Effect of Behavioral Lifestyle Intervention on Frailty in Older Adults With Diabetes

• Self-reported (SR) exhaustion (Y/N ) on Center for Epidemiologic Studies Depression (CES-D) scale: "Do you feel full of energy?" "No" scored a 1 (exhausted).
• SR unintentional weight loss: "In the last year, have you lost more than 10 pounds unintentionally?". "Yes" scored a 1.
• SR physical activity over the last year using the Minnesota Leisure Time Activity Questionnaire, (energy expenditure in kcal/week, standardized for sex). The lowest quintile for each sex group received a score of 1
• Grip strength measured (Kg) with a dynamometer in the dominant hand, standardized using body mass index quartiles and sex. The average of 3 trials was recorded. The lowest quintile for each sex group received a score of 1 (for weak).
• 10 feet walked at usual pace, standardized based on height and sex. The fastest of 2 trials was recorded. Participants in the lowest quintile for each sex group were considered slow (score =1) A higher scale score from 0-5 indicates greater frailty

Change in HbA1c measured over the study period

The balance test assesses a person's ability to stand with the feet together in side-by-side, semi-tandem, and full-tandem positions for 10 seconds each, responses ranging between 0-4 with a higher score indicating better balance. Three balance tests are performed and scoring is as follows:

Side-by-side stand: person attempts to stand with feet together, side-by-side, for 10 seconds.

• 1 point if held for 10 seconds
• 0 points if not held for 10 seconds or not attempted Semi-tandem stand: person attempts to stand with the side of the heel of one foot touching the big toe of the other foot for 10 seconds.
• 1 point if held for 10 seconds
• 0 points if not held for 10 seconds or not attempted Tandem stand: person attempts to stand with the heel of one foot in front of and touching the toes of the other foot for about 10 seconds.
• 2 points if held for 10 seconds
• 1 point if held for 3 to 9.99 seconds
• 0 points if held for <3 seconds or not attempted

Gait speed at a 4-meter walk is timed in seconds as participants walk at their usual pace. Two trials were administered, time (in seconds) was recorded for each trial. The fastest walk of two trials was recorded. Score is recorded between 0-4 with a higher score indicating a faster gait speed. Scoring is as follows:

• 0 points if unable to do the walk
• 1 point if time is more than 8.70 sec
• 2 points if time is 6.21 to 8.70 sec
• 3 points if time is 4.82 to 6.20 sec
• 4 points if time is less than 4.82 sec

Chair stand represents the time to complete five chair rises, sit to stand from a chair, as quickly as possible, without using hands, responses ranging between 0-4. Scoring is as follows:

• 0 points if unable to complete 5 chair stands or completes stands in >60 seconds
• 1 point if chair stand time is 16.70 sec or more
• 2 points if chair stand time is 13.70 to 16.69 sec or more
• 3 points if chair stand time is 11.20 to 13.69 sec
• 4 points if chair stand time is 11.19 sec or less