Hyperglycemia and incidence of frailty and lower extremity mobility limitations in older women
Open accessAbstract
Objectives: To determine the degree to which hyperglycemia predicts the development of frailty and lower extremity mobility limitations. Design: Secondary data analysis of longitudinal data collected in a prospective cohort study. Setting: B altimore, M aryland. Participants: Three hundred twenty‐nine women from the W omen's H ealth and A ging S tudy II aged 70 to 79 at baseline who had all variables needed for analysis. Measurements: Glycosylated hemoglobin ( H b A 1c) at baseline, categorized as less than 5.5%, 5.5% to 5.9%, 6.0% to 6.4%, 6.5% to 7.9%, and 8.0% and greater, was the independent variable. The incidence of frailty and lower extremity mobility limitations (based on self‐reported walking difficulty, walking speed, and S hort P erformance P hysical B attery score) was determined (follow‐up ≈ 9 years). Frailty was assessed using the C ardiovascular H ealth S tudy criteria. Covariates included demographic characteristics, body mass index, interleukin‐6 level, and clinical history of comorbidities. Statistical analyses included Kaplan–Meier survival curves and Cox regression models adjusted for important covariates. Results: In time‐to‐event analyses, H b A 1c category was associated with incidence of walking difficulty ( P = .049) and low physical performance ( P = .001); association with incidence of frailty and low walking speed had a trend toward significance (both P = .10). In regression models adjusted for demographic characteristics, H b A 1c of 8.0% or greater (vs < 5.5%) was associated with an approximately three‐times greater risk of incident frailty and three to five times greater risk of lower extremity mobility limitations (all P < .05). In fully adjusted models, H b A 1c of 8.0% or greater (vs < 5.5%) was associated with incident frailty (hazard ratio ( HR ) = 3.33, 95% confidence interval ( CI ) = 1.24–8.93), walking difficulty ( HR = 3.47, 95% CI = 1.26–9.55), low walking speed ( HR = 2.82, 95% CI = 1.19–6.71), and low physical performance ( HR = 3.60, 95% CI = 1.52–8.53). Conclusion: Hyperglycemia is associated with the development of frailty and lower extremity mobility limitations in older women. Future studies should identify mediators of these relationships.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Some older adults with diabetes have other underlying chronic conditions, substantial diabetes-related comorbidity, limited cognitive or physical functioning, or frailty.
“Some older adults with diabetes have other underlying chronic conditions, substantial diabetes-related comorbidity, limited cognitive or physical functioning, or frailty (48,49).”
From 13. Older Adults: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [49]
The Introduction (page unavailable) links diabetes in older people to impaired physical functioning, lower-extremity mobility limitations, and frailty. The Discussion mentions cardiovascular disease and neuropathy, but the paper does not establish substantial diabetes-related comorbidity or address limited cognitive functioning. It therefore supports only part of the list attributed to it. (LLM, conf=0.86)
Experimental — accuracy not yet measuredSome older adults with diabetes have other underlying chronic conditions, substantial diabetes-related comorbidity, limited cognitive or physical functioning, or frailty.
“Some older adults with diabetes have other underlying chronic conditions, substantial diabetes-related comorbidity, limited cognitive or physical functioning, or frailty (58,59).”
From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [59]
The Introduction associates diabetes in older adults with lower-extremity mobility limitations and frailty, supporting the physical-functioning and frailty portions of the claim. The Methods (Variables) record chronic conditions and neuropathy, but the cited passages do not establish substantial diabetes-related comorbidity or address limited cognitive functioning. Page numbers are unavailable in our copy. (LLM, conf=0.85)
Experimental — accuracy not yet measuredHyperglycaemia is associated with frailty and incident mobility limitations, potentially mediated by loss of muscle.
