Resumen de Hyperglycemia and Incidence of Frailty and Lower Extremity Mobility Limitations in Older Women
Rita R. Kalyani, Jing Tian, Qian-Li Xue, Jeremy D. Walston, Anne R. Cappola, Linda P. Fried, Frederick L. Brancati, Caroline S. Blaum
Objectives: To determine the degree to which hyperglycemia predicts the development of frailty and lower extremity mobility limitations.
Design: Secondary data analysis of longitudinal data collected in a prospective cohort study.
Setting: Baltimore, Maryland.
Participants: Three hundred twenty-nine women from the Women's Health and Aging Study II aged 70 to 79 at baseline who had all variables needed for analysis.
Measurements: Glycosylated hemoglobin (HbA1c) at baseline, categorized as less than 5.5%, 5.5% to 5.9%, 6.0% to 6.4%, 6.5% to 7.9%, and 8.0% and greater, was the independent variable. The incidence of frailty and lower extremity mobility limitations (based on self-reported walking difficulty, walking speed, and Short Performance Physical Battery score) was determined (follow-up ? 9 years). Frailty was assessed using the Cardiovascular Health Study criteria. Covariates included demographic characteristics, body mass index, interleukin-6 level, and clinical history of comorbidities. Statistical analyses included Kaplan�Meier survival curves and Cox regression models adjusted for important covariates.
Results: In time-to-event analyses, HbA1c category was associated with incidence of walking difficulty (P = .049) and low physical performance (P = .001); association with incidence of frailty and low walking speed had a trend toward significance (both P = .10). In regression models adjusted for demographic characteristics, HbA1c of 8.0% or greater (vs < 5.5%) was associated with an approximately three-times greater risk of incident frailty and three to five times greater risk of lower extremity mobility limitations (all P < .05). In fully adjusted models, HbA1c of 8.0% or greater (vs < 5.5%) was associated with incident frailty (hazard ratio (HR) = 3.33, 95% confidence interval (CI) = 1.24�8.93), walking difficulty (HR = 3.47, 95% CI = 1.26�9.55), low walking speed (HR = 2.82, 95% CI = 1.19�6.71), and low physical performance (HR = 3.60, 95% CI = 1.52�8.53).
Conclusion: Hyperglycemia is associated with the development of frailty and lower extremity mobility limitations in older women. Future studies should identify mediators of these relationships.
