Metabolic frailty phenotyping guidance published

An individual’s frailty phenotype determines what glucose-lowering therapy they should use, a new study has determined. 

A team of established clinical academics from fDROP (Foundation for Diabetes Research in Older People), King’s College London and Rotherham have revealed that the presence of frailty can be seen as a spectrum of metabolic phenotypes that vary in insulin resistance, of which have been defined into two phenotypes.

These include the sarcopenic obese (SO) frail phenotype – increased visceral fat and increased insulin resistance – and the anorexic malnourished (AM) frail phenotype – significant muscle loss and reduced insulin resistance.

The study has found that in view of these varying metabolic phenotypes, the choice of hypoglycaemic therapy, glycaemic targets and overall goals of therapy are likely to be different.

Co-lead author, Professor Alan Sinclair said: “Whilst we have firmly established that frailty represents 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”

The report said: “In the SO phenotype, weight-limiting hypoglycaemic agents, especially the new agents of GLP-1RA and SGLT-2 inhibitors, should be considered early on in therapy due to their benefits on weight reduction and ability to achieve tight glycaemic control where the focus will be on the reduction of cardiovascular risk.”

The researchers summarised: “In the AM phenotype, weight-neutral agents or insulin therapy should be considered early on due to their benefits of limiting further weight loss and the possible anabolic effects of insulin.

“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.”

According to the academics, future research is still required to develop novel hypoglycaemic agents with a positive effect on body composition in those who are frail.

To access the study, click here.

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