Abstract
BackgroundFrailty is broadly characterized by vulnerability and decline in physical, mental and social activities and is more common in elderly patients with type 2 diabetes mellitus (T2DM). Frailty is closely associated with nutrition, muscle strength, inflammation, and hormones etc. In hormones, dehydroepiandrosterone sulfate (DHEA-S) and cortisol are suggested to be such candidates affecting frailty. Little investigation has been performed using a wider range of measures of frailty to clarify risk factors for frailty including the above two hormones.MethodsWe performed a cross-sectional study to investigate the risk factors for frailty in elderly T2DM patients (n = 148; ≥65 years), using a broad assessment, the clinical frailty scale. We compared parameters between the non-frail and frail groups using the unpaired t and Mann-Whitney U tests. The Jonckheere-Therpstra test was used to identify relationships with the severity of frailty, and risk factors were identified using binary regression analysis.ResultsSimple regression analysis identified a number of significant risk factors for frailty, including DHEAS < 70 μg/dL and cortisol/DHEA-S ratio ≥ 0.2. Multiple regression analysis showed that low albumin (< 4.0 g/dl) (odds ratio [OR] = 5.79, p < 0.001), low aspartate aminotransferase (AST) activity (< 25 IU/L) (OR = 4.34, p = 0.009), and low body mass (BM) (< 53 kg) (OR = 3.85, p = 0.012) were independent risk factors for frailty. A significant decrease in DHEA-S and a significant increase in the cortisol/DHEA-S ratio occurred alongside increases in the severity of frailty. DHEA-S concentration positively correlated with both serum albumin and BM.ConclusionsHypoalbuminemia, low AST, and low BM are independent risk factors for frailty in elderly T2DM patients, strongly implying relative malnutrition in these frail patients. DHEA-S may be important for the maintenance of liver function and BM. A decrease in DHEA-S and an increase in the cortisol/DHEAS ratio may be involved in the mechanism of the effect of malnutrition in elderly T2DM patients.
Highlights
Frailty is broadly characterized by vulnerability and decline in physical, mental and social activities and is more common in elderly patients with type 2 diabetes mellitus (T2DM)
On the basis of a diagnosis of frailty made using the Clinical Frailty Scale (CFS), that 42% of 132 elderly patients with type 2 diabetes (T2DM) were frail and that aging and low circulating concentrations of albumin, high-density lipoprotein-cholesterol (HDL-C), systolic blood pressure (SBP), HbAlc, and total cholesterol were risk factors for frailty [4, 5]
We showed that a cortisol/dehydroepiandrosterone sulfate (DHEA-S) ratio of ≥0.2 is the strongest independent risk factor for sarcopenia [9]
Summary
Frailty is broadly characterized by vulnerability and decline in physical, mental and social activities and is more common in elderly patients with type 2 diabetes mellitus (T2DM). Little investigation has been performed using a wider range of measures of frailty to clarify risk factors for frailty including the above two hormones. In Japan, both men and women have long life expectancies. The aging population of Japan includes 10 million people with diabetes, and 50% of diabetes patients are elderly. People frequently develop a geriatric syndrome that includes frailty. Frailty is a state of vulnerability and a consequence of cumulative decline in multiple physiologic systems over a lifespan, and is associated with a number of adverse outcomes, including falls, disability, hospitalization, care home admission, and mortality [1, 2]. The risk factors for frailty have not been fully characterized
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