an OR of 2.46 (95% CI: 1.68, 3.62). When frailty was regarded as a binary variable, the effect increased to 4.62 (95% CI: 2.54, 8.38) in the older subgroup. Conclusion Frailty was associated with a higher risk of fall in people with type 2 diabetes, and the effects were higher in vulnerable groups. This evidence suggested that more attention should be paid to vulnerable groups for fall prevention.

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Evaluation of a Family-Based Interactive Lifestyle Intervention to Reduce the Risk of Developing Type 2 Diabetes in the Future (PRE-STARt Intervention)

Diabetes ◽

10.2337/db18-1355-p ◽

2018 ◽

Vol 67 (Supplement 1) ◽

pp. 1355-P ◽

Cited By ~ 1

Author(s):

EMER M. BRADY ◽

LAURA J. GRAY ◽

SUSANN WEIHRAUCH-BLÜHER ◽

CHARLOTTE EDWARDSON ◽

DEIRDRE HARRINGTON ◽

...

Keyword(s):

Type 2 Diabetes ◽

Lifestyle Intervention ◽

The Future ◽

Family Based

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2397-PUB: PowerHouse: A Lifestyle Intervention for Youth at Risk for Type 2 Diabetes (T2D)

Diabetes ◽

10.2337/db19-2397-pub ◽

2019 ◽

Vol 68 (Supplement 1) ◽

pp. 2397-PUB

Author(s):

HALA K. EL MIKATI ◽

JULIE PIKE ◽

KATIE HABERLIN-PITTZ ◽

LISA YAZEL-SMITH ◽

BRETT M. MCKINNEY ◽

...

Keyword(s):

Type 2 Diabetes ◽

At Risk ◽

Lifestyle Intervention ◽

Youth At Risk

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Within trial cost-effectiveness of a structured lifestyle intervention in adults with overweight/obesity and type 2 diabetes: Results from the Action for Health in Diabetes (Look AHEAD) Study

10.2337/figshare.13084802 ◽

2020 ◽

Author(s):

Ping Zhang ◽

Karen M. Atkinson ◽

George Bray ◽

Haiying Chen ◽

Jeanne M. Clark ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cost Effectiveness ◽

Lifestyle Intervention ◽

Health Utility Index ◽

Health Benefit ◽

Cost Effective ◽

Health Utility ◽

Health Care Expenditures ◽

Quality Adjusted Life Year

OBJECTIVE To assess the cost-effectiveness (CE) of an intensive lifestyle intervention (ILI) compared to standard diabetes support and education (DSE) in adults with overweight/obesity and type 2 diabetes, as implemented in the Action for Health in Diabetes study. RESEARCH DESIGN AND METHODS Data were from 4,827 participants during the first 9 years of the study from 2001 to 2012. Information on Health Utility Index-2 and -3, SF-6D, and Feeling Thermometer [FT]), cost of delivering the interventions, and health expenditures were collected during the study. CE was measured by incremental cost-effectiveness ratios (ICERs) in costs per quality-adjusted life year (QALY). Future costs and QALYs were discounted at 3% annually. Costs were in 2012 US dollars. RESULTS <a>Over the </a>9 years studied, the mean cumulative intervention costs and mean cumulative health care expenditures were $11,275 and $64,453 per person for ILI and $887 and $68,174 for DSE. Thus, ILI cost $6,666 more per person than DSE. Additional QALYs gained by ILI were not statistically significant measured by the HUIs and were 0.17 and 0.16, respectively, measured by SF-6D and FT. The ICERs ranged from no health benefit with a higher cost based on HUIs, to $96,458/QALY and $43,169/QALY, respectively, based on SF-6D and FT. Conclusions Whether ILI was cost-effective over the 9-year period is unclear because different health utility measures led to different conclusions.

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