Identifying and assessing frailty in people with diabetes should be a priority, in order to better treat and manage patients and reduce mortality.

A new study, led by researchers at the University of Glasgow and published today in the Lancet Healthy Longevity, undertook a systematic review of more than 100 studies, and concluded that diabetes is a risk factor for the development and progression of frailty.

 

Frailty, described as a state of increased vulnerability to adverse health outcomes, is an increasing medical problem around the world as populations get older. However, more recently, researchers have highlighted that frailty can be found in middle age populations, particularly in those who have underlying health conditions.

In this study, researchers found that frailty is very common in people with diabetes, but that there is still a lack of nuanced understanding about how the two conditions interact. Overall they found that frailty prevalence can be expected to lie between 10% and 25% in people with diabetes aged 60 years-old and over. They also found that frailty was found in relatively young and middle aged people with diabetes.

People with diabetes and frailty have a much higher chance of mortality, hospital admission, complications of diabetes, as well as a lower quality of life and higher rates of disability.

Current guidelines recommend different blood sugar targets for people with diabetes and frailty – however this study found that there was often little difference in average blood sugar levels between people with and without frailty. The researchers concluded, that as the relationship between frailty and diabetes is still poorly understood, some people with both conditions may not be being managed in an effective way.

Instead the researchers argue a more tailored approach for each patient, based on further evidence and assessment, should be used to better treat individuals who have diabetes and frailty.

Dr Peter Hanlon, clinical research fellow at the University of Glasgow, said: “Our findings suggest the importance of identifying frailty in patients who have diabetes, given higher chances of mortality and hospitalisation.

“However we also found that there is a lack of nuanced understanding of how these two conditions interact. In particular, the relationship between frailty and glycaemia, and the impact of frailty in specific groups needs to be better understood to enable guidelines to be tailored to individuals with frailty.”

Diabetes may speed up the development and progression of frailty through a number of ways. Researchers suggest possible mechanisms could include accelerated muscle loss, increased inflammation and cardiovascular risk factors.

The authors are calling for frailty screening to be embedded within existing diabetes protocols and healthcare management, so that clinicians can identify individuals who may be most at risk, or who may need further care interventions.

Professor Frances Mair, Norie Miller Professor of General Practice at the University of Glasgow, said: “Frailty is consistently associated with a range of adverse outcomes including mortality, hospital admission, disability, and a lower quality of life. It is also a condition that we need to recognise can affect not just older people, but middle age and younger people too.

“This study shows the importance of recognising frailty in patients who also have diabetes. If we can identify these people routinely, it will also mean we can better treat them and improve their quality of life.”

The study, ‘Frailty in diabetes: A systematic review and meta-analysis of frailty measurement, prevalence, incidence, and clinical implications in people with diabetes’ is published in the Lancet Healthy Longevity. The work was funded by the Medical Research Council (MRC).

Enquiries: ali.howard@glasgow.ac.uk or elizabeth.mcmeekin@glasgow.ac.uk / 0141 330 6557 or 0141 330 4831

First published: 19 November 2020

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