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An Evaluation of Multimodal Interventions for Co-morbid Frailty and Type 2 Diabetes Mellitus

It is estimated that 1 in 5 adults aged over 65 present with type 2 diabetes mellitus (T2DM), a statistic which is projected to double over the next 20 years. Importantly, the pathological interplay between T2DM and frailty exacerbates functional decline in older populations. While lifestyle interventions centred on physical activity and nutrition have shown promise in managing both conditions, preliminary findings in older T2DM patients highlight a significant non-response rate. Behavioural interventions’ ability to enhance physical function among frail older adults with T2DM, however, remains inadequately investigated. This study aims to assess individual responses to a structured multimodal intervention on functional performance through a cluster-randomised multicentre clinical trial enrolling 843 prefrail and frail individuals aged ≥70 years with T2DM. Participants were randomised into usual care control or multimodal intervention groups, which included 16-week progressive resistance training, seven nutritional and diabetological educational sessions, and achieving glycated haemoglobin (7–8%) and blood pressure (<150 mmHg) targets.

It is estimated that 1 in 5 adults aged over 65 present with type 2 diabetes mellitus (T2DM), a statistic which is projected to double over the next 20 years. Importantly, the pathological interplay between T2DM and frailty exacerbates functional decline in older populations. While lifestyle interventions centred on physical activity and nutrition have shown promise in managing both conditions, preliminary findings in older T2DM patients highlight a significant non-response rate. Behavioural interventions’ ability to enhance physical function among frail older adults with T2DM, however, remains inadequately investigated.

This study aims to assess individual responses to a structured multimodal intervention on functional performance through a cluster-randomised multicentre clinical trial enrolling 843 prefrail and frail individuals aged ≥70 years with T2DM. Participants were randomised into usual care control or multimodal intervention groups, which included 16-week progressive resistance training, seven nutritional and diabetological educational sessions, and achieving glycated haemoglobin (7–8%) and blood pressure (<150 mmHg) targets.

Key learnings:

At the 1-year follow-up, 53.7% of participants in the intervention group, compared to 38.0% in the control group, showed a ≥1-point improvement in their Short Physical Performance Battery (SPPB) score, with the largest improvement noted in gait speed. Factors such as age, SPPB score, and the number of frailty criteria met at baseline were found to reduce the likelihood of functional improvement. Response to the intervention correlated with adherence, age, and baseline functional status indicated by SPPB score and number of frailty criteria met. An adherence rate of at least 84% was necessary to reap the benefits of these multimodal interventions, with the highest probability of improving SPPB observed at adherence rates of 85% or higher. Consequently, individuals with fewer frailty criteria and lower SPPB scores may derive the greatest benefit from the intervention. Future studies are needed to evaluate the benefits of longer interventional programmes and explore sarcopenia’s influence on multimodal intervention-mediated improvements in SPPB scores.

Article: An Evaluation of Multimodal Interventions for Co-morbid Frailty and Type 2 Diabetes Mellitus

Reviewed by: S. Duarte

Authors: Alvarez-Bustos A, Laosa O, Marzetti E et al.

Published in: Age and Ageing (January 2024)

Article link

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