An analysis of frailty and multimorbidity in 20,566 UK Biobank participants with type 2 diabetes

Hanlon, P. , Jani, B. D. , Butterly, E., Nicholl, B. , Lewsey, J. , McAllister, D. A. and Mair, F. S. (2021) An analysis of frailty and multimorbidity in 20,566 UK Biobank participants with type 2 diabetes. Communications Medicine, 1, 28. (doi: 10.1038/s43856-021-00029-9)

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).

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Jani, Dr Bhautesh and Hanlon, Dr Peter and McAllister, Professor David and Nicholl, Dr Barbara and Butterly, Dr Elaine and Lewsey, Professor Jim and Mair, Professor Frances
• Authors: Hanlon, P., Jani, B. D., Butterly, E., Nicholl, B., Lewsey, J., McAllister, D. A., and Mair, F. S.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
• Journal Name: Communications Medicine
• Publisher: Nature Research
• ISSN: 2730-664X
• ISSN (Online): 2730-664X
• Copyright Holders: Copyright © 2021 The Authors
• First Published: First published in Communications Medicine 1: 28
• Publisher Policy: Reproduced under a Creative Commons License

Project Code	Award No	Project Name	Principal Investigator	Funder's Name	Funder Ref	Lead Dept
305232		Understanding prevalence and impact of frailty in chronic illness and implications for clinical management	Frances Mair	Medical Research Council (MRC)	MR/S021949/1	HW - General Practice and Primary Care