“Hyperglycaemia is associated with the development of frailty and incident mobility limitations, potentially mediated by loss of muscle.44”
From Age-related and disease-related muscle loss: The effect of diabetes, obesity, and other diseases (2014) · cites this paper as [44]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Frailty in Older Adults: Evidence for a Phenotype
Fried, L. P., Tangen, C. M., Walston, J., Newman, A. B., Hirsch, C., Gottdiener, J., Seeman, T., Tracy, R., Kop, W. J., Burke, G., et al. (2001) · The Journals of Gerontology Series A: Biological Sciences and Medical Sciences · doi:10.1093/gerona/56.3.m146 · Cited by 24,907 · see citing works
Self-citationWild, S., Roglic, G., Green, A., Sicree, R., & King, H. (2004) · Diabetes Care · doi:10.2337/diacare.27.5.1047 · Cited by 15,297 · see citing works
(2000) · PubMed · Cited by 13,173 · see citing works
Guralnik, J. M., Simonsick, E. M., Ferrucci, L., Glynn, R. J., Berkman, L. F., Blazer, D. G., Scherr, P. A., & Wallace, R. B. (1994) · Journal of Gerontology · doi:10.1093/geronj/49.2.m85 · Cited by 9,792 · see citing works
Effects of Intensive Glucose Lowering in Type 2 Diabetes
(2008) · New England Journal of Medicine · doi:10.1056/nejmoa0802743 · Cited by 7,888 · see citing works
Basevi, V., Mario, S. D., Morciano, C., Nonino, F., & Magrini, N. (2011) · Diabetes Care · doi:10.2337/dc11-0174 · Cited by 3,058 · see citing works
Guralnik, J. M., Ferrucci, L., Pieper, C. F., Leveille, S. G., Markides, K. S., Ostir, G. V., Studenski, S., Berkman, L. F., & Wallace, R. B. (2000) · The Journals of Gerontology Series A: Biological Sciences and Medical Sciences · doi:10.1093/gerona/55.4.m221 · Cited by 2,898 · see citing works
Standards of medical care in diabetes—2011
American Diabetes Association (2011) · Diabetes Care · doi:10.2337/dc11-s011 · Cited by 2,880 · see citing works
Glycated hemoglobin, diabetes, and cardiovascular risk in nondiabetic adults
Selvin, E., Steffes, M. W., Zhu, H., Matsushita, K., Wagenknecht, L., Pankow, J., Coresh, J., & Brancati, F. L. (2010) · New England Journal of Medicine · doi:10.1056/nejmoa0908359 · Cited by 1,544 · see citing works
Self-citationPhysical performance measures in the clinical setting
Studenski, S., Perera, S., Wallace, D., Chandler, J. M., Duncan, P. W., Rooney, E., Fox, M., & Guralnik, J. M. (2003) · Journal of the American Geriatrics Society · doi:10.1046/j.1532-5415.2003.51104.x · Cited by 1,218 · see citing works
Phenotype of frailty: characterization in the women's health and aging studies
Bandeen-Roche, K., Xue, Q.-L., Ferrucci, L., Walston, J., Guralnik, J. M., Chaves, P., Zeger, S. L., & Fried, L. P. (2006) · The Journals of Gerontology Series A: Biological Sciences and Medical Sciences · doi:10.1093/gerona/61.3.262 · Cited by 1,215 · see citing works
Self-citationFull accounting of diabetes and pre-diabetes in the U.S. population in 1988–1994 and 2005–2006
Cowie, C. C., Rust, K. F., Ford, E. S., Eberhardt, M. S., Byrd-Holt, D. D., Li, C., Williams, D. E., Gregg, E. W., Bainbridge, K. E., Saydah, S. H., et al. (2009) · Diabetes Care · doi:10.2337/dc08-1296 · Cited by 1,154 · see citing works
Walston, J. (2002) · Archives of Internal Medicine · doi:10.1001/archinte.162.20.2333 · Cited by 940 · see citing works
Self-citationVisser, M., Kritchevsky, S. B., Goodpaster, B. H., Newman, A. B., Nevitt, M., Stamm, E., & Harris, T. B. (2002) · Journal of the American Geriatrics Society · doi:10.1046/j.1532-5415.2002.50217.x · Cited by 845 · see citing works
Associations of Subclinical Cardiovascular Disease With Frailty
Newman, A. B., Gottdiener, J. S., McBurnie, M. A., Hirsch, C. H., Kop, W. J., Tracy, R. P., Walston, J. D., & Fried, L. P. (2001) · The Journals of Gerontology Series A · doi:10.1093/gerona/56.3.m158 · Cited by 803 · see citing works
Self-citationExcessive Loss of Skeletal Muscle Mass in Older Adults With Type 2 Diabetes
