Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2020 Sep 25;75(10):1921-1927.
doi: 10.1093/gerona/glz197.

Impact of Multidomain Lifestyle Intervention on Frailty Through the Lens of Deficit Accumulation in Adults with Type 2 Diabetes Mellitus

Felicia R Simpson  1 , Nicholas M Pajewski  2 , Barbara Nicklas  3 , Stephen Kritchevsky  3 , Alain Bertoni  4 , Frank Ingram  1 , Daniel Ojeranti  1 , Mark A Espeland  1   2 ; Indices for Accelerated Aging in Obesity and Diabetes Ancillary Study of the Action for Health in Diabetes (Look AHEAD) Trial
Affiliations
Randomized Controlled Trial

Impact of Multidomain Lifestyle Intervention on Frailty Through the Lens of Deficit Accumulation in Adults with Type 2 Diabetes Mellitus

Felicia R Simpson et al. J Gerontol A Biol Sci Med Sci. .

Abstract

Background: Type 2 diabetes and obesity increase the accumulation of health deficits and may accelerate biological aging. Multidomain lifestyle interventions may mitigate against this.

Methods: Within a large, randomized clinical trial of intensive lifestyle intervention including caloric restriction, increased physical activity, dietary counseling, and risk factor monitoring compared with diabetes support and education, we examined the accumulation of health deficits across 8 years. We used two complementary frailty indices (FIs) based on deficit accumulation, one modeled on work in the Systolic Blood Pressure Intervention Trial and the other including additional deficits related to obesity and type 2 diabetes mellitus. Differences between intervention groups and their consistency among subgroups were assessed with re-randomization tests.

Results: Data from 4,859 adults (45-76 years at baseline, 59% female) were analyzed. Random assignment to intensive lifestyle intervention was associated with lower FI scores throughout follow-up as captured by areas under curves traced by longitudinal means (p ≤ .001), over which time mean (SE) differences between intervention groups averaged 5.8% (0.9%) and 5.4% (0.9%) for the two indices. At year 8, the percentage of participants classified as frail (FI > 0.21) was lower among intensive lifestyle intervention (39.8% and 54.5%) compared with diabetes support and education (42.7% and 60.9%) for both FIs (both p < .001). Intervention benefits were relatively greater for participants who were older, not obese, and without history of cardiovascular disease at baseline.

Conclusions: Eight years of multidomain lifestyle intervention create a buffer against the accumulation of age-related health deficits in overweight or obese adults with type 2 diabetes.ClinicalTrials.gov Identifier: NCT00017953.

Keywords: Multidomain lifestyle intervention; Aging; Diabetes mellitus; Obesity.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Scatterplot of the FISPR and FIAUG deficit accumulation frailty indices at baseline (r = .90).
Figure 2.
Figure 2.
Trajectory of mean FISPR (A) and FIAUG (B) with bars from 95% confidence intervals over follow-up by intervention assignment.
See this image and copyright information in PMC

References

    1. Morley JE. Diabetes and aging: epidemiologic overview. Clin Geriatr Med. 2008;24:395–405. doi:10.1016/j.cger.2008.03.005 - PubMed
    1. Ahima RS. Connecting obesity, aging and diabetes. Nat Med. 2009;15:996–997. doi:10.1038/nm0909-996 - PubMed
    1. Tchkonia T, Morbeck DE, Von Zglinicki T, et al. . Fat tissue, aging, and cellular senescence. Aging Cell. 2010;9:667–684. doi:10.1111/j.1474-9726.2010.00608.x - PMC - PubMed
    1. Walston J, Bandeen-Roche K, Buta B, et al. . Moving frailty toward clinical practice: NIA Intramural Frailty Science Symposium Summary. J Am Geriatr Soc. 2019;67:1559–1564. doi:10.1111/jgs.15928 - PMC - PubMed
    1. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381:752–762. doi:10.1016/S0140-6736(12)62167-9 - PMC - PubMed

Publication types

Associated data