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Clinical Summary

Pre-Frailty and Frailty Linked to Diabetic Microvascular Complications Risk


  • In patients with type 2 diabetes (T2D), both pre-frailty and frailty were associated with a higher risk of overall diabetic microvascular complications and its subtypes such as diabetic nephropathy, diabetic neuropathy, and diabetic retinopathy.

Why This Matters

  • Findings have significant clinical implications for integrating routine clinical assessment and surveillance of frailty into the prevention and management of diabetic microvascular complications in T2D.

Study Design

  • A population based cohort study of 18,062 patients (age 40-69 years) with T2D, identified from the UK Biobank (2006-2010).
  • Primary outcome: overall incident diabetic microvascular complications (composite of diabetic nephropathy, diabetic neuropathy, and/or diabetic retinopathy).
  • Funding: None disclosed.

Key Results

  • Of 18,062 patients, 1888 (10.4%) were frail, 10,073 (55.8%) were pre-frail, and 6101 (33.8%) were non-frail.
  • Compared with patients with non-frailty, the risk of (adjusted HR [aHR]; 95% CI):
    • overall diabetic microvascular complications was higher in those with:
      • pre-frailty (1.10; 1.02 to 1.18); and
      • frailty (1.52; 1.36 to 1.69; Ptrend<0.0001).
    • diabetic nephropathy was higher in those with:
      • pre-frailty (1.15; 1.04 to 1.27; and
      • frailty (1.59; 1.38 to 1.83).
  • Patients with vs without frailty had a higher risk of (aHR; 95% CI):
    • diabetic retinopathy (1.32; 1.10 to 1.58); and
    • diabetic neuropathy (1.87; 1.46 to 2.39).
  • Each 1-point increase in the frailty phenotype score was associated with 13%, 16%, 10%, and 20% increase in the risk of diabetic microvascular complications, diabetic nephropathy, diabetic retinopathy, and diabetic neuropathy, respectively.


  • Observational design.