Multi-dimensional frailty management in elderly diabetic patients

doi:10.3760/cma.j.issn.2095-8757.2025.01.003

Abstract

Abstract:

Diabetes， a significant chronic disease that affects the functional status of the elderly，is closely associated with the onset and progression of sarcopenia and frailty. With aging， the body undergoes muscle-adipose tissue remodeling， leading to decreased muscle function and exacerbated insulin resistance. This creates a vicious cycle between diabetes and frailty， significantly impacting the clinical prognosis and treatment decisions for elderly diabetic patients. This paper comprehensively explores a multidimensional frailty management approach for elderly diabetic patients， including optimizing glycemic control strategies， implementing personalized nutritional interventions， developing tailored exercise prescriptions， and precision medication selection， so as to provide scientific guidance for improving patients' overall functional capacity and clinical outcomes.

Key words: Diabetes, Frailty, Aged, Blood glucose management, Frailty management

Tingting Huang, Li Qin, Juan Liu. Multi-dimensional frailty management in elderly diabetic patients[J]. Chinese Journal of Geriatrics Research(Electronic Edition), 2025, 12(01): 12-16.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhlnbyjdzzz.cma-cmc.com.cn/EN/10.3760/cma.j.issn.2095-8757.2025.01.003

https://zhlnbyjdzzz.cma-cmc.com.cn/EN/Y2025/V12/I01/12

References 30

［21］	Morrison S， Colberg SR， Mariano M， et al. Balance training reduces falls risk in older individuals with type 2 diabetes［J］.Diabetes Care， 2010， 33（4）：748-750.
［22］	Piercy KL， Troiano RP， Ballard RM， et al. The physical activity guidelines for Americans［J］. JAMA， 2018， 320（19）：2020-2028.
［23］	Kutz A， Kim DH， Wexler DJ， et al. Comparative cardiovascular effectiveness and safety of SGLT-2 inhibitors， GLP-1 receptor agonists， and DPP-4 inhibitors according to frailty in type 2 diabetes［J］. Diabetes Care， 2023， 46（11）：2004-2014.
［24］	American Diabetes Association Professional Practice Committee.Introduction and methodology： Standards of care in diabetes-2025［J］. Diabetes Care， 2025， 48（1 Suppl 1）：S1-S5.
［25］	Nishimura A， Masuda C， Murauchi C， et al. Relationship between frailty and diabetic pharmacologic therapy in older adults with type 2 diabetes： A cross-sectional study［J］. Drugs Aging， 2024，41（6）：531-542.
［26］	Sola D， Rossi L， Schianca GP， et al. Sulfonylureas and their use in clinical practice ［J］. Arch Med Sci， 2015， 11（4）：840-848.
［27］	Zhu ZN， Jiang YF， Ding T. Risk of fracture with thiazolidinediones： An updated meta-analysis of randomized clinical trials ［J］. Bone， 2014， 68：115-123.
［28］	Ahmad J， Rafat D. HbA1c and iron deficiency： A review［J］.Diabetes Metab Syndr， 2013， 7（2）：118-122.
［29］	Sinha B， Ghosal S. Meta-analyses of the effects of DPP-4 inhibitors， SGLT2 inhibitors and GLP1 receptor analogues on cardiovascular death， myocardial infarction， stroke and hospitalization for heart failure［J］. Diabetes Res Clin Pract， 2019，150：8-16.
［30］	Strain WD， Down S， Brown P， et al. Diabetes and frailty： An expert consensus statement on the management of older adults with type 2 diabetes［J］. Diabetes Ther， 2021， 12（5）：1227-1247.
［1］	国家老年医学中心，中华医学会老年医学分会，中国老年保健协会糖尿病专业委员会.中国老年糖尿病诊疗指南（2024版）［J］.协和医学杂志，2024，15（4）：771-800.
［2］	Chhetri JK， Zheng Z， Xu X， et al. The prevalence and incidence of frailty in pre-diabetic and diabetic community-dwelling older population： Results from Beijing longitudinal study of agingⅡ（BLSA-Ⅱ）［J］. BMC Geriatr， 2017， 17（1）：47.
