Report finds that intervention can support older people living with type 2 diabetes and frailty

Study looks at benefit of short-term intervention to improve frailty over a period of up to two years.

Frailty is a regular complication experienced by older people living with type 2 diabetes.

As part of a recent study, researchers reviewed benefits of intervention over an 18-month period to assess if there were any changes to the frailty status of people aged 70 and older.

The study followed 298 adults who had previously taken part in the MID-Frail study, for follow-up research over 18-24 months.

MID-Frail was an international research study examining the effectiveness of combining optimised medical management with exercise and dietary programmes to maintain function and quality of life in people aged 70 years and over, who are living with type 2 diabetes.

Researchers said: “Type 2 diabetes is a highly prevalent metabolic disorder in ageing populations, affecting approximately 20% of people aged 65 years and over. Diabetes is associated with increased frailty and an accelerated decline in the ability to carry out activities of daily living, which impairs quality of life.

“There is a significant accompanying personal and social burden and increased healthcare costs through the effects of diabetes complications leading to increased hospitalisation rates.”

Sixteen centres in seven countries across Europe participated in this 4-year study, which is supported by the European Union. 

In a recently published report in The Journal of Nutrition, Health and Aging, researchers said: “The MID-Frail intervention improved frailty status and physical function at long-term follow-up in older people with type 2 diabetes.”

The older people taking part in the study were either frail, or pre-frail and for the study were allocated to follow either usual care routines or receive intervention procedures.

Those in the intervention group underwent a 16-week exercise programme and a series of nutritional-educational sessions.

Frailty status was determined by the Fried Frailty Phenotype criteria from the beginning and end of the study. The criteria referred to a set of five physical indicators used to assess frailty in an individual, including: unintentional weight loss, weakness (low hand-grip strength), self-reported exhaustion, slow walking speed and low physical activity. A person is considered frail if they meet three or more of these criteria.

Researchers concluded: “This extended MID-Frail study shows that a multimodal intervention can reverse the frailty status and slow down the progression of frailty in older people with diabetes mainly in the earliest stages of the disease (prefrailty) in a long-term (18–24 months). Additionally, this intervention improves physical function measured by the Short Physical Performance Battery (SPPB) test. This type of intervention should be provided whenever possible in health care services in frail and prefrail older people with diabetes.”

Professor Sinclair, Chair of the Foundation for Diabetes Research in Older People (fDROP) and the National Advisory Panel for Care Home Diabetes (NAPCHD) and study author, said: “Once again, we see evidence that frailty is not irreversible but can be effectively managed if frail older people with type 2 diabetes can be encouraged to adhere to an exercise-based intervention.

“It is essential that all diabetes specialists and commissioners of diabetes services recognise that frailty has a more prognostic significance in terms of clinical outcome and mortality than diabetes-related complications.”

Read the report in The Journal of Nutrition, Health and Aging

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