Multimorbidity, Frailty and Diabetes in Older People-Identifying Interrelationships and Outcomes

Abstract

Multimorbidity and frailty are highly prevalent in older people with diabetes. This high prevalence is likely due to a combination of ageing and diabetes-related complications and other diabetes-associated comorbidities. Both multimorbidity and frailty are associated with a wide range of adverse outcomes in older people with diabetes, which are proportionally related to the number of morbidities and to the severity of frailty. Although, the multimorbidity pattern or cluster of morbidities that have the most adverse effect are not yet well defined, it appears that mental health disorders enhance the multimorbidity-related adverse outcomes. Therefore, comprehensive diabetes guidelines that incorporate a holistic approach that includes screening and management of mental health disorders such as depression is required. The adverse outcomes predicted by multimorbidity and frailty appear to be similar and include an increased risk of health care utilisation, disability and mortality. The differential effect of one condition on outcomes, independent of the other, still needs future exploration. In addition, prospective clinical trials are required to investigate whether interventions to reduce multimorbidity and frailty both separately and in combination would improve clinical outcomes.

Keywords: diabetes; frailty; multimorbidity; older people; outcomes.

Figure 1

PRISMA flow diagram.

Figure 2

Multimorbidity-frailty interaction. Multiple subclinical organ dysfunction lead to frailty, multimorbidity associated with other factors such as weakness lead to frailty, both multimorbidity and frailty lead to disability, which in turn worsens multimorbidity and frailty and eventually increases mortality. MSO = Musculoskeletal/somatic, NMH = Neurological/mental health, CV = cardiovascular.