Abstract
The focus in diabetes care has traditionally been around the optimisation of the glycaemic control and prevention of complications. However, the prevention of frailty and improvement in physical function have now emerged as new targets of diabetes management. This is mainly driven by the significant adverse impact that early onset frailty and decline in physical function have on health outcomes, functional independence, and quality of life in people with type 2 diabetes (T2D). There is an increasing emphasis in the expert consensus and management algorithms to improve physical function in people with T2D, predominantly through lifestyle interventions, including exercise and the control of modifiable risk factors. Trials of novel glucose-lowering therapies (GLTs) also now regularly assess the impact of these novel agents on measures of physical function within their secondary outcomes to understand the impact that these agents have on physical function. However, challenges remain as there is no consensus on the best method of assessing physical function in clinical practice, and the recognition of impaired physical function remains low. In this review, we present the burden of a reduced physical function in people with T2D, outline methods of assessment used in healthcare and research settings, and discuss strategies for improvement in physical function in people with T2D.
Highlights
A concept closely related to impaired physical function is physical disability, which is defined as difficulty in carrying out activities essential to independent living, including tasks needed for self-care and which are considered important for a good quality of life [5]
Diverse tools have been employed in clinical research to measure physical function either directly or indirectly, from the use of subjective, but validated, questionnaires and patient-reported outcomes (PRO), e.g., the 36-Item Short Form Survey (SF36) [32], EuroQol5D (EQ-5D) [33], Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes (SHIELD-WQ9) [34], 14-item Current Health Satisfaction Questionnaire (CHES-Q) [35], and Impact of Weight on Quality of Life-Lite (IWQOL-Lite) [36], to physical laboratory-based assessments that can test an individual’s capacity to perform basic activities of daily living (ADL) and instrumental activities of daily living (IADL)
People with type 2 diabetes (T2D) are at an increased risk of frailty and impaired physical function
Summary
When the term frailty is mentioned, the first concept that usually comes to mind is a thin elderly person using a frame or a stick for mobility and who is at an increased risk of recurrent falls, infection, illness, and hospitalisation. The frailty phenotype in type 2 diabetes (T2D) can coexist in younger persons with underlying obesity and multiple comorbidities. This is a rapidly emerging pattern in people with T2D due to an increase in the incidence of early onset T2D (
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