Sweet Frailty

As we age and our abilities decline, there comes a time when the younger generation consider us to be 'frail'. It seems obvious therefore that we should be interested in understanding what causes frailty considering that our own decline is inevitable and we will eventually become dependent upon others for care.

Frailty also has important socioeconomic ramifications for our ageing population; we can expect this global phenomenon to have profound implications for all facets of human life in the twenty-first century. Genes, environment and lifestyle are all known to play a role in the pathway to frailty. Disease also plays a role. Type 2 diabetes mellitus (T2DM), a disabling chronic cardiovascular and metabolic disease, places its own burdens on our ageing communities. A link has been proposed between diabetes and the increased vulnerability to environmental stressors that results from reduced physiological reserve (an objective definition of frailty) and age-related loss of strength (due to loss of muscle mass, termed sarcopaenia) in the elderly. The question arises as to whether there are any interventions that could slow development of frailty and lessen its impact on our daily lives.

The likelihood of people developing T2DM is known to be strongly associated with lifestyle; with risk increasing in sedentary and/or overweight people who have a poor diet. Lifestyle interventions are not just beneficial before the development of T2DM. Adopting a healthy lifestyle, with a healthy diet, regular exercise and weight loss, has been the cornerstone of diabetes treatment for decades. A broad range of clinical investigations conducted over the years support these conclusions, however, few lifestyle studies have been conducted in elderly diabetics. We find that as a consequence clinical guidelines are of limited utility in elderly patients. Evidence suggests that efforts to improve the function and well-being of patients may be of more clinical benefit than attention to metabolic control. The MID-Frail study focuses on the health benefits in elderly T2DM patients (over 70 years of age) and investigates whether diet and exercise improve general abilities and enhance quality of life rather than impact on traditional outcomes of diabetic studies such as glucose- and blood pressure-lowering.

A consortium of 16 organisations, involving experts in the fields of health of the elderly and diabetes, have come together to look at how exercise, education and dietary advice can improve the quality of life of older people with diabetes. In support of this pioneering clinical research, the consortium has been awarded a multi-million euro grant by the prestigious Seventh Framework Programme for Research and Technological Development (7FP), run by the EU Commission. The grant underlines recognition of the high profile support for continued research into the value of non-drug clinical interventions by bodies involved in planning for future healthcare delivery in an ageing population. During 2013, the consortium will be initiating this large clinical trial in older patients with T2DM recruited across seven EU countries. The study is spearheaded by Professor Alan Sinclair (Institute of Diabetes for Older People, UK) and Professor Leocadio Rodríguez Mañas (Hospital Universitario de Getafe, Spain) and has the support of Diabetes UK, a major patient and family advocacy organisation.

There is no doubt that the MID-Frail study is a unique piece of research. Its findings are not only expected to offer potential benefits to patients in a population often overlooked when it comes to novel medical care, it will also provide data essential for those planning for healthcare delivery in the twenty-first century.

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