An analysis of frailty and multimorbidity in 20,566 UK Biobank participants with type 2 diabetes - PubMed (original) (raw)

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

Peter Hanlon et al. Commun Med (Lond). 2021.

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).

Keywords: Epidemiology; Type 2 diabetes.

© The Author(s) 2021.

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Conflict of interest statement

Competing interestsThe authors declare no competing interests.

Figures

Fig. 1

Fig. 1. Distribution of frailty or multimorbidity.

This figure shows the distribution of each measure of frailty or multimorbidity (panel (a) frailty index, (b) frailty phenotype, (c) Charlson index, (d) long-term condition count). The height of the bar indicates the number of participants with percentages indicated above the bars.

Fig. 2

Fig. 2. Venn diagram of overlap between frailty and multimorbidity measures.

This figure shows the overlap between each definition of frailty or multimorbidity. The percentage of participants identified by each combination of measures is shown by the percentages in each overlapping section. Note that 58% of participants were below the 75th centile for all definitions and are therefore not included in the Venn diagram.

Fig. 3

Fig. 3. Relationship between frailty or multimorbidity and all-cause mortality.

This figure shows the predicted 5-year mortality rate for each measure of frailty or multimorbidity (panel (a) frailty index, (b) frailty phenotype, (c) Charlson index, (d) long-term condition count). Coloured lines or points indicate point estimates for predicted 5-year mortality. Men are shown in blue, and women in red. Shaded areas indicate 95% confidence intervals. Grey circles indicate the number of participants with each level of frailty or multimorbidity. Models are adjusted for age, sex, socioeconomic status, body mass index, smoking, and alcohol. Predicted 5-year mortality is based on age 60, socioeconomic status and body mass index held at the sample mean, previous smokers, and 1–4 times weekly alcohol intake.

Fig. 4

Fig. 4. Relationship between frailty or multimorbidity and MACE, hypoglycaemia, and falls.

This figure shows the predicted 5-year rate of fall or fracture (panels a, b, c, and d showing the frailty index, frailty phenotype, Charlson index, and long-term condition count, respectively) hospitalization with hypoglycaemia (panels e, f, g, and h showing the frailty index, frailty phenotype, Charlson index, and long-term condition count, respectively) and MACE (panels i, j, k and m showing the frailty index, frailty phenotype, Charlson index, and long-term condition count, respectively). Coloured lines or points indicate point estimates for predicted 5-year mortality. Men are shown in blue, and women in red. Shaded areas indicate 95% confidence intervals. Models are adjusted for age, sex, socioeconomic status, body mass index, smoking, and alcohol. Predicted 5-year risk is based on age 60, socioeconomic status and body mass index held at the sample mean, previous smokers, and 1–4 times weekly alcohol intake.

Fig. 5

Fig. 5. HbA1c and all-cause mortality.

This figure shows the relationship between HbA1c and predicted 5-year mortality at different levels of frailty or multimorbidity (panel (a) frailty index, (b) frailty phenotype, (c) Charlson index, (d) long-term condition count). Coloured lines or points indicate point estimates for predicted 5-year mortality. Colours indicate the level of frailty or multimorbidity according to centiles. Shaded areas indicate 95% confidence intervals. Models are adjusted for age, sex, socioeconomic status, body mass index, smoking, and alcohol. Predicted 5-year mortality is based on age 60, socioeconomic status, and body mass index held at the sample mean, previous smokers, and 1–4 times weekly. There was a significant interaction between the frailty phenotype and HbA1c. Interactions between frailty index, Charlson index, and LTC count were not significant.

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