The relationship between frailty and diabetes: An investigation of self-rated health, depression symptoms and quality of life in the Study of Health Aging and Retirement in Europe

Aims: To assess the impact of diabetes and frailty on self-rated health, depressive symptoms and quality of life (QoL). Methods: Data were pooled for participants aged >= 50 years from five waves of the Survey of Health, Ageing and Retirement in Europe. Measures included diabetes (self-reported), physical frailty (>= 3/5 criteria), low self-rated health (SRH; "poor" or "fair"), depression (screened using the EURO-D >= 4) and low QoL (CASP-12 <35). Logistic regression was used to adjust for confounding. Results: Participants with diabetes (n=11,661/97,691) were more likely to be older (68 vs. 64 years, p<0.001), male (50% vs. 45%, p<0.001) and frail (21% vs. 8%, p<0.001). Age, sex, diabetes and frailty were all independently associated with low SRH, depression and low QoL. Frailty had the highest adjusted odds ratios for low SRH (9.43; 95% CI:8.89-10.02), depression (6.39; 95% CI:6.07-6.71) and low QoL (9.65; 95% CI:9.17-10.16). For diabetes, the adjusted odds ratios were 2.82 (2.70-2.95), 1.49 (1.42-1.56) and 1.67 (1.60-1.74), respectively. Participants with both diabetes and frailty reported the worst self-rated health, the most depression symptoms and the lowest QoL. Conclusions: Frailty was prevalent in older people with diabetes and independently associated with low self-rated health, depressive symptoms and low QoL. Prompt identification and management of frailty should be a key consideration in diabetes care.