People with prediabetes have elevated blood glucose levels (hyperglycemia) that aren’t high enough to be considered diabetes. Prediabetes is associated with hypertension and other cardiovascular conditions that in turn are known to be linked with an increased risk of frailty as people age.

Gaetano Santulli, M.D., Ph.D., and colleagues were interested in whether hyperglycemia itself might contribute to frailty. They studied a group of 302 “pre-frail” hypertensive adults aged 65 and over. At a one-year follow-up, the researchers demonstrated for the first time that adults who had developed prediabetes were significantly more likely than others to have become frail. Insulin resistance (the body’s impaired response to insulin) causes hyperglycemia that leads to prediabetes and, ultimately, to diabetes. Dr. Santulli and colleagues found significant correlations between insulin-resistance levels of prediabetic people and their risk for both physical and cognitive decline. Then, for six months, a subgroup of frail individuals was administered metformin (a commonly used anti-diabetes drug that restores the body’s sensitivity to insulin). When compared with an untreated group of frail patients, the metformin-treated patients exhibited a substantial decrease in frailty levels. The researchers recommend that hypertension management should include efforts to lower insulin resistance. The study, which was featured on the cover, was published in the July 2024 issue of Hypertension.

Dr. Santulli is associate professor of medicine and of molecular pharmacology at Einstein.