New metabolic frailty phenotyping recommendations issued

Concise advice on how an individual’s frailty phenotype influences what glucose-lowering therapy they should use is now available. 

According to researchers from the Foundation for Diabetes Research in Older People (fDROP), King’s College London and Rotherham, frailty is measured on a scale of metabolic phenotypes that differ in insulin resistance.

The two phenotypes identified by the academics include:

  • Sarcopenic obese (SO) frail phenotype – increased visceral fat and increased insulin resistance
  • Anorexic malnourished (AM) frail phenotype – significant muscle loss and reduced insulin resistance

The guidance shows that an individual’s metabolic phenotype determines their hypoglycaemic therapy, glycaemic targets and overall goals of therapy.

Professor Alan Sinclair, co-lead author, