Effects of glycemic control on frailty: a multidimensional perspective

Diabetes prevalence increases with increasing age due to increased life expectancy. In older people with diabetes, frailty is an emerging diabetes-related complication. Although the literature is focused on the physical decline as the main manifestation of frailty, other domains such as cognitive and emotional dysfunction are commonly associated with physical frailty constituting a triad of impairment (TOI). The TOI is a better predictor of adverse outcomes than physical frailty alone. Previous diabetes studies focused on cardiovascular events as the main outcome with little data exploring the effect of glycemic control on frailty as a multidimensional perspective. Current evidence suggests that poor glycemic control may be associated with an increased risk of the three components of the TOI, however, the association of tighter glycemic control and the risk of TOI is inconsistent. In general HbA1c range of 6.5-7.9% appears to be less associated with TOI, while HbA1c > 8.0% is associated with a higher risk although most of the studies have limitations such as retrospective or cross-sectional design. So far, there is very little evidence from clinical trials to suggest that tight glycemic control would prevent or delay the development of frailty as a wide spectrum of physical, cognitive or emotional dysfunction. Therefore, future clinical trials are required to explore the effect of tight glycemic control on the multidimensional aspect of frailty as the main outcome. However, tight glycemic control in older people is associated with increased risk of hypoglycemia, which increases the risk of frailty. Therefore, novel hypoglycemic agents with intrinsic properties to reduce the risk of frailty, independent of glycemic control, are also required.