［3］	Xue M， Xu W， Ou YN， et al. Diabetes mellitus and risks of cognitive impairment and dementia： A systematic review and meta-analysis of 144 prospective studies［J］. Ageing Res Rev，2019， 55：100944.
［4］	Buch A， Carmeli E， Boker LK， et al. Muscle function and fat content in relation to sarcopenia， obesity and frailty of old age--An overview［J］. Exp Gerontol， 2016， 76：25-32.
［5］	Tamura Y， Omura T， Toyoshima K， et al. Nutrition management in older adults with diabetes： A review on the importance of shifting prevention strategies from metabolic syndrome to frailty［J］.Nutrients， 2020， 12（11）：3367.
［6］	王双，詹俊鲲，程梅，等.中国养老机构内老年人血糖规范化管理专家共识（2021）［J］.中华老年医学杂志，2021，40（6）：683-694.
［7］	Liu GX， Chen Y， Yang YX， et al. Pilot study of the mini nutritional assessment on predicting outcomes in older adults with type 2 diabetes［J］. Geriatr Gerontol Int， 2017， 17（12）：2485-2492.
［8	］Nam GE， Park YG， Han K， et al. BMI， weight change， and dementia risk in patients with new-onset type 2 diabetes： A nationwide cohort study ［J］. Diabetes Care， 2019， 42（7）：1217-1224.
［9］	Sieber CC. Malnutrition and sarcopenia［J］. Aging Clin Exp Res，2019， 31（6）：793-798.
［10］	Verlaan S， Ligthart-Melis GC， Wijers SLJ， et al. High prevalence of physical frailty among community-dwelling malnourished older adults-a systematic review and meta-analysis［J］. J Am Med Dir Assoc， 2017， 18（5）：374-382.
［11］	Malara A， Sgrò G， Caruso C， et al. Relationship between cognitive impairment and nutritional assessment on functional status in Calabrian long-term-care［J］. Clin Interv Aging， 2014， 9：105-110.
［12］	Silva R， Pizato N， da Mata F， et al. Mediterranean diet and musculoskeletal-functional outcomes in community-dwelling older people： A systematic review and meta-analysis［J］. J Nutr Health Aging， 2018， 22（6）：655-663.
［13］	Kojima G， Avgerinou C， Iliffe S， et al. Adherence to Mediterranean diet reduces incident frailty risk： Systematic review and metaanalysis［J］. J Am Geriatr Soc， 2018， 66（4）：783-788.
［14］	Mattei J， Bigornia SJ， Sotos-Prieto M， et al. The Mediterranean diet and 2-year change in cognitive function by status of type 2 diabetes and glycemic control［J］. Diabetes Care， 2019， 42（8）：1372-1379.
［15］	Iimuro S， Yoshimura Y， Umegaki H， et al. Dietary pattern and mortality in Japanese elderly patients with type 2 diabetes mellitus： Does a vegetable- and fish-rich diet improve mortality？An explanatory study［J］. Geriatr Gerontol Int， 2012， 12 Suppl 1：59-67.
［16］	Rashidi Pour Fard N， Amirabdollahian F， Haghighatdoost F.Dietary patterns and frailty： A systematic review and metaanalysis［J］. Nutr Rev， 2019， 77（7）：498-513.
［17］	Hawley JA， Hargreaves M， Joyner MJ， et al. Integrative biology of exercise［J］. Cell， 2014， 159（4）：738-749.
［18］	Izquierdo M， Merchant RA， Morley JE， et al. International exercise recommendations in older adults （ICFSR）： Expert consensus guidelines［J］. J Nutr Health Aging， 2021， 25（7）：824-853.
［19］	Kobayashi Y， Long J， Dan S， et al. Strength training is more effective than aerobic exercise for improving glycaemic control and body composition in people with normal-weight type 2 diabetes： A randomised controlled trial［J］. Diabetologia， 2023，66（10）：1897-1907.
［20］	Sampath Kumar A， Maiya AG， Shastry BA， et al. Exercise and insulin resistance in type 2 diabetes mellitus： A systematic review and meta-analysis［J］. Ann Phys Rehabil Med， 2019， 62（2）：98-103.

