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DIABETES AND
OBESITY

Diabetes in Veterans

DETECTING FRAILTY IN TIME

By Patricia S. Machado, MS2

An older diabetic man wakes up in the morning feel- sugar. Patients who are diagnosed with Type II diabetes Mellitus
ing an overwhelming sense of physical exhaus-
are at the highest risk to develop frailty compared to all other med-
tion and fatigue. The motivation to undergo
strongly correlated with the severity of diabetes because abnor-
day-to-day activities is low. Gripping a cup of coffee is difficult as ical comorbidities combined. The extensive increase in frailty is
he notices a greater decline in grip strength and senses a decrease mally high glucose levels in the blood can lead to the development
in knee extensor strength. As he walks across the room, there is a of an “insulin-resistant environment” in the body, which feeds
marked decrease in walking speed and he realizes his strength is into the mechanism of chronic inflammation. This environment
just not as it used to be. but there is no reason to worry as these has increased circulatory inflammatory cytokines such as CRP (C-
are all the normal signs of aging, right? Wrong. These character- reactive protein), Il-6, Il-1,TNF-a,TNFsR1 and TNFs2, fibrino-
istics are not the natural progression of aging, but a medical syn- gen, and transferrin which are all are predictive factors of frailty
drome that can be associated with poor health outcomes. This impairments of mobility and physical function. This step-wise de-
syndrome is termed frailty, which is a medical comorbidity that cline of physical function related to diabetes has been extensively
increases risk of hospitalization, falls, disability, and even death. studied in several cohorts, including our own San Antonio longi-
Patients who are “frail,” are shown to exhibit chronic inflam- tudinal Study of Aging. Which means the negative consequences
mation throughout the muscles, joints, and bones that cause pa- of diabetes could already knocking on our own front door.
tients to become exponentially weaker in time. The catalyst for So how can we help patients that already suffer from frailty?
the increased inflammatory state can be due to chronic high blood Unfortunately, there are no definitive treatments or prevention
pressure, heart disease, obesity, but most importantly high blood measures as of today for the management of frailty. However,

30 San Antonio Medicine • December 2018