A Pilot Study of the FRAIL Scale on Predicting Outcomes in Chinese Elderly People With Type 2 Diabetes.

OBJECTIVE: To determine the prevalence of frailty in older diabetic inpatients using the FRAIL scale and to evaluate the association of frailty with physical function and diabetic vascular complications, as well as its relationship to hospitalization and mortality.

METHODS: This pilot study was conducted at the Center of Gerontology and Geriatrics, West China Hospital. A total of 146 inpatients aged 60 years or older with type 2 diabetes were enrolled between December 2011 and October 2012, and participants were followed until December 2013. Frailty, functional status, diabetic nephropathy, and macroangiopathy were assessed at enrollment. The longitudinal outcomes were hospitalization and mortality. Frailty was determined by the 5-item FRAIL scale. Functional status was determined using activities of daily living (ADLs), instrumental activities of daily living (IADLs), and timed "Up and Go" test (TUG).

RESULTS: At baseline, 47.2% of participants were robust, 37.7% were prefrail, and 15.1% were frail. After adjusting for age, gender, MMSE score, body mass index (BMI), and the duration and severity of diabetes, both prefrailty and frailty were significantly associated with ADL disability (odds ratio [OR] 2.84 and 6.58, respectively), mobility impairment (OR 3.89 and 22.15, respectively), and diabetic nephropathy (OR 4.31 and 4.46, respectively). In the year after enrollment, the proportion of participants with 3 or more hospitalizations was 16.0% among robust participants, 23.6% among prefrail participants, and 40.9% among frail participants. Being frail predicted a greater number of hospitalizations (OR 5.99). There was no cumulative mortality for robust participants, whereas 3.6% of prefrail participants and 22.7% of frail participants died during follow-up (P < .001).

CONCLUSION: In older diabetic inpatients in China, frailty is an independent risk factor for adverse health outcomes. Clinicians could use the FRAIL scale to regularly identify individuals who are frail or who are at risk of becoming frail.