American Diabetes Association
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An examination of whether diabetes control and treatments are associated with change in frailty index across 8 Years. An ancillary exploratory study from the Action for Health in Diabetes (Look AHEAD) Trial

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posted on 2022-12-21, 17:43 authored by Felicia R. Simpson, Jamie N. Justice, Scott J. Pilla, Stephen B. Kritchevsky, Edward J. Boyko, Medha N. Munshi, Chloe K. Ferris, Mark A. Espeland, the Action for Health in Diabetes (Look AHEAD) Trial

OBJECTIVE: The aim of this study was to describe cross-sectional and longitudinal associations between glycated hemoglobin (HbA1c) levels and strategies to control type 2 diabetes with baseline levels and 8-year changes in a deficit accumulation frailty index (FI), a commonly used marker of biological aging.

RESEARCH DESIGN AND METHODS: We conducted exploratory analyses from 4,169 participants, ages 45-76, who were followed in the Action for Health in Diabetes (Look AHEAD) randomized controlled clinical trial, pooling data across intervention groups. We related baseline and 8-year levels of HbA1c with FI scores using analyses of variance and covariance. Associations between 8-year changes in FI and the use of diabetes medication classes and weight changes were assessed with control for HbA1c levels. Inverse probability weighting was used to assess bias associated with differential follow-up. 

RESULTS: Baseline and average HbA1c levels over time of <7%, as compared with >8%, were associated with less increase in FI scores over 8 years (both p<0.002). After adjustment for HbA1c, use of metformin and weight loss >5% were independently associated with slower increases in frailty.

CONCLUSIONS: Lower HbA1c levels among individuals with diabetes are associated with slower biological aging as captured by a deficit accumulation FI. Strategies to control diabetes through weight loss or metformin use may also slow aging.


This research was funded by two diversity supplements to the Action for Health in Diabetes Extension Study Biostatistics Research Center (3U01DK057136-19S1 and 3U01DK057136-19S2) and by the parent award, U01DK057136. Support was also provided by R01AG058571, U01AG073697, and P30AG021332. Additional funding sources and the Look AHEAD study group are listed in Supplemental Exhibit S8.


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