Park, S. W., Goodpaster, B. H., Lee, J. S., Kuller, L. H., Boudreau, R., de Rekeneire, N., Harris, T. B., Kritchevsky, S., Tylavsky, F. A., Nevitt, M., et al. (2009) · Diabetes Care · doi:10.2337/dc09-0264 · Cited by 778 · see citing works
Accelerated Loss of Skeletal Muscle Strength in Older Adults With Type 2 Diabetes
Park, S. W., Goodpaster, B. H., Strotmeyer, E. S., Kuller, L. H., Broudeau, R., Kammerer, C., de Rekeneire, N., Harris, T. B., Schwartz, A. V., Tylavsky, F. A., et al. (2007) · Diabetes Care · doi:10.2337/dc06-2537 · Cited by 766 · see citing works
Guidelines for improving the care of the older person with diabetes mellitus
California Healthcare Foundation/American Geriatrics Society, C. (2003) · Journal of the American Geriatrics Society · doi:10.1046/j.1532-5415.51.5s.1.x · Cited by 651 · see citing works
Ferrucci, L., Penninx, B. W. J. H., Volpato, S., Harris, T. B., Bandeen‐Roche, K., Balfour, J., Leveille, S. G., Fried, L. P., & Md, J. M. G. (2002) · Journal of the American Geriatrics Society · doi:10.1046/j.1532-5415.2002.50605.x · Cited by 618 · see citing works
Self-citationFried, L. P., Xue, Q.-L., Cappola, A. R., Ferrucci, L., Chaves, P., Varadhan, R., Guralnik, J. M., Leng, S. X., Semba, R. D., Walston, J. D., et al. (2009) · The Journals of Gerontology Series A: Biological Sciences and Medical Sciences · doi:10.1093/gerona/glp076 · Cited by 539 · see citing works
Self-citationPreclinical mobility disability predicts incident mobility disabilityin older women
Fried, L. P., Bandeen‐Roche, K., Chaves, P. H. M., & Johnson, B. A. (2000) · The Journals of Gerontology Series A · doi:10.1093/gerona/55.1.m43 · Cited by 483 · see citing works
Self-citationFrailty, Body Mass Index, and Abdominal Obesity in Older People
Hubbard, R. E., Lang, I., Llewellyn, D. J., & Rockwood, K. J. (2009) · The Journals of Gerontology Series A · doi:10.1093/gerona/glp186 · Cited by 459 · see citing works
Insulin Resistance and Inflammation as Precursors of Frailty: The Cardiovascular Health Study
Barzilay, J. I. (2007) · Archives of Internal Medicine · doi:10.1001/archinte.167.7.635 · Cited by 453 · see citing works
Short-term variability in measures of glycemia and implications for the classification of diabetes
Selvin, E. (2007) · Archives of Internal Medicine · doi:10.1001/archinte.167.14.1545 · Cited by 402 · see citing works
Hypoglycemia and cardiovascular risks
Frier, B. M., Schernthaner, G., & Heller, S. R. (2011) · Diabetes Care · doi:10.2337/dc11-s220 · Cited by 381 · see citing works
Phielix, E., Schrauwen-Hinderling, V. B., Mensink, M., Lenaers, E., Meex, R., Hoeks, J., Kooi, M. E., Moonen-Kornips, E., Sels, J.-P., Hesselink, M. K. C., et al. (2008) · Diabetes · doi:10.2337/db08-0391 · Cited by 359 · see citing works
Glycemic Control, Complications, and Death in Older Diabetic Patients
Huang, E. S., Liu, J. Y., Moffet, H. H., John, P. M., & Karter, A. J. (2011) · Diabetes Care · doi:10.2337/dc10-2377 · Cited by 341 · see citing works
Association of Diabetes, Comorbidities, and A1C With Functional Disability in Older Adults
Kalyani, R. R., Saudek, C. D., Brancati, F. L., & Selvin, E. (2010) · Diabetes Care · doi:10.2337/dc09-1597 · Cited by 336 · see citing works
Self-citationFrailty Status and Altered Glucose-Insulin Dynamics
Kalyani, R. R., Varadhan, R., Weiss, C. O., Fried, L. P., & Cappola, A. R. (2011) · The Journals of Gerontology Series A · doi:10.1093/gerona/glr141 · Cited by 139 · see citing works
Self-citationProgression of Lower-Extremity Disability in Older Women With Diabetes
Volpato, S., Ferrucci, L., Blaum, C. S., Ostir, G. V., Cappola, A. R., Fried, L. P., Fellin, R., & Guralnik, J. M. (2003) · Diabetes Care · doi:10.2337/diacare.26.1.70 · Cited by 108 · see citing works
Self-citationIs Hyperglycemia Associated with Frailty Status in Older Women?
