AIMS: Type 2 diabetes (T2D) is associated with frailty in older people. We aim to explore changes in frailty status after ≥18 months of intervention. METHODS: 298 community-dwelling older adults (>70 years) participating in MIDFRAIL followed-up for 18-24 months were randomly allocated by trial site (cluster) to intervention IG (16-weeks resistance exercise program, nutritional-educational sessions, optimization of diabetes care), or usual care group (UCG). Frailty status was assessed by the Fried Frailty Phenotype criteria at baseline and final visit. Functional status was assessed by the SPPB in every visit. We used multivariate linear and logistic regression for continuous and dichotomous outcomes. This study was registered at Clinicaltrials.gov (NCT01654341). RESULTS: Mean age was 77.7 (SD 5.54), 47% were male, 32.9% frail and 67.1% prefrail. The probability of improving the frailty status and decreasing the number of Fried's frailty criteria was higher in the IG than in the UCG (OR 2.6, 95%CI 1.3-5.4; p = 0.009 and OR 1.9; 95%CI 1.1-3.1; p = 0.02, respectively). IG participants more frequently improved ≥1 point in SPPB score (OR 1.85; 95%CI 1.09-3.12; p = 0.022). These benefits were mainly accounted for the prefrail participants. CONCLUSIONS: The MIDFRAIL intervention improved frailty status and physical function at long-term follow-up in older people with T2D.

• Keywords
• Clinical trial, Diabetes, Frailty, Functional impairment, Older people,
• MeSH
• Diabetes Mellitus, Type 2 * therapy   complications   physiopathology   MeSH
• Geriatric Assessment MeSH
• Frailty * therapy   MeSH
• Frail Elderly * MeSH
• Humans MeSH
• Resistance Training MeSH
• Independent Living MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Physical Functional Performance * MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Randomized Controlled Trial MeSH

OBJECTIVE: To determine whether a multicomponent intervention based on physical activity with technological support and nutritional counselling prevents mobility disability in older adults with physical frailty and sarcopenia. DESIGN: Evaluator blinded, randomised controlled trial. SETTING: 16 clinical sites across 11 European countries, January 2016 to 31 October 2019. PARTICIPANTS: 1519 community dwelling men and women aged 70 years or older with physical frailty and sarcopenia, operationalised as the co-occurrence of low functional status, defined as a short physical performance battery (SPPB) score of 3 to 9, low appendicular lean mass, and ability to independently walk 400 m. 760 participants were randomised to a multicomponent intervention and 759 received education on healthy ageing (controls). INTERVENTIONS: The multicomponent intervention comprised moderate intensity physical activity twice weekly at a centre and up to four times weekly at home. Actimetry data were used to tailor the intervention. Participants also received personalised nutritional counselling. Control participants received education on healthy ageing once a month. Interventions and follow-up lasted for up to 36 months. MAIN OUTCOME MEASURES: The primary outcome was mobility disability (inability to independently walk 400 m in <15 minutes). Persistent mobility disability (inability to walk 400 m on two consecutive occasions) and changes from baseline to 24 and 36 months in physical performance, muscle strength, and appendicular lean mass were analysed as pre-planned secondary outcomes. Primary comparisons were conducted in participants with baseline SPPB scores of 3-7 (n=1205). Those with SPPB scores of 8 or 9 (n=314) were analysed separately for exploratory purposes. RESULTS: Mean age of the 1519 participants (1088 women) was 78.9 (standard deviation 5.8) years. The average follow-up was 26.4 (SD 9.5) months. Among participants with SPPB scores of 3-7, mobility disability occurred in 283/605 (46.8%) assigned to the multicomponent intervention and 316/600 (52.7%) controls (hazard ratio 0.78, 95% confidence interval 0.67 to 0.92; P=0.005). Persistent mobility disability occurred in 127/605 (21.0%) participants assigned to the multicomponent intervention and 150/600 (25.0%) controls (0.79, 0.62 to 1.01; P=0.06). The between group difference in SPPB score was 0.8 points (95% confidence interval 0.5 to 1.1 points; P<0.001) and 1.0 point (95% confidence interval 0.5 to 1.6 points; P<0.001) in favour of the multicomponent intervention at 24 and 36 months, respectively. The decline in handgrip strength at 24 months was smaller in women assigned to the multicomponent intervention than to control (0.9 kg, 95% confidence interval 0.1 to 1.6 kg; P=0.028). Women in the multicomponent intervention arm lost 0.24 kg and 0.49 kg less appendicular lean mass than controls at 24 months (95% confidence interval 0.10 to 0.39 kg; P<0.001) and 36 months (0.26 to 0.73 kg; P<0.001), respectively. Serious adverse events occurred in 237/605 (39.2%) participants assigned to the multicomponent intervention and 216/600 (36.0%) controls (risk ratio 1.09, 95% confidence interval 0.94 to 1.26). In participants with SPPB scores of 8 or 9, mobility disability occurred in 46/155 (29.7%) in the multicomponent intervention and 38/159 (23.9%) controls (hazard ratio 1.25, 95% confidence interval 0.79 to 1.95; P=0.34). CONCLUSIONS: A multicomponent intervention was associated with a reduction in the incidence of mobility disability in older adults with physical frailty and sarcopenia and SPPB scores of 3-7. Physical frailty and sarcopenia may be targeted to preserve mobility in vulnerable older people. TRIAL REGISTRATION: ClinicalTrials.gov NCT02582138.

• MeSH
• Frailty * MeSH
• Frail Elderly MeSH
• Humans MeSH
• Child, Preschool MeSH
• Independent Living MeSH
• Sarcopenia * prevention & control   MeSH
• Aged MeSH
• Hand Strength MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Child, Preschool MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Randomized Controlled Trial MeSH