Impact of multidomain lifestyle intervention on frailty through the lens of deficit accumulation in adults with type 2 diabetes mellitus
Open accessAbstract
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 Conclusions Eight years of mult…
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Lifestyle intervention produced benefits on aging-relevant outcomes such as reductions in multimorbidity and improvements in physical function and quality of life.
“In addition, lifestyle intervention produced benefits on aging relevant outcomes such as reductions in multimorbidity and improvements in physical function and quality of life (85-88).”
From 13. Older Adults: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [86]
Lifestyle intervention in Look AHEAD produced benefits on aging relevant outcomes, such as reductions in multimorbidity and improvements in physical function and quality of life.
“In addition, lifestyle intervention produced benefits on aging relevant outcomes, such as reductions in multimorbidity and improvements in physical function and quality of life (92-95).”
From 13. Older Adults: Standards of Care in Diabetes—2025 (2025) · cites this paper as [93]
The Look AHEAD lifestyle intervention produced benefits on aging-relevant outcomes, including reductions in multimorbidity, improved physical function, and enhanced quality of life.
“The lifestyle intervention also produced benefits on aging-relevant outcomes, including reductions in multimorbidity, improved physical function, and enhanced quality of life”
From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [104]
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- Authors
- Simpson, F. R., Pajewski, N. M., Nicklas, B., Kritchevsky, S., Bertoni, A., Ingram, F., Ojeranti, D., Espeland, M. A., & Trial, F. T. I. F. A. A. I. O. A. D. A. S. O. T. A. F. H. I. D. (. A.
- Affiliations
- Winston-Salem State University (US)
- Department of Biostatistics and Data Science, Winston-Salem, North Carolina
- Department of Internal Medicine, Winston-Salem, North Carolina
- Wake Forest University Health Sciences (US)
- Corresponding author
- Espeland, Mark A
- ORCID
- Venue
- The Journals of Gerontology: Series A
- Publisher
- Oxford University Press (OUP)
- Published
- 2019-09-27
- Volume
- 75
- Issue
- 10
- Pages
- 1921-1927
- ISSN
- 1079-5006 (ISSN-L)
- 1758-535X
- PMC
- PMC7518562
- OpenAlex
- W2977174290
- Cited by
- 66
- References
- 48
- Citations by year
- 2026: 11 · 2025: 6 · 2024: 11 · 2023: 6 · 2022: 9 · 2021: 14 · 2020: 8 · 2019: 1
- FWCI
- 4.21
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- The Journals of Gerontology Series A (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Action for Health in Diabetes Extension Study Biostatistics Research Center (3U01DK057136, 19S1 and 3U01DK057136-19S2, U01DK057136)
- National Institutes of Health (DK57136, DK57149, DK56990, DK57177, DK57171, DK57151, DK57182, DK57131, DK57002, DK57078, DK57154, DK57178, DK57219, DK57008, DK57135, DK56992, DK 046204)
- National Institute of Diabetes and Digestive and Kidney Diseases
- National Heart, Lung, and Blood Institute
- National Institute of Nursing Research
- National Center on Minority Health and Health Disparities
- Office of Research on Women’s Health
- Centers for Disease Control and Prevention
- Department of Veterans Affairs
- Intramural Research Program of the National Institute of Diabetes and Digestive and Kidney Diseases
- University of Pittsburgh General Clinical Research Center (M01RR000056)
- Clinical Translational Research Center
- Clinical and Translational Science Award (UL1 RR 024153)
- Frederic C. Bartter General Clinical Research Center (M01RR01346)
- Wake Forest Alzheimer’s Disease Core Center (P30AG049638-01A1)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- type 2 diabetes, frailty, deficit accumulation, frailty index, multidomain lifestyle intervention, intensive lifestyle intervention, diabetes support and education, obesity, caloric restriction, physical activity, biological aging
- MeSH terms
- Frailty, Aged, Counseling, Diabetes Mellitus, Type 2, Diet, Female, Humans, Life Style, Male, Middle Aged, Obesity, Risk Factors, Exercise, Overweight
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