• Chia-Ter Chao, Jui Wang, Kuo-Liong Chien, and COhort of GEriatric Nephrology in NTUH (COGENT) study group.
• Department of Medicine, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan.
• Cardiovasc Diabetol. 2018 Sep 27; 17 (1): 130.

BackgroundDiabetes mellitus (DM) correlates with accelerated aging and earlier appearance of geriatric phenotypes, including frailty. However, whether pre-frailty or frailty predicts greater healthcare utilization in diabetes patients is unclear.MethodsFrom the Longitudinal Cohort of Diabetes Patients in Taiwan (n = 840,000) between 2004 and 2010, we identified 560,795 patients with incident type 2 DM, categorized into patients without frailty, or with 1, 2 (pre-frail) and ≥ 3 frailty components, based on FRAIL scale (Fatigue, Resistance, Ambulation, Illness, and body weight Loss). We examined their long-term mortality, cardiovascular risk, all-cause hospitalization, and intensive care unit (ICU) admission.ResultsAmong all participants (56.4 ± 13.8 year-old, 46.1% female, and 84.8% community-dwelling), 77.8% (n = 436,521), 19.2% (n = 107,757), 2.7% (n = 15,101), and 0.3% (n = 1416) patients did not have or had 1, 2 (pre-frail), and ≥ 3 frailty components (frail), respectively, with Fatigue and Illness being the most common components. After 3.14 years of follow-up, 7.8% patients died, whereas 36.6% and 9.1% experienced hospitalization and ICU stay, respectively. Cox proportional hazard modeling discovered that patients with 1, 2 (pre-frail), and ≥ 3 frailty components (frail) had an increased risk of mortality (for 1, 2, and ≥ 3 components, hazard ratio [HR] 1.05, 1.13, and 1.25; 95% confidence interval [CI] 1.02-1.07, 1.08-1.17, and 1.15-1.36, respectively), cardiovascular events (HR 1.05, 1.15, and 1.13; 95% CI 1.02-1.07, 1.1-1.2, and 1.01-1.25, respectively), hospitalization (HR 1.06, 1.16, and 1.25; 95% CI 1.05-1.07, 1.14-1.19, and 1.18-1.33, respectively), and ICU admission (HR 1.05, 1.13, and 1.17; 95% CI 1.03-1.07, 1.08-1.14, and 1.06-1.28, respectively) compared to non-frail ones. Approximately 6-7% risk elevation in mortality and healthcare utilization was noted for every frailty component increase.ConclusionPre-frailty and frailty increased the risk of mortality and cardiovascular events, and entailed greater healthcare utilization in patients with type 2 DM.

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