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

OBJECTIVE The aim of this study was to describe cross-sectional and longitudinal associations between glycated hemoglobin (HbA(1c)) 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, aged 45-76 years, 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 HbA(1c) 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 HbA(1c) levels. Inverse probability weighting was used to assess bias associated with differential follow-up. RESULTS Baseline and average HbA(1c) 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 HbA(1c), use of metformin and weight loss >5% were independently associated with slower increases in frailty. CONCLUSIONS Lower HbA(1c) 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.

Automated summary

This study aimed to explore the relationship between glycated hemoglobin (HbA(1c)) levels and strategies to control type 2 diabetes with biological aging as measured by a deficit accumulation frailty index (FI). The study found that lower HbA(1c) levels were associated with slower biological aging, while higher levels were associated with faster aging. Additionally, the use of metformin and weight loss greater than 5% were independently associated with slower increases in frailty.