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Randomized Controlled Trial
. 2023 Oct 28;78(11):2119-2126.
doi: 10.1093/gerona/glad088.

Long-term Impact of a 10-Year Intensive Lifestyle Intervention on a Deficit Accumulation Frailty Index: Action for Health in Diabetes Trial

Joni K Evans  1 , Chinenye O Usoh  2 , Felicia R Simpson  3 , Sara Espinoza  4 , Helen Hazuda  5 , Ambarish Pandey  6 , Tara Beckner  1 , Mark A Espeland  1   7
Affiliations
Randomized Controlled Trial

Long-term Impact of a 10-Year Intensive Lifestyle Intervention on a Deficit Accumulation Frailty Index: Action for Health in Diabetes Trial

Joni K Evans et al. J Gerontol A Biol Sci Med Sci. .

Abstract

Background: Multidomain lifestyle interventions may slow aging as captured by deficit accumulation frailty indices; however, it is unknown whether benefits extend beyond intervention delivery.

Methods: We developed a deficit accumulation frailty index (FI-E) to span the 10 years that the Action for Health in Diabetes (Look AHEAD) randomized controlled clinical trial delivered interventions (a multidomain lifestyle intervention focused on caloric restriction, increased physical activity, and diet compared to a control condition) and to extend across an additional 8 years post-delivery. The study cohort included 5 145 individuals, aged 45-76 years at enrollment, who had type 2 diabetes and either obesity or overweight.

Results: Overall, FI-E scores were relatively lower among lifestyle participants throughout follow-up, averaging 0.0130 [95% confidence interval: 0.0104, 0.0156] (p < .001) less across the 18 years. During Years 1-8, the mean relative difference between control and lifestyle participants' FI-E scores was 0.0139 [0.0115, 0.0163], approximately 10% of the baseline level. During Years 9-18, this average difference was 0.0107 [0.0066, 0.0148]. Benefits were comparable for individuals grouped by baseline age and body mass index and sex but were not evident for those entering the trial with a history of cardiovascular disease.

Conclusions: Multidomain lifestyle intervention may slow biological aging long term, as captured by an FI-E. Clinical Trials Registration Number: NCT00017953.

Keywords: Diabetes; Epidemiology; Frailty; Obesity.

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Conflict of interest statement

None declared.

Figures

Figure 1.
Figure 1.
Comparison of FI-E and FI trajectories from baseline to Year 8 by intervention group. Means, with time from baseline through follow-up parameterized as a class variable, were derived from mixed-effects models with first-order autoregressive covariance used to control for repeated measures over time. DSE = diabetes support and education; FI = frailty index; FI-E = deficit accumulation frailty index; ILI = intensive lifestyle intervention.
Figure 2.
Figure 2.
Trajectories of FI-E across 18 years by intervention group. These averaged [95% confidence interval] 0.0130 [95% CI: 0.0104, 0.0156] (p < .001) greater among DSE compared with ILI participants across the 18 years. Means, with time from baseline through follow-up parameterized as a class variable, were derived from mixed-effects models with first-order autoregressive covariance used to control for repeated measures over time. DSE = diabetes support and education; FI-E = deficit accumulation frailty index; ILI = intensive lifestyle intervention.
Figure 3.
Figure 3.
Trajectories of FI-E across 18 years for participants grouped by baseline history of CVD. Among those without baseline history of CVD, DSE participants averaged [95% confidence interval] 0.0018 [−0.0053, 0.0089] greater FI-E scores across follow-up. Among those with history of CVD, DSE participants averaged 0.0148 [0.0120, 0.0176] lower FI-E scores. Plotted means, with time from baseline through follow-up parameterized as a class variable, were derived from mixed-effects models with first-order autoregressive covariance used to control for repeated measures over time. CVD = cardiovascular disease; DSE = diabetes support and education; FI-E = deficit accumulation frailty index; ILI = intensive lifestyle intervention.
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References

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