The Association of Prior Intensive Lifestyle Intervention and Diabetes Support and Education with Frailty Prevalence at Long-Term Follow-up in the Action for Health in Diabetes Extension Study

Abstract

Abstract Background Frailty is common in older adults with obesity and diabetes. We compared prevalence of the frailty phenotype between intervention groups in long-term follow-up of Look AHEAD, a randomized trial comparing a multidomain intensive lifestyle intervention (ILI) that promoted weight loss and physical activity with a diabetes support and education (DSE) control group in adults with type 2 diabetes and overweight or obesity. Methods Participants included 2,979 individuals randomized to ILI or DSE in 2001-04 who completed frailty assessment in Look AHEAD - Extension Wave 1 (2016-2018) at average age of 72.1 ± 6.2 years. Frailty was assessed using a modified frailty phenotype (excluding weight loss) defined as the presence of 3 or more of: weakness, slow gait speed, low physical activity, and exhaustion. Frailty odds by intervention assignment (DSE vs. ILI) were estimated using multivariable logistic regression, adjusting for sex, clinic site, and time since randomization. Results At median follow-up of 14.0 years [IQR: 13.8-14.1], frailty prevalence was 10.9% in ILI compared with 11.6% in DSE (odds ratio for frailty in ILI vs. DSE =0.94, 95% confidence interval = 0.75-1.18, P =0.60). Frailty was more prevalent in participants who were older, female, non-white, of lower socioeconomic status, and at baseline had a higher BMI and waist circumference, longer duration of diabetes, history of CVD, and metabolic syndrome. Conclusions Prior randomization to ILI compared with DSE was not associated with a lower prevalence of frailty after a median follow-up of 14.0 years in adults with diabetes and overweight or obesity.