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

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. 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. 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. 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). Hanlon et al. study the prevalence of frailty and multimorbidity in a cohort of 20,566 UK Biobank participants with type 2 diabetes aged between 40 and 72 years. They observe that, even in this relatively young population, people living with frailty and/or multimorbidity are at increased risk of adverse outcomes including mortality, major adverse cardiovascular events, and hypoglycaemia. People living with type 2 diabetes often have multiple other long-term conditions (multimorbidity) or increased vulnerability to aging-related declines in health (frailty). These states are common in older people, however their prevalence and impact in people aged under 65 years are less clear. This study uses data from UK Biobank, a large group of people aged 40–72 years old, to study the impact of frailty and multimorbidity in relatively younger people with type 2 diabetes. We found that both frailty and multimorbidity were common in people with type 2 diabetes, even at relatively younger ages. People living with frailty or multimorbidity were at greater risk of mortality, heart attacks or strokes, falls or fractures, and of being hospitalized with low blood sugar. Assessing frailty and multimorbidity may help to identify people requiring individualized clinical management and assessment of risk.