[1]	Ying Pi, Qiang Zhang, Zhirong Huang. Predictive factors for one-year postoperative mortality in patients over 80 years old with femoral neck fractures [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2025, 19(01): 13-20.
[2]	Xun Liu, Qinglin Yan, Fubin Li, Jun Guo. Ultrasound-guided iliofascial block combined with general anaesthesia in elderly hip replacements [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2025, 19(01): 109-115.
[3]	Bing Han, Yutong Bi, Da He. Meta-analysis of relationship between frailty index and postoperative complications after lumbar spinal surgery [J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2025, 20(03): 233-240.
[4]	Jingya Yu, Yulan Shi, Lijuan Xiang, Cheng Chen, Yudie Luo. Analysis on the current status and influencing factors of frailty in elderly patients with chronic wounds [J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2025, 20(02): 141-147.
[5]	Binxiong Chen, Ming Xie. The therapeutic effects of sleeve gastrectomy and gastric bypass surgery on obesity complicated with type 2 diabetes mellitus [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(04): 461-466.
[6]	Puzhao Liang, Yuyi Wu, Zhentao Tian. A case report of diabetes secondary left perinephric abscess with splenic abscess and pleural effusion [J]. Chinese Journal of Endourology(Electronic Edition), 2025, 19(01): 116-119.
[7]	Juan Liu, Xiufeng Liu, Chen Zhang. The influence of diffenrent administration routes of dexmedetomidine on cognitive function in elderly patients undergoing heria repair surgery [J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2025, 19(02): 210-213.
[8]	Junyi Wang, Zhenfeng Xue. Application of absorbable mesh in open inguinal hernia repair in elderly patients [J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2025, 19(01): 88-91.
[9]	Li Han, Qiyuan Wang, Jie Meng, Xinliang Yang, Xia Liu, Chenyan He. Risk factors of secondary pulmonary fungal infection in patients with diabetes mellitus and pulmonary tuberculosis [J]. Chinese Journal of Lung Diseases(Electronic Edition), 2025, 18(02): 304-309.
[10]	Jiajun Jiang, Deling Wei, Hongbing Ren, Hai Zhu, Jilong Wang, Banghao Xu, Ya Guo, Tingting Lu, Ling Zhang, Zili Lyu, Zhang Wen. Safety and efficacy of total pancreatectomy for pancreatic cancer and literature review [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2025, 14(02): 281-289.
[11]	Huan Wang, Hongfeng Wang, Zhongzhen Jin, Xiaofen Peng, Yanhua Jin, Dewei Zhang, Yanning Zhang. Predictive role of neutrophil to lymphocyte ratio in cardiovascular disease mortality risk of peritoneal dialysis patients with diabetes mellitus [J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2025, 14(01): 7-12.
[12]	Yahui Li, Lin Luan, Huiyun Huang. Construction and validation of risk model for young and middle-aged patients with liver cancer at different recurrence stages after radical operation [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2025, 15(02): 112-119.
[13]	Ziyu Dai, Bin Xie, Yuanbo Wu, Qiong Chen. Research progress on chronic obstructive pulmonary disease complicated with frailty [J]. Chinese Journal of Geriatrics Research(Electronic Edition), 2025, 12(01): 1-6.
[14]	Lanxin Zhao, Jingtong Wang. Clinical characteristics and advances in diagnosis and treatment of oral frailty [J]. Chinese Journal of Geriatrics Research(Electronic Edition), 2025, 12(01): 7-11.
[15]	Ting Pang, Yuankai Shao, Zhibin Wang, Ping Xi, Li Zhou, Yuan Zhang, Pan Zhou, Zhe Deng. Recombinant human acidic fibroblast growth factor promotes healing of acute wound in diabetic mice by inhibiting chronicity of acute inflammation [J]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2025, 11(01): 31-36.

Please choose a citation manager

Content to export