Frailty and incident diabetes among middle-aged and older adults: Evidence from a large prospective cohort in China.

Background and aims: The relationship between baseline frailty status, changes in frailty status, and the risk of diabetes onset among older adults remains unclear.

Methods and results: This study used data from the China Health and Retirement Longitudinal Study, a prospective and nationally representative cohort. Baseline frailty status was measured by the frailty index (FI) and classified as robust, pre-frail, or frail. Changes in frailty status were assessed by the transitions between non-frailty and frailty at baseline and the second survey within 2-year interval. A total of 11,044 participants were included in the baseline analysis (57.61 years, 49.5 % men), and 7005 participants (56.81 years; 50.3 % men) were included in the analysis of changes in frailty status. Compared with the robust group, the hazard ratio (HR) for diabetes was 1.40 [95 % confidence interval (CI) 1.19-1.64] for the pre-frail group and 2.07 (95 % CI 1.67-2.57) for the frail group. Each 0.1 increase in FI was independently associated with a 30 % higher risk of diabetes. Compared to the stable non-frail group, participants who progressed to frail status had an elevated risk of diabetes (HR 1.72, 95 % CI 1.26-2.35). Conversely, participants who recovered to non-frail status had a decreased risk of diabetes compared to those in the stable frail group (HR 0.46, 95 % CI 0.25-0.83).

Conclusion: Pre-frail and frail participants showed elevated risks of diabetes among middle-aged and older adults. Progression of frailty status correlated with increased diabetes risk, while recovery of frailty status was associated with reduced risk.