Evidence mapPaperPMID 34788804Full record

Trial reportThe journals of gerontology. Series A, Biological sciences and medical sciences2022

Eight-Year Changes in Multimorbidity and Frailty in Adults With Type 2 Diabetes Mellitus: Associations With Cognitive and Physical Function and Mortality.

Mark A Espeland, Jamie Nicole Justice, Judy Bahnson, Joni K Evans, Medha Munshi, Kathleen M Hayden, Felicia R Simpson, Karen C Johnson, Craig Johnston, Stephen R Kritchevsky

Registry-linked trialOpen access · greenAbstract readClinical Trial
In one paragraph

Trial report in The journals of gerontology. Series A, Biological sciences and medical sciences, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00017953 (Look AHEAD), which is not on this map. Cited by 28 papers.

0numbers the graph read from it
0cells of the map it votes in
28citing papers in PubMed
3.8field-weighted citation impact, top 6% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00017953 nacompletednot on this map

Look AHEAD: Action for Health in Diabetes

TypeinterventionalSponsorWake Forest University Health SciencesRan2001 to 2020Enrolled5,145ConditionsDiabetes, Myocardial Infarction, Stroke, Kidney DiseasesArmsLifestyle Intervention, Diabetes Support and Education
3 · Its place in the literature

Who cites it

28 citing papers in PubMed, 34 citations in OpenAlex.

  1. Relative impact of multidomain lifestyle interventions on deficit accumulation frailty over 24 months in the U.S. POINTER trial.The journals of gerontology. Series A, Biological sciences and medical sciences · 2026
    Trial
  2. Trial
  3. Late-life disability following the action for health in diabetes (Look AHEAD) trial.The journals of gerontology. Series A, Biological sciences and medical sciences · 2026
    Trial
  4. Associations Between Deficit Accumulation Frailty and Baseline Markers of Lifestyle in the U.S. POINTER Trial.The journals of gerontology. Series A, Biological sciences and medical sciences · 2025
    Trial
  5. Trial
  6. Trial
  7. Trial
  8. Article
  9. Article
  10. Observational
  11. Review
  12. Review
  13. Multimorbidity Management: A Scoping Review of Interventions and Health Outcomes.International journal of environmental research and public health · 2025
    Article
  14. Review
  15. Article
  16. Review
  17. Article
  18. Article
  19. Article
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 5 institutions in 1 country.

Mark A EspelandSticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.ORCID 0000-0002-3711-1949
Jamie Nicole JusticeSticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.ORCID 0000-0003-2953-4404
Judy BahnsonDepartment of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
Joni K EvansDepartment of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
Medha MunshiJoslin Geriatric Diabetes Program, Joslin Diabetes Center, Boston, Massachusetts, USA.
Kathleen M HaydenDepartment of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.ORCID 0000-0002-7745-3513
Felicia R SimpsonDepartment of Mathematics, Winston-Salem State University, Winston-Salem, North Carolina, USA.
Karen C JohnsonDepartment of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.ORCID 0000-0002-3493-4077
Craig JohnstonDepartment of Health and Human Performance, University of Houston, Houston, Texas, USA.
Stephen R KritchevskySticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.ORCID 0000-0003-3336-6781
Wake Forest University · USJoslin Diabetes Center · USUniversity of Houston · USUniversity of Tennessee Health Science Center · USWinston-Salem State University · US

