Control blood sugar helps delay aging, metformin, weight loss into keywords! The Look AHEAD study is another important finding

Aging, since it cannot be avoided, can it be delayed?

Over the past three decades, the global prevalence of diabetes has increased dramatically, and diabetes is also considered a significant cause
of premature death and disability.
Can blood sugar control delay the aging process of diabetics? It has not yet been determined
.

Recently, an exploratory analysis based on Look AHEAD research data gave an important reminder: through 8 years of follow-up, it was found that in patients with type 2 diabetes, good blood sugar control can significantly delay the physiological aging process
.
In addition, among the many treatment strategies of diabetes, "the use of metformin" and "weight loss" have played a more obvious role in delaying aging, and the study was published in the journal Diabetes Care (IF: 17.
152).

An important indicator for assessing the aging process – "defect accumulation debilitating index"

The defective cumulative frailty index (FI) is used as an important indicator to assess the aging process, which combines dozens of indicators such as age-related body function and cognitive level to predict physical condition, and higher FI values mean worse health and faster aging
.
In older patients with type 2 diabetes, low levels of FI mean better health, while increased FI means an increased risk of death and a worse
trajectory of future physical/cognitive function changes.

In this study, the investigators used the 8-year follow-up data of the Look AHEAD study to conduct exploratory analysis (a total of 4169 participants, aged 45~76 years) to evaluate the relationship between
blood glucose control and FI trajectories in type 2 diabetes.
At the same time, it was investigated whether this association differed
depending on the treatment strategy (weight loss, use of different glucose-lowering drugs).

Good blood sugar control helps delay aging!

The study found that the FI score of participants increased graded with the increase of baseline HbA1c level (P=0.
002); And over time, HbA1c<7<b13>% of subjects had significantly lower increases in FI scores (P<0.
001)<b20> compared with HbA1c≥8% of participants.

Table 1 Changes in frailty scores in different HbA1c groups (8-year follow-up)

"Metformin" and "weight loss" became key words

Further exploration showed that "weight loss of >5%" and "metformin use" were independently associated
with relative improvement in frailty index after adjustment for HbA1c levels.

➤ Metformin use is associated with slowing aging progression: patients with type 2 diabetes treated with metformin had a smaller increase in FI (2.
23), while insulin use appeared to accelerate the rise in FI (4.
7).

There was little association
between the use of other oral diabetes medications used in this cohort and changes in FI.

➤ Weight loss is associated with delayed aging progression: Regarding changes in FI scores, 1.
41 in patients with > weight loss; 2.
90 in patients with stable weight; and 6.
05
in patients with >5% weight gain.

Table 2 Changes in frailty scores in different drug groups (8-year follow-up)

Possible mechanisms of metformin delaying aging?

A growing body of research shows that metformin use may help slow down the process of weakness and, on this basis, slow down biological aging
.
Possible pathways for targeting aging include improvement in inflammation, immunological effects, etc
.
In mouse model studies, mice that took metformin for a long time from "middle age" were significantly extended in healthy life
.
However, clinical studies have not found an association between the two, and further exploration
is needed in the future.

In this study, the potential benefit shown by metformin does not appear to extend to other diabetes medications, including insulin
.
It is important to note that SGLT-2i and GLP-1RA
were not included in this study.

brief summary

In people with type 2 diabetes, poor blood sugar control often means worse physical condition
over time.
This study suggests that maintaining better glycosylated hemoglobin levels in diabetic patients slows down the biological aging process, and this association is more pronounced
in patients treated with metformin and achieving weight loss.

Resources:

[1] Felicia R.
Simpson, Jamie N.
Justice, Scott J.
Pilla, Stephen B.
Kritchevsky, Edward J.
Boyko, Medha N.
Munshi, Chloe K.
Ferris, Mark A.
Espeland; for the Action for Health in Diabetes（Look AHEAD） Trial, An Examination of Whether Diabetes Control and Treatments Are Associated With Change in Frailty Index Across 8 Years: An Ancillary Exploratory Study From the Action for Health in Diabetes（Look AHEAD）Trial.
Diabetes Care 2022; dc221728.
https://doi.
org/10.
2337/dc22-1728

[2]https://medicaldialogues.
in/diabetes-endocrinology/news/optimal-blood-sugar-control-tied-to-slow-ageing-in-adults-with-type-2-diabetes-105290

Image source: Photogram

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