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© The Author(s) 2021. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

Abstract

Background

Frailty and multimorbidity are common in type 2 diabetes (T2D), including people <65 years. Guidelines recommend adjustment of treatment targets in people with frailty or multimorbidity. It is unclear how recommendations to adjust treatment targets in people with frailty or multimorbidity should be applied to different ages. We assess implications of frailty/multimorbidity in middle/older-aged people with T2D.

Methods

We analysed UK Biobank participants (n = 20,566) with T2D aged 40–72 years comparing two frailty measures (Fried frailty phenotype and Rockwood frailty index) and two multimorbidity measures (Charlson Comorbidity index and count of long-term conditions (LTCs)). Outcomes were mortality, Major Adverse Cardiovascular Event (MACE), hospitalization with hypoglycaemia or fall/fracture.

Results

Here we show  that choice of measure influences the population identified: 42% of participants are frail or multimorbid by at least one measure; 2.2% by all four measures. Each measure is associated with mortality, MACE, hypoglycaemia, and fall or fracture. The absolute 5-year mortality risk is higher in older versus younger participants with a given level of frailty (e.g. 1.9%, and 9.9% in men aged 45 and 65, respectively, using frailty phenotype) or multimorbidity (e.g. 1.3%, and 7.8% in men with 4 LTCs aged 45 and 65, respectively). Using frailty phenotype, the relationship between higher HbA1c and mortality is stronger in frail compared with pre-frail or robust participants.

Conclusions

Assessment of frailty/multimorbidity should be embedded within routine management of middle-aged and older people with T2D. Method of identification as well as features such as age impact baseline risk and should influence clinical decisions (e.g. glycaemic control).

Hanlon et al. study the prevalence of frailty and multimorbidity in a cohort of 20,566 UK Biobank participants with type 2 diabetes aged between 40 and 72 years. They observe that, even in this relatively young population, people living with frailty and/or multimorbidity are at increased risk of adverse outcomes including mortality, major adverse cardiovascular events, and hypoglycaemia.

Details

Title
An analysis of frailty and multimorbidity in 20,566 UK Biobank participants with type 2 diabetes
Author
Hanlon, Peter 1   VIAFID ORCID Logo  ; Jani, Bhautesh D. 1 ; Butterly, Elaine 1   VIAFID ORCID Logo  ; Nicholl, Barbara 1 ; Lewsey, Jim 1   VIAFID ORCID Logo  ; McAllister, David A. 1 ; Mair, Frances S. 1 

 University of Glasgow, Institute of Health and Wellbeing, Glasgow, UK (GRID:grid.8756.c) (ISNI:0000 0001 2193 314X) 
Pages
28
Publication year
2021
Publication date
Dec 2021
Publisher
Springer Nature B.V.
e-ISSN
2730664X
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2788446219
Copyright
© The Author(s) 2021. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.