The impact of frailty on glycaemic control in older adults with type 1 diabetes: An observational study

The type 1 diabetes population is ageing. Frailty is the age-related physiological decline that occurs across organ systems, increasing the body's vulnerability to stressors. Current consensus-based guidelines, derived from evidence in type 2 diabetes, prioritise hypoglycaemia avoidance, which increases falls, hospitalisation and mortality risk in older adults. This study assesses whether frailty is associated with increased hypoglycaemia in older adults with type 1 diabetes.

Participants were over 65, with type 1 diabetes, confirmed by C-peptide measurement. Frailty was categorized as robust, prefrail or frail as per Fried Frailty Phenotype (gait speed, weight loss, hand-grip strength, exhaustion and physical activity). Secondary analyses used Clinical Frailty Scale and Short Physical Performance Battery. Cognition was assessed using Montreal Cognitive Assessment score (MoCA). Blinded continuous glucose monitors (CGM), Dexcom G6/G7, were worn for 10 days. CGM metrics were compared between frailty categories, focusing on percentage time below range (%TBR).

83 participants met the inclusion criteria. 38 were robust (45.8%), 29 prefrail (34.9%) and 16 frail (19.3%). Frail participants were older, with more comorbidities and diabetes complications. Frailty was associated with higher HbA1c (p = 0.025) and lower MoCA scores (p = < 0.001). There was no difference between any CGM-derived glycaemic parameter across the frailty spectrum, regardless of frailty assessment used.

While frailty is often associated with hypoglycaemia in diabetes, this was not demonstrated in our type 1 diabetes cohort. Raised HbA1c levels with frailty may reflect recommendations to relax glucose targets. However, no difference was found in %TBR with frailty.