Blaum, C. S., Xue, Q., Tian, J., Semba, R. D., Fried, L. P., & Walston, J. D. (2009) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2009.02196.x · Cited by 98 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Age-related and disease-related muscle loss: The effect of diabetes, obesity, and other diseases
Kalyani, R. R., Corriere, M., & Ferrucci, L. (2014) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(14)70034-8 · Cited by 1,102 · see citing works
Self-citation13. Older Adults: <i>Standards of Medical Care in Diabetes—2022</i>
American Diabetes Association Professional Practice Committee (2022) · Diabetes Care · doi:10.2337/dc22-s013 · Cited by 381 · see citing works
Frailty and sarcopenia - newly emerging and high impact complications of diabetes
Sinclair, A. J., Abdelhafiz, A. H., & Rodríguez-Mañas, L. (2017) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2017.05.003 · Cited by 276 · see citing works
Hyperglycemia Predicts Persistently Lower Muscle Strength With Aging
Kalyani, R. R., Metter, E. J., Egan, J., Golden, S. H., & Ferrucci, L. (2015) · Diabetes Care · doi:10.2337/dc14-1166 · Cited by 236 · see citing works
Self-citation13. Older Adults: Standards of Care in Diabetes—2025
American Diabetes Association Professional Practice Committee, ElSayed, N. A., McCoy, R. G., Aleppo, G., Balapattabi, K., Beverly, E. A., Briggs Early, K., Bruemmer, D., Echouffo-Tcheugui, J. B., Ekhlaspour, L., et al. (2025) · Diabetes Care · doi:10.2337/dc25-s013 · Cited by 209 · see citing works
13. Older Adults: <i>Standards of Care in Diabetes—2024</i>
American Diabetes Association Professional Practice Committee, ElSayed, N. A., Aleppo, G., Bannuru, R. R., Bruemmer, D., Collins, B. S., Ekhlaspour, L., Hilliard, M. E., Johnson, E. L., Khunti, K., et al. (2024) · Diabetes Care · doi:10.2337/dc24-s013 · Cited by 161 · see citing works
13. Older Adults: Standards of Care in Diabetes—2026
American Diabetes Association Professional Practice Committee for Diabetes*, Bajaj, M., McCoy, R. G., Balapattabi, K., Bannuru, R. R., Bellini, N. J., Bennett, A. K., Beverly, E. A., Briggs Early, K., ChallaSivaKanaka, S., et al. (2026) · Diabetes Care · doi:10.2337/dc26-s013 · Cited by 87 · see citing works
A High Serum Cortisol/DHEA-S Ratio Is a Risk Factor for Sarcopenia in Elderly Diabetic Patients
Yanagita, I., Fujihara, Y., Kitajima, Y., Tajima, M., Honda, M., Kawajiri, T., Eda, T., Yonemura, K., Yamaguchi, N., Asakawa, H., et al. (2019) · Journal of the Endocrine Society · doi:10.1210/js.2018-00271 · Cited by 67 · see citing works
Diabetes Deprescribing in Older Adults: A Randomized Clinical Trial
Grant, R. W., Peterson, I., McCloskey, J. M., Lipska, K. J., Nugent, J., Karter, A. J., & Gilliam, L. K. (2025) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2025.2015 · Cited by 11 · see citing works
- Authors
- Kalyani, R. R., Tian, J., Xue, Q., Walston, J., Cappola, A. R., Fried, L. P., Brancati, F. L., & Blaum, C. S.
- Affiliations
- Johns Hopkins University (US)
- University of Pennsylvania (US)
- Columbia University (US)
- University of Michigan (US)
- ORCID
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2012-08-10
- Volume
- 60
- Issue
- 9
- Pages
- 1701-1707
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- PMC
- PMC4144067
- OpenAlex
- W2065888972
- Cited by
- 157
- References
- 31
- Citations by year
- 2026: 7 · 2025: 10 · 2024: 15 · 2023: 13 · 2022: 17 · 2021: 13 · 2020: 11 · 2019: 18 · 2018: 12 · 2017: 12 · 2016: 6 · 2015: 8 · 2014: 6 · 2013: 9
- FWCI
- 3.61
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- Funders
- National Institutes of Health (5r37ag019905-10)
- National Institute on Aging (R01AG021493, R37-AG019905, R37-AG19905, P30AG021334)
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK079637, K23DK093583)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Keywords
- hyperglycemia, frailty, older women, HbA1c, walking speed, physical performance, walking difficulty, type 2 diabetes, aging, physical function decline, interleukin-6, comorbidities, body mass index, cardiovascular risk factors
- MeSH terms
- Aged, Female, Humans, Hyperglycemia, Longitudinal Studies, Prospective Studies, Baltimore, Incidence, Chi-Square Distribution, Proportional Hazards Models, Survival Analysis, Walking, Frail Elderly, Peripheral Vascular Diseases, Mobility Limitation
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
