Association of metformin use and nutritional status with cognitive frailty in older adults with type 2 diabetes

Cognitive frailty (CF), defined as the coexistence of physical frailty and cognitive impairment in the absence of dementia, is common among older adults with diabetes.

This study investigated associations of metformin use and nutritional status with CF, cognitive impairment, and physical frailty among older adults with type 2 diabetes.

This cross-sectional study was conducted at the geriatric outpatient clinic of a tertiary care hospital. CF was defined as the coexistence of cognitive impairment (Montreal Cognitive Assessment (MoCA) ≤ 25 points) and physical frailty (FRAIL score ≥ 3 points). Nutritional status was measured using the MNA-SF. Hierarchical multivariable logistic regression models were constructed to assess the independent associations of metformin use and nutritional status with CF, cognitive impairment, and physical frailty, progressively adjusting for age, sex, BMI, education level, vitamin B12 level, eGFR, polypharmacy, HbA1c level, PPI use, and insulin use.

A total of 468 older adults with diabetes were included, median age 70 years (IQR:66-75), 70.3% of the participants were female. Based on clinical assessments, 9.6% were classified as having CF, 18.8% as having physical frailty only, and 9.6% as having cognitive impairment alone. Logistic regression analysis indicated that metformin use and being well-nourished were significantly associated with lower odds of CF (OR[95%CI]: 0.275 [0.160-0.620], p = 0.002; and 0.150 [0.118-0.245], p < 0.001, respectively). Similar associations were observed for cognitive impairment and physical frailty.

Metformin use and optimal nutritional status were independently associated with lower odds of cognitive frailty, cognitive impairment, and physical frailty, suggesting that these modifiable factors might contribute to better outcomes in geriatric diabetes care.