Objectives: We investigated whether there was a higher prevalence of cognitive impairment (CI) and/or physical frailty (PF) in persons with diabetes compared to their non-diabetic counterparts, and the individual and combined impact of CI and PF on functional and mortality outcomes among diabetic older persons.
Method: Community-living diabetic and non-diabetic participants (N = 2696) aged 55 and above were assessed on CI (MMSE) and PF (CHS criteria) status. Among 486 diabetic persons, we estimated the odds ratio and 95% confidence intervals (OR, 95% CI) of association of CI and/or PF with prevalent IADL and ADL disability and mortality from 11 years of follow up.
Results: Diabetes was associated with significantly higher prevalence of CI and/or PF. Adjusted for sex, age, education, smoking, alcohol intake, physical activity, and BMI, diabetes was associated with higher prevalence of PF alone (OR = 2.24, 1.16-4.34) and PF with CI (OR = 2.01, 1.12-3.60), but not with CI alone (OR = 1.02, 0.73-1.44). In multivariable analyses of 486 diabetic older adults, compared to non-frail (NF) and cognitive normal (CN), CI alone was not significantly associated with IADL (OR = 1.06, 0.53-2.10), but PF alone was associated with considerably higher prevalence of IADL (OR = 6.72, 1.84-24.5). PF with CI was associated with the highest prevalence of IADL (OR = 17.8, 3.66-8.68) and ADL disability (OR = 93.8, 23.6-372.4). Whether singly or in combination, PF and/or CI were associated with worse hazard (HR) ratio for mortality outcomes: CI alone (HR = 2.72, 1.48-5.01), PF alone (HR = 4.30, 1.88-9.82) and CI with PF (HR = 8.41, 3.95-17.9).
Conclusion: Cognitive impairment and/or physical frailty are powerful prognostic factors identifying people with diabetes at high risk of mortality.
Keywords: Frailty; cognitive impairment; disability and mortality; type 2.