Frailty predicts adverse outcomes in older people with diabetes

The greatest proportional increase in the number of people with diabetes by age group is predicted to occur in those aged 60 to 79. In older people living with diabetes, geriatric syndromes, which indicate frailty, are emerging as a third category of complications in addition to the traditional microvascular and macrovascular sequelae. Frailty is defined by the presence of three or more phenotypes (weight loss, weakness, decreased physical activity, exhaustion and slow gait speed). The presence of one or two phenotypes describes a pre-frail state, and the absence of phenotypes describes a non-frail person. Sarcopenia, or loss of muscle mass, is the muscular manifestation of frailty phenotype and is defined as a generalised loss of skeletal muscle mass and strength that leads to low physical performance. Persistent hyperglycaemia has been shown to be associated with poor muscle quality, performance and strength independent of age, race, sex, weight, height and physical activity. The coexistence of dementia and diabetes also increases the risk of frailty. There is evidence that midlife behaviours such as smoking, alcohol consumption, poor diet and low levels of physical activity are associated with frailty and dementia in later life. Frailty is a dynamic condition which can worsen or improve over time. Patients may progress from a non-frail to pre-frail or frail state. With timely intervention, there is a greater chance for an individual to recover from pre-frail to non-frail than to deteriorate into frailty. The progression of frailty is likely to be multifactorial, therefore multimodal intervention, including maintenance of adequate nutrition, physical exercise, and glycaemic control, may help to delay or prevent the development of frailty and to improve outcomes.