Frailty and diabetes in older adults: Overview of current controversies and challenges in clinical practice

This article examines the challenges healthcare professionals face when addressing the modern and often twin epidemics of frailty and diabetes mellitus (DM) in ageing societies. Frailty is a complex, multisystem, age-associated syndrome that increases vulnerability to functional decline and adverse events, including death (1, 2). DM is a metabolic disease of defective insulin secretion in response to glucose and impaired insulin sensitivity defined by hyperglycaemia and, similar to frailty, results from the complex interplay of genetic and acquired factors (3). Both conditions are highly prevalent with age. Global frailty prevalence is estimated at between 12-24% in older (age 50 years) community-dwellers (4), though proportions vary widely depending on the sampling frame, participant characteristics and definitions used (5). DM is an epidemic disease with a worldwide prevalence of 20-25% among those 70 years (6). Like frailty, DM is associated with increased disability and mortality in older people (7). In developed countries, more than half of the population with DM are aged 65 years (8), and it is estimated that the prevalence of frailty is 3-5 fold higher among people with DM than those without (9, 10). Alone and in combination, DM and frailty significantly impact health service provision (11), increasing total healthcare costs (1214). Frailty and DM together in combination, negatively impact mortality, psychosocial wellbeing and quality of life (15, 16). The objectives of this article are to provide an up-to-date, evidence-based overview of the relationship between DM and frailty in older adults, specifically examining knowledge gaps and the unique challenges when these conditions co-exist and what clinicians and healthcare systems can do better to address them.