Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Jan 5, 2023
Open Peer Review Period: Jan 5, 2023 - Jan 19, 2023
Date Accepted: Mar 23, 2023
(closed for review but you can still tweet)
Frailty associated with the increased risk of adverse outcomes among 38,950 UK Biobank participants with prediabetes: a prospective cohort study
ABSTRACT
Background:
It remains poorly understood whether frailty could identify adults who are most at risk of adverse outcomes related to prediabetes.
Objective:
We aimed to systematically evaluate the associations of frailty, a simple health indicator, with risks of multiple adverse outcomes in late life among adults with prediabetes.
Methods:
We evaluated 38,950 adults aged 40-64 years with prediabetes from the baseline survey of the UK Biobank. Frailty was assessed using the frailty phenotype (FP, 0-5), and participants were grouped into non-frail (FP =0), pre-frail (1≤ FP ≤2), and frail (FP ≥3). Multiple health outcomes were ascertained during a median follow-up of 12 years. Cox proportional hazards regression models were used to estimate the associations.
Results:
At baseline, 49.1% and 5.9% of adults with prediabetes were identified as pre-frail and frail, respectively. Both pre-frailty and frailty were associated with higher risks of multiple adverse outcomes in adults with prediabetes (P for trend <.001). For instance, compared with their non-frail counterparts, frail participants with prediabetes had a significantly higher risk (P<.001) of type 2 diabetes mellitus (T2DM) (hazard ratio [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) in the multivariable-adjusted models. Furthermore, with each 1-point increase in FP score, the risk of these adverse outcomes increased by 10% to 42%.
Conclusions:
In UK adults with prediabetes, both pre-frailty and frailty are significantly associated with higher risks of multiple adverse outcomes, including T2DM, diabetes-related diseases, and all-cause mortality. Our findings suggest that frailty assessment should be incorporated into the routine care for middle-aged adults with prediabetes, to improve the allocation of healthcare resources and reduce diabetes-related burdens. Clinical Trial: Not applicable.
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