Why more research is required to explore the increased risk of COVID-19, frailty and diabetes in older people

By Editor
10th June 2020
Coronavirus, Older people

Research drives improvements to frontline healthcare. The evidence it generates is at the core of medical innovations, pathways and treatments.

Our Behind the Science feature tackles the latest developments, discussions and approaches and what they mean to healthcare professionals working in diabetes care.

We ask experts to delve deeper into their speciality, providing a unique approach and insight into their work.

This month’s article is written by Professor Alan Sinclair, who has an international reputation in the field of older people and founded Diabetes Frail which explores the emerging importance of frailty. He was also the first National Clinical Lead for Diabetes in Older People at NHS Diabetes. 

Diabetes in our ageing societies worldwide continues to be a high impact complex chronic illness associated with rising prevalences 1, high multimorbid profiles2, frailty 3, functional disability 4, amelioration by intervention 5, and which requires a multi-domain management approach 6.

Recruiting and maintaining older people with diabetes in research is often problematical although this area has recently been reviewed and guidance to promote this given 7.

However, a new exciting development in the area of diabetes and ageing is the proposed creation of the The International Foundation for Diabetes and Ageing which will hope to bring together clinicians and scientists to participate in activities such as research and diabetes education that will enhance the future quality of care to delivered to people with this condition.

Professor Alan Sinclair

The emergence of this Foundation follows naturally from a series of organisations previously established by myself, such as the Institute of Diabetes for Older People (IDOP) which was created as part of the Beds & Herts Postgraduate Medical School at the University of Bedfordshire in 2008. It played significant roles in national and early European medical research and clinical guideline development in the area of diabetes and older people.

On leaving the University in 2014, I established Diabetes Frail Ltd as an European Union (EU), validated not for profit research medical research organisation, which subsequently was associated as a partner with seven EU-funded projects whose combined research income across the European Union partners was over 60m euros.

Since then, Diabetes Frail has been involved in collaborative (Advisory, guidelines, educational) work with Diabetes UK, Joint British Diabetes Societies (JBDS), International Diabetes Federation (IDF),  International Federation of Ageing,  World Health Organisation (WHO), the International Conference on Frailty and Sarcopenia Research (ICFSR), Canadian Frailty Network, and the International Association of Geriatrics and Gerontology (IAGG) who in 2014 awarded me with the Presidential Medal for services to older people, particularly those with diabetes.

A ‘Roadmap’ of research areas (see picture below) has been produced to be part of the Foundation’s work and lists a number of research gaps that need to be addressed in the field of diabetes and older people.

This represents a review of recent reports that have previously examined what research directions are required and hopes to guide researchers to those priority areas.8,9

These may be prevention-based research that tackles the emerging epidemic of diabetes as well interventions that prevent diabetes-related disability.

The Roadmap also prioritises the high impact areas of frailty detection and management, and dementia care, as well as de-intensification research and glycaemic management.

The Roadmap emphasises the importance of collaborative work between medical and basic scientists, major pharma, epidemiologists and health economists, and that the sources of new data can be widely accessed varying from observational real life studies to randomised controlled trials (RCTs).

This research framework has been adopted by the European Diabetes Working Party for Older People (EDWPOP). 10

The Foundation invites colleagues across Europe and the rest of the world to work with it to stimulate greater interest in the area of diabetes in our ageing societies and hopes that new initiatives in research and education can be promoted.

The significant impact of the COVID-19 pandemic has highlighted the importance of the need for more research in this area and the potentially increased risk of developing the virus and poorer outcomes if frailty is present in older person with diabetes – a triple jeopardy 11.

A future aim is to establish the Foundation as a medical charity and will seek to obtain donations that will allow it to be a source of knowledge and enrichment not only to health professionals but also to those with diabetes, their families and carers, and those that are responsible for funding and coordinating new clinical pathways in this area.


  1. Sinclair A, Saeedi P, Kaundal A, Karuranga S, Malanda B, Williams R Diabetes and global ageing among 65-99-year-old adults: Findings from the International Diabetes Federation Diabetes Atlas, 9th edition.Diabetes Res Clin Pract. 2020 Feb 14:108078

2 – Huang ES, Liu JY, Moffet HH, John PM, Karter AJ. (2011) Glycemic control, complications, and death in older diabetic patients. Diabetes Care 34: 1329–1336.

  1. Sinclair AJ, Abdelhafiz AH, Rodríguez-Mañas L. Frailty and sarcopenia – newly emerging and high impact complications of diabetes. J Diabetes Complications. 2017 Sep;31(9):1465-1473

4 -Kalyani RR, Saudek CD, Brancati FL, et al. The Association of Diabetes, Comorbidities, and

Hemoglobin A1c with Functional Disability in Older Adults: Results from the National Health and

Nutrition Examination Survey (NHANES), 1999–2006. Diabetes Care. 2010; 33:1055–1060.aper

  1. Rodriguez-Mañas L, Laosa O, Vellas B, Paolisso G, Topinkova E, Oliva-Moreno J, Bourdel-Marchasson I, Izquierdo M, Hood K, Zeyfang A, Gambassi G, Petrovic M, Hardman TC, Kelson MJ, Bautmans I, Abellan G, Barbieri M, Peña-Longobardo LM, Regueme SC, Calvani R, De Buyser S, Sinclair AJ; European MID-Frail Consortium.Effectiveness of a multimodal intervention in functionally impaired older people with type 2 diabetes mellitus. J Cachexia Sarcopenia Muscle. 2019 Apr 23.
  2. Sinclair A, Dunning T, Rodriguez-Mañas L. Diabetes in older people: new insights and remaining challenges. Lancet Diabetes Endocrinol. 2015 Apr;3(4):275-85
  3. Sinclair AJ, Heller SR, Pratley RE, Duan R, Heine RJ, Festa A, Kiljański J. Evaluating glucose-lowering treatment in older people with diabetes: Lessons from the IMPERIUM trial. Diabetes Obes Metab. 2020 Feb 26
  4. Schernthaner G, Schernthaner-Reiter MH. Diabetes in the older patient: heterogeneity requires individualisation of therapeutic strategies. Diabetologia. 2018 Jul;61(7):1503-1516
  5. Sinclair AJ, Abdelhafiz AH, Forbes A, Munshi M. Evidence-based diabetes care for older people with Type 2 diabetes: a critical review. Diabet Med. 2018 Nov 8. doi: 10.1111/dme.13859. [Epub ahead of print]
  6. EDWPOP supports the recent research framework launched. European Diabetes Working Party for Older People March 2020 (http://diabetesfrail.org/the-european-diabetes-working-party-for-older-people-edwpop/)
  7. Sinclair AJ, Abdelhafiz AH. Age, frailty and diabetes – triple jeopardy for vulnerability to Covid-19 infection. EClinicalMedicine 2020; 22:100343. Published April 23rd 2020. Available at: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30087-0/fulltext

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