The role of assessing frailty in cardiometabolic risk management

Aims: Frailty is highly associated with morbidity and mortality in type 2 diabetes mellitus (T2DM). This viewpoint article reviews the importance of considering frailty in T2DM and cardiometabolic risk factor management and recommends its systematic integration into clinical practice. We propose that frailty is not merely a complication of metabolic disease, but an independent modifier of risk, treatment response, and outcomes. Data synthesis: We conducted a literature review on the epidemiology of frailty in T2DM, bidirectional biological mechanisms linking frailty to T2DM and cardiometabolic disease, comparative utility of frailty measurement tools, and opportunities for incorporation of frailty assessments into routine T2DM and cardiometabolic care. Conclusions: Frailty is highly prevalent among individuals with T2DM and independently amplifies the risk of adverse outcomes including mortality, cardiovascular disease (CVD) events, functional decline, and hypoglycemia, beyond traditional cardiometabolic risk factors. The bidirectional relationship between frailty and dysglycemia, mediated by sarcopenia, chronic inflammation, and insulin resistance, highlights the importance of early, systematic frailty assessment in diabetes care. The Fried Frailty Phenotype and the Frailty Index are validated tools suitable for clinical and research contexts. Frailty evaluation can assist with the prioritization of interventions and the individualization of glycemic targets. Integrating frailty assessment into routine T2DM and cardiometabolic risk factor management is feasible, clinically meaningful, and can promote person-centred care for older adults.