Comorbidity, Frailty, and Glycaemic Control Among Older Patients with Diabetes: A Multi-Centre Study in Vietnam

Abstract

Objectives. This study aimed to examine the burden of comorbidity and frailty in older adults with type 2 diabetes mellitus (T2DM) in Vietnam and their relationship with poor glycaemic control. Methods. This is a cross-sectional study of patients aged 60 years or older diagnosed with T2DM who visited the cardio-metabolic clinics of two urban hospitals in Ho Chi Minh City, Vietnam, between November 2022 and June 2023. Poor glycaemic control was defined as HbA1c ≥ 8.0%. Comorbidity severity was assessed using the Charlson Comorbidity Index (CCI). Frailty was defined using Fried’s criteria. Multivariable logistic regression models were applied to identify the factors associated with poor glycaemic control. Results are presented as adjusted odds ratios (aOR) and 95% confidence intervals (CI). Results. There were 576 participants. They had a mean age of 71.9 (SD 7.6) years, 46% were female, 34% of the participants had moderate to severe comorbidity (CCI ≥ 3), 30% were frail and 46% were prefrail. The prevalence of poor glycaemic control was 22%. In the multivariable logistic models, the factors significantly associated with poor glycaemic control were frailty and duration of diabetes. Compared to the robust, the aORs were 2.86 (95%CI 1.35–6.04) among the frail, and 2.12 (95%CI 1.16–3.88) among the prefrail. Compared to those with 1–5 years of T2DM, the aORs were 3.19 (95%CI 1.13–8.99) among those with <1 year, 1.70 (95%CI 0.94–3.06) among those with 6–10 years, and 2.05 (95%CI 1.13–3.72) among those with >10 years. The relationship between comorbidity severity with poor glycemic control was not statistically significant. Conclusion. There was a high burden of comorbidity and frailty among the participants, and frailty was associated with greater odds of poor glycaemic control. Routine assessment of frailty is essential in managing long-term diabetes.