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Bidirectional relationship between diabetes and frailty in middle-aged and older adults: A systematic review and
Huaxin Si1, Yiran Zhang2, Peng Zhao2
1School of Public Health, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China; China Center for Health Development Studies, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China.
Background:
Diabetes and frailty are prevalent and burdensome in middle-aged and older adults. However, current evidence on their association is inconsistent, and no quantitative meta-analysis exists. We conducted a systematic review and meta-analysis to examine whether diabetes increased the risk of frailty and vice versa.
Methods:
We systematically searched PubMed, Web of Science, Embase, and CINAHL databases from inception to 10 April 2025. Random-effects models were used to calculate pooled odds ratio (OR) and 95 % confidence interval (CI) for cross-sectional analysis and pooled relative risk (RR) for longitudinal analysis. The certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.
Results:
From 8559 non-duplicated records, 31 articles were included. People with diabetes had increased risks of prevalent frailty (OR=2.21, 95 %CI: 1.60-3.06, I2=99.0 %, n = 15; GRADE=Low), prevalent pre-frailty (OR=2.23, 95 %CI: 2.19-2.28, I2=0.0 %, n = 2; GRADE=Very low), and incident frailty (RR=1.50, 95 %CI: 1.36-1.65, I2=0.0 %, n = 7; GRADE=Moderate). Those with pre-frailty (OR=1.95, 95 %CI: 1.61-2.36, I2=0.0 %; GRADE=Very low) but not with frailty (OR=2.28, 95 %CI:0.96-5.46, I2=92.3 %; GRADE=Very low) had increased odds of prevalent diabetes in two studies. In 15 studies, the pooled RRs for incident diabetes were 1.47 (95 %CI: 1.37-1.57, I2=91.0 %; GRADE=Moderate) in pre-frail participants and 1.96 (95 %CI: 1.73-2.23, I2=92.7 %; GRADE=Moderate) in frail participants.
Conclusion:
Our findings support the bidirectional relationship between diabetes and frailty in middle-aged and older adults, with each condition contributing to the development of the other. This highlights the importance of early detection and integrated management strategies for diabetes and frailty.
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