Abstract / Summary
Abstract Frailty may link glycemic status with later mortality among adults with diabetes, but longitudinal evidence accounting for pre-existing frailty is limited. We analyzed data from the 2011, 2015, 2018, and 2020 waves of the China Health and Retirement Longitudinal Study. The primary cohort included 578 adults aged 45 years or older with diabetes. HbA1c and baseline frailty were assessed in 2011, subsequent frailty in 2015, and mortality by 2020. Each 1-percentage-point increase in baseline HbA1c was associated with a 0.053-unit increase in the scaled 2015 Frailty Index (95% CI 0.004–0.102, P = 0.034), and each 0.1-unit increase in the 2015 Frailty Index was associated with higher mortality odds (adjusted OR 1.40, 95% CI 1.08–1.81, P = 0.011). HbA1c ≥ 7.0% was associated with higher mortality odds than HbA1c < 7.0% (adjusted OR 2.28, 95% CI 1.15–4.59, P = 0.018). The indirect association through the 2015 Frailty Index was 0.461 (bootstrap 95% CI -0.001 to 0.831), with similar findings using 2018 frailty. These findings support subsequent frailty as a potential intermediate state linking glycemic status with later mortality.