Researchers have defined two distinct types of frailty, which is a common complication of diabetes in older patients, which can guide clinicians in the choice of glucose-lowering therapy.
The two phenotypes are sarcopenic obese (SO), characterised by increased visceral fat and increased insulin resistance – and anorexic malnourished (AM), determined by significant muscle loss and reduced insulin resistance.
In the SO phenotype, GLP-1 RAs and SGLT2 inhibitors should be considered early on in therapy due to their benefits of weight reduction and ability to achieve tight glycaemic control, the researchers said, with a focus on cardiovascular risk reduction.
But in the AM phenotype, weight neutral agents such as metformin and/or DPP-4 inhibitors, or insulin therapy, should be considered early on, because they would limit further weight loss, and because of the possible anabolic and weight gaining effects of insulin. The study says: ‘Here the goals of therapy will be a combination of more relaxed glycaemic control and avoidance of hypoglycaemia, and the focus will be on maintenance of a good quality of life.’
The study co-lead Professor Alan Sinclair said that while frailty was ‘firmly established as a distinct complication of diabetes, we still know relatively little about what glucose-lowering treatments are optimal in this syndrome. The use of phenotype targeting is a step towards precision medicine.’
Sinclair AJ, et al. Aging Clin Exp Res 2022. https://link.springer.com/article/10.1007/s40520-022-02142-8
