Can metformin prevent frailty in prediabetic adults?

Could a diabetes drug, metformin, prevent older adults from becoming frail?

The National Institute on Aging awarded $2 million to UT Health San Antonio and its Sam & Ann Barshop Institute for Longevity & Aging Studies to find out.

Frailty is a clinical syndrome marked by slow walking speed, weak grip, poor balance, exhaustion and low physical activity.

“We are enrolling senior adults who are at least 65 and have prediabetes,” said Sara Espinoza, M.D., M.Sc., clinical investigator with the Sam & Ann Barshop Institute. “We seek older adults with prediabetes because they are at higher risk of becoming frail.”

The study is conducted at the South Texas Veterans Health Care System-Audie L. Murphy Hospital, a clinical partner of UT Health San Antonio. Study volunteers do not have to be veterans.

Prospective volunteers may call Barshop Clinical Research at (210) 450-0020.

Metformin is commonly prescribed to treat type 2 diabetes and also to prevent the disease in individuals who are considered prediabetic. Metformin also has been associated with longevity in mouse models.

“Many people who have prediabetes don’t know it,” Dr. Espinoza said. “We will screen study applicants using an oral glucose tolerance test. Prediabetes is not that hard to find in older patients, unfortunately.”

The study investigators will also perform a comprehensive geriatric assessment of each volunteer—an overview of cognition, physical function, depression and quality of life.

Patients will be seen every three months for two years and compensation is available.

Smokers are not eligible.

The goal is to enroll 150 senior adults with prediabetes, Dr. Espinoza said.

The investigators will monitor biomarkers of inflammation that are known to be increased with frailty, Dr. Espinoza said. These include indicators called interleukin-6, C-reactive protein and tumor necrosis factor-alpha.

Inflammation plays a key role in aging, diabetes and obesity, and metformin is known to lower inflammatory biomarkers. The study will evaluate whether improving this will reduce frailty.

Dr. Espinoza is an associate professor in UT Health San Antonio’s Joe R. & Teresa Lozano Long School of Medicine. She joined The University of Texas Health Science Center, now called UT Health San Antonio, in 2006.

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