Both hypoglycemia and hyperglycemia (dysglycemia) increase the risk of frailty in older patients with type 2 diabetes, but the characteristics of the two groups are different, according to a study published in the April 2022 issue of the Journal of Diabetes and its Complications.¹

In this study, researchers from the UK conducted a systematic review of eight clinical trials that reported an association between dysglycemia and frailty with an objective to examine the characteristics of older frail patients with type 2 diabetes.

Out of these eight studies that met the inclusion criteria of the trial, four examined the association of frailty with low glycemia. Two of these showed that hypoglycemia was associated with 44% elevated risk of frailty with a hazard ratio of 1.60 and also predicted greater level of dependency. The other two studies showed an inverse association with clinical frailty scale and subjects with A1c < 6.0% were at a higher risk of disability. Frail patients were more likely to be malnourished as evident by low serum albumin or have lower BMI or low total cholesterol levels. They also had more comorbidities.

The remaining four studies investigated the association of frailty with high glycemia. In two studies, the probability of being frail was found to be increased in patients with higher A1c values with odds ratio of 1.43 and the higher A1c also showed a positive correlation with the Edmonton frail score (r = 0.44). According to the other two studies, the prevalence of frailty in individuals with A1c ≥ 6.5% was 70.3% and patients with higher baseline A1c were more likely to be frail all through the later years. Frail patients in this group had higher body weight, waist circumference and BMI including high cholesterol levels. They were more sedentary and had more comorbid conditions.

This study has shown that not just hypoglycemia, hyperglycemia too increased the risk of frailty in older adults with type 2 diabetes, which further puts them at risk of disability and adverse outcomes. It has further characterized the metabolic phenotypes associated with the risk of frailty in this patient group and identified features of both. This is the age of precision or personalized medicine. Hence, clinicians should be aware of the two metabolic phenotypes and their distinct features and keep them in consideration in treatment planning. Their early recognition permits timely intervention with a multipronged strategy of nutritional therapy, physical exercise and adjustment of anti-diabetic medication. However, the authors also state the need for more research “to further characterise frailty subtype in order to practice a precision-based medicine”.

Reference

1. Abdelhafiz AH, et al. Metabolic phenotypes explain the relationship between dysglycaemia and frailty in older people with type 2 diabetes. J Diabetes Complications. 2022 Apr;36(4):108144. doi: 10.1016/j.jdiacomp.2022.108144.