La fragilità come fattore principale per l’aumento del rischio di morte e disabilità negli anziani con diabete

M. Castro-Rodríguez, J.A. Carnicero, F. J. Garcia-Garcia, Stephan Walter, John E. Morley, Fernando Rodríguez-Artalejo, Alan J. Sinclair, L. Rodríguez-Mañas

J Am Med Dir Assoc. 2016;17(10):949-55

The objective of this prospective cohort study on 1825 individuals (≥65years old) was to assess the role of frailty in predicting death and incident disability in older adults with type 2 diabetes mellitus.

Participants were followed for a median of 5.5 years for mortality and 4.98 years for incident functional disability in activities of daily living. Self-reported diabetes, comorbidities (Charlson index), cardio- and cerebrovascular diseases,drug treatments, Frailty Trait Score(FTS) and Frailty Index (FI),activities of daily living, heart rate, and blood pressure among others were collected at baseline.

A total of 363 people had diabetes. Among them, 83 deaths and 84 cases of incident disability occurred during follow-up. People with diabetes died more frequently than those without diabetes [hazard ratio 1.36,95% confidence interval (CI) 1.06-1.75; P=.002], showing a poorer functional status at baseline.

Survival analysis showed a relationship between frailty quartiles and the risk of death. In the adjusted Cox-models, only age and frailty indices, but not comorbidity or cardio/cerebrovascular diseases, were associated with the risk of death and incident disability after adjusting for measures of frailty.

The hazard ratio for death was 1.51 (95% CI 1.28-1.77) and 1.83 (95% CI 1.49-2.26) for each 10 points increase in the FTS and FI; odds ratio for incident disability was 1.64(95%CI1.22-2.20) and 1.35 (95%CI 1.09-1.67) when using FI and FTS, respectively.

Comment: It can be concluded that frailty is an important risk factor for death and disability in older adults with diabetes, supporting the recent recommendations that frailty status should be routinely assessed in these patients.