An investigation into the impact of frailty on glycaemic control in older adults with type 1 diabetes mellitus

Abstract

Background:
People with type 1 diabetes (T1DM) are living longer as medical care advances. Frailty is an ageing related decline in an individual’s ability to respond to external stressors, with recognised tools for diagnosis and assessment. No research has specifically investigated T1DM in older adults with frailty. A key clinical consideration is hypoglycaemia, a known risk in older adults with type 2 diabetes (T2DM) linked with falls, fractures and hospital admissions. Guidelines promote a gradual relaxation of glucose targets as frailty progresses, mitigating hypoglycaemia risk. However, T1DM necessitates insulin therapy, a medication with an inherent hypoglycaemia risk, and concerns remain about diabetic ketoacidosis with elevated glycaemic targets. Consequently, unanswered questions remain in how to manage frailty in older adults with T1D.
Methods:
This study assessed whether older adults living with T1DM and frailty were having more hypoglycaemia than those not living with frailty. People over 65-years-old, with T1DM were recruited. Low C-peptide confirmed T1DM. Frailty was assessed using three frailty scores including the Fried Frailty Phenotype. Blinded Continuous Glucose Monitors measured duration of hypoglycaemia, which was compared across people with different levels of frailty. A qualitative sub-study re-recruited some individuals alongside carers of older adults with T1DM, aiming to explore their experiences and expectations. 30 interviews were recorded and transcribed and then thematically analysed.
Results:
86 participants were recruited, 16 assessed as living with frailty. No difference was observed in the presence of hypoglycaemia across the frailty spectrum. Interviews revealed people are finding T1DM management easier with ageing, citing factors such as technology, increased time, and greater experience in managing T1DM. Participants were concerned about the consequences of reduced cognition with ageing and the potential impact of this on self-care. This was echoed by the carers who feel adopting another person’s T1DM management is very difficult, with concerns raised about the training they receive and their ability to react at any moment to unpredictable glucose fluctuations.
Conclusions:
T1DM self-management is challenging, with hypoglycaemia a key consideration, but older adults in this research have displayed a high aptitude to maintain adequate self-care despite the challenges that frailty poses. This research highlights impaired cognition, and the complexities of handing over T1DM management to a carer as areas of significant concern for older adults living with T1DM. Further research should seek to clarify these findings and further investigate loss of cognition in the context of T1DM, and its impact on T1DM self-care.

Date of Award	Jan 2026
Original language	English
Awarding Institution	University of Brighton
Supervisor	Tom J. Levett (Supervisor), Ali Chakera (Supervisor) & Juliet Wright (Supervisor)