Is Hyperglycemia Associated with Frailty Status in Older Women?

Authors

  • Caroline S. Blaum MD, MS,

    1. From the *Division of Geriatric Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MichiganGeriatric Research, Education and Clinical Center, Veterans Administration Health Center, Ann Arbor, MichiganDivision of Geriatric Medicine and Gerontology, Department of Medicine, §Center on Aging and Health, and Department of Ophthalmology, The Johns Hopkins Medical Institutions, Baltimore, Maryland#Department of Public Health, Mailman School of Public Health, and **Department of Epidemiology and Medicine, Columbia University Medical Center, Columbia University, New York, New York.
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  • Qian Li Xue PhD,

    1. From the *Division of Geriatric Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MichiganGeriatric Research, Education and Clinical Center, Veterans Administration Health Center, Ann Arbor, MichiganDivision of Geriatric Medicine and Gerontology, Department of Medicine, §Center on Aging and Health, and Department of Ophthalmology, The Johns Hopkins Medical Institutions, Baltimore, Maryland#Department of Public Health, Mailman School of Public Health, and **Department of Epidemiology and Medicine, Columbia University Medical Center, Columbia University, New York, New York.
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  • Jing Tian PhD,

    1. From the *Division of Geriatric Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MichiganGeriatric Research, Education and Clinical Center, Veterans Administration Health Center, Ann Arbor, MichiganDivision of Geriatric Medicine and Gerontology, Department of Medicine, §Center on Aging and Health, and Department of Ophthalmology, The Johns Hopkins Medical Institutions, Baltimore, Maryland#Department of Public Health, Mailman School of Public Health, and **Department of Epidemiology and Medicine, Columbia University Medical Center, Columbia University, New York, New York.
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  • Richard D. Semba MD, MPH,

    1. From the *Division of Geriatric Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MichiganGeriatric Research, Education and Clinical Center, Veterans Administration Health Center, Ann Arbor, MichiganDivision of Geriatric Medicine and Gerontology, Department of Medicine, §Center on Aging and Health, and Department of Ophthalmology, The Johns Hopkins Medical Institutions, Baltimore, Maryland#Department of Public Health, Mailman School of Public Health, and **Department of Epidemiology and Medicine, Columbia University Medical Center, Columbia University, New York, New York.
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  • Linda P. Fried MD, MPH,

    1. From the *Division of Geriatric Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MichiganGeriatric Research, Education and Clinical Center, Veterans Administration Health Center, Ann Arbor, MichiganDivision of Geriatric Medicine and Gerontology, Department of Medicine, §Center on Aging and Health, and Department of Ophthalmology, The Johns Hopkins Medical Institutions, Baltimore, Maryland#Department of Public Health, Mailman School of Public Health, and **Department of Epidemiology and Medicine, Columbia University Medical Center, Columbia University, New York, New York.
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  • Jeremy Walston MD

    1. From the *Division of Geriatric Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MichiganGeriatric Research, Education and Clinical Center, Veterans Administration Health Center, Ann Arbor, MichiganDivision of Geriatric Medicine and Gerontology, Department of Medicine, §Center on Aging and Health, and Department of Ophthalmology, The Johns Hopkins Medical Institutions, Baltimore, Maryland#Department of Public Health, Mailman School of Public Health, and **Department of Epidemiology and Medicine, Columbia University Medical Center, Columbia University, New York, New York.
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Address correspondence to Caroline S. Blaum, The University of Michigan Medical School, Geriatrics Center, NIB, Room 914, 300 North Ingalls Street, Ann Arbor, MI 48109-2007. E-mail: cblaum@umich.edu

Abstract

OBJECTIVES: To determine whether hyperglycemia is related to prevalent frailty status in older women.

DESIGN: Secondary data analysis of baseline data of a prospective cohort study.

SETTING: Baltimore, Maryland.

PARTICIPANTS: Five hundred forty-three women aged 70 to 79.

METHODS: Research used baseline data from 543 participants in the Women's Health and Aging Studies I and II aged 70 to 79 who had all variables needed for analyses. The dependent variable was baseline frailty status (not frail, prefrail, frail), measured using an empirically derived model defining frailty according to weight loss, slow walking speed, weakness, exhaustion, and low activity (1–2 characteristics present=prefrail, ≥3=frail). Covariates included body mass index (BMI), interleukin-6 (IL-6), age, race, and several chronic diseases. Analyses included descriptive methods and multinomial logistic regression to adjust for key covariates.

RESULTS: A hemoglobin A1c (HbA1c) level of 6.5% or greater in older women was significantly associated with higher likelihood of prefrail and frail status (normal HbA1c <6.0% was reference). The association between HbA1C levels of 6.0% to 6.5% and frailty status was not different from that of normal HbA1c, but HbA1c levels of 6.5% to 6.9% had nearly twice the likelihood of frailty (odds ratio (OR)=1.96, 95% confidence interval (CI)=1.47–2.59) as normal HbA1c. A HbA1c level of 9.0% or greater was also strongly associated (OR=2.57, 95% CI=1.99,3.32). Significant associations were also seen between baseline prefrail and frail status and low (18.5–20.0 kg/m2) and high (>30.0 kg/m2) body mass index (BMI), interleukin-6, and all chronic diseases evaluated, but controlling for these covariates only minimally attenuated the independent association between HbA1c and frailty status.

CONCLUSION: Hyperglycemia is associated with greater prevalence of prefrail and frail status; BMI, inflammation, and comorbidities do not explain the association. Longitudinal research and study of alternative pathways are needed.

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