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Clinical frailty and long-term mortality in elderly subjects with diabetes

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Abstract

Elderly subjects are characterized by a high prevalence of diabetes and clinical frailty. This study aimed to examine the predictive role of clinical frailty on long-term mortality in elderly subjects with and without diabetes. The study evaluated mortality after 12-year follow-up in 188 subjects with diabetes and 1,100 subjects without diabetes selected in 1992. Clinical frailty was assessed according to the “Frailty Staging System” and stratified in tertiles. After 12-year follow-up, mortality was 50.5 % in subjects without and 66.5 % in subjects with diabetes (p < 0.001). With increasing frailty, mortality increases from 57.9 to 79.0 % (p for trend <0.01) in subjects without and from 75.9 to 87.0 % in subjects with diabetes (p for trend <0.001). Multivariate analysis shows that both diabetes (hazard ratio = 1.38; 95 % confidence interval = 1.12–1.95; p = 0.02) and frailty score (hazard ratio = 1.58 for each unit of increase; 95 % confidence interval = 1.41–2.35; p = 0.04) are predictive of long-term mortality. Moreover, when Cox regression analysis was performed by selecting sex, frailty increases the risk of long-term mortality for each unit of increase by 14 % (hazard ratio = 1.14; 95 % confidence interval = 1.10–1.18; p < 0.01) in women and by 60 % in men (hazard ratio = 1.60; 95 % confidence interval = 1.21–2.12; p < 0.001) in the absence and by 31 % (Hazard ratio = 1.31, 95 % confidence interval = 1.03–1.85, p = 0.03) in women and by 60 % in men (hazard ratio = 1.99, 95 % confidence interval = 1.75–3.05, p < 0.001) in the presence of diabetes, respectively. We concluded that diabetes predicts long-term mortality in elderly subjects. Moreover, clinical frailty significantly predicts mortality in subjects without and even more in those with diabetes. This phenomenon is particularly evident in men. Thus, clinical frailty may be considered a new prognostic factor to identify subjects with diabetes at high risk of mortality.

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Acknowledgments

We thank all participating men and women in the “Osservatorio Geriatrico Campano” study. The “Osservatorio Geriatrico Campano” team comprises research scientists, statisticians, study coordinators, nurses, data managers, administrative assistants, and data entry staff, who make the study possible.

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Authors and Affiliations

  1. Dipartimento di Medicina Clinica e Scienze Cardiovascolari ed Immunologiche, Cattedra di Geriatria, Università degli Studi di Napoli “Federico II”, 80131, Naples, Italy

    Francesco Cacciatore, Gianluca Testa, Francesca Mazzella, Assunta Langellotto, Gilda Pirozzi, Gaetana Ferro, Gaetano Gargiulo, Franco Rengo & Pasquale Abete

  2. Istituto Scientifico di Telese, Fondazione Salvatore Maugeri, IRCCS, Benevento, Italy

    Francesco Cacciatore, Francesca Mazzella, Nicola Ferrara & Franco Rengo

  3. Dipartimento di Medicina e Scienze della Salute, Università del Molise, Campobasso, Italy

    Gianluca Testa & Nicola Ferrara

  4. Istituto Scientifico di Veruno, Fondazione Salvatore Maugeri, IRCCS, Veruno, NO, Italy

    Gianluigi Galizia

  5. Department of Laboratory Medicine and Advanced Biotechnologies, IRCCS San Raffaele Pisana, Rome, Italy

    David Della-Morte

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  1. Francesco Cacciatore
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  2. Gianluca Testa
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  3. Gianluigi Galizia
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  5. Francesca Mazzella
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  8. Gaetana Ferro
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  9. Gaetano Gargiulo
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  11. Franco Rengo
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  12. Pasquale Abete
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Corresponding author

Correspondence to Pasquale Abete.

Additional information

Communicated by Guido Pozza.

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Cacciatore, F., Testa, G., Galizia, G. et al. Clinical frailty and long-term mortality in elderly subjects with diabetes. Acta Diabetol 50, 251–260 (2013). https://doi.org/10.1007/s00592-012-0413-2

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  • DOI: https://doi.org/10.1007/s00592-012-0413-2

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