Metformin slowed the accumulation of health deficits in older adults with prediabetes

Metformin slowed the accumulation of health deficits in older adults with prediabetes

On July 28, Nicolas Musi and colleagues published the results of a two-year trial of metformin in 145 older adults with impaired glucose tolerance. A frailty index based on 95 deficits increased more slowly with metformin than with placebo. Weight loss affected the result on the Fried scale.

In the study by Nicolas Musi and colleagues, 145 participants aged 65–90 years received metformin or placebo for 24 months. Of these, 141 began taking their assigned treatment. The mean age was 72 years. All participants were either prefrail or not frail, and their impaired glucose tolerance increased their risk of developing frailty.

The authors measured frailty in two ways. The frailty index combines 95 diseases, impairments in bodily function, and limitations in daily activities. A greater number of these deficits produces a higher score. In the metformin group, the index increased by 0.006 points per year less than it did in the placebo group. The difference remained after adjustment for age, sex, lipids, glucose, and body mass index.

The Fried scale counts five observable features: weight loss, exhaustion, weak grip strength, slow walking speed, and low physical activity. Over two years, participants receiving metformin lost an average of 5.7 kilograms, compared with 2.3 kilograms among those receiving placebo. The authors attribute the higher score during the first year to this difference in weight loss. After weight was removed from the scale, the differences between the groups did not reach statistical significance.

The index based on 95 deficits describes a broad range of health problems. The Fried scale assesses physical vulnerability through five observable features, one of which is weight loss. In this trial, metformin reduced body weight, and the total score changed with it.

Walking speed, grip strength, leg strength, and physical performance test results remained similar between the groups. A drug that reduces body weight also changes one of the features included in the Fried scale. Examining the scale's individual components therefore shows what drove the change in the total score: body weight, walking speed, grip strength, or physical activity.