Funding

Metformin in Alzheimer's dementia Prevention (MAP)R01AG062624 · NIA · COLUMBIA UNIVERSITY HEALTH SCIENCES · 2023 to 2025
$22.5M
HEALTH OUTCOMES OF WEIGHT-LOSS: DATA COORDINATING CENTERU01DK057136 · WAKE FOREST UNIVERSITY HEALTH SCIENCES · 1999 to 2005
$18.5M
PILOT STUDY--SECRETORY TARGETING IN PANCREATIC B CELLSP30DK036836 · JOSLIN DIABETES CENTER · 1986 to 2025
$12.1M
Clinical Center for Look AHEAD: Health in DiabetesU01DK057151 · UNIVERSITY OF COLORADO DENVER · 1999 to 2005
$8.4M
SHOW PROJECTU01DK057154 · MASSACHUSETTS GENERAL HOSPITAL · 1999 to 2005
$8.1M
STUDY OF HEALTH OUTCOMES OF WEIGHT-LOSS (SHOW)U01DK057078 · UNIVERSITY OF TENNESSEE HEALTH SCI CTR · 1999 to 2005
$7.4M
STUDY OF HEALTH OUTCOMES OF WEIGHT LOSSU01DK057182 · UNIVERSITY OF MINNESOTA TWIN CITIES · 1999 to 2005
$7.3M
STUDY OF HEALTH OUTCOMES OF WEIGHT-LOSS (SHOW)U01DK057131 · UNIVERSITY OF WASHINGTON · 1999 to 2005
$7.1M
Clinical Center for Look AHEAD: Health in DiabetesU01DK057219 · UNIVERSITY OF SOUTHERN CALIFORNIA · 1999 to 2005
$6.9M
Clinical Center for Look AHEAD: Health in DiabetesU01DK057008 · UNIVERSITY OF ALABAMA AT BIRMINGHAM · 1999 to 2005
$6.5M
REC CoreP30AG072947 · WAKE FOREST UNIVERSITY HEALTH SCIENCES · 2025 to 2025
$3.0M
Action for Health in Diabetes (Look AHEAD) Extended Follow-up (LA-E2)U01AG073697 · WAKE FOREST UNIVERSITY HEALTH SCIENCES · 2025 to 2025
$1.3M
NIA NIH HHS P30 AG072947NIA NIH HHS R01 AG058571NIA NIH HHS R01 AG062624NIA NIH HHS U01 AG073697NIDDK NIH HHS P30 DK036836NIDDK NIH HHS R01 DK092237NIDDK NIH HHS U01 DK057008NIDDK NIH HHS U01 DK057078NIDDK NIH HHS U01 DK057131NIDDK NIH HHS U01 DK057136NIDDK NIH HHS U01 DK057151NIDDK NIH HHS U01 DK057154NIDDK NIH HHS U01 DK057182NIDDK NIH HHS U01 DK057219
6 · The paper itself

Abstract

backgroundIndices of multimorbidity and deficit accumulation (ie, frailty indices) have been proposed as markers of biological aging. If true, changes in these indices over time should predict downstream changes in cognition and physical function, and mortality.

methodsWe examined associations that 8-year changes in (i) a multimorbidity index comprised of 9 chronic diseases and (ii) a frailty index (FI) based on deficit accumulation in functional, behavioral, and clinical characteristics had with subsequent measures of cognitive and physical function over 10 years. We drew data from 3 842 participants in the Action for Health in Diabetes clinical trial. They were aged 45-76 years at baseline and at risk for accelerated biological aging due to overweight/obesity and type 2 diabetes mellitus.

resultsA total of 1 501 (39%) of the cohort had 8-year increases of 1 among the 9 diseases tracked in the multimorbidity index and 868 (23%) had increases of ≥2. Those with greatest increases in multimorbidity tended to be older individuals, males, and non-Hispanic Whites. Greater FI increases tended to occur among individuals who were older, non-Hispanic White, heavier, and who had more baseline morbidities. Changes in multimorbidity and FI were moderately correlated (r = 0.26; p < .001). Increases in both multimorbidity and FI were associated with subsequently poorer composite cognitive function and 400-m walk speed and increased risk for death (all p < .001).

conclusionsAccelerated biological aging, as captured by multimorbidity and frailty indices, predicts subsequent reduced function and mortality. Whether intensive lifestyle interventions generally targeting multimorbidity and FI reduce risks for downstream outcomes remains to be seen. Clinical Trials Registration Number: NCT00017953.

Indexed as

Diabetes Mellitus, Type 2FrailtyAgedCognitionFrail ElderlyHumansMaleMultimorbidityAgingDeficit accumulationIntensive lifestyle intervention

Identifiers

PMID34788804
PMCPMC9373968
OpenAlexW3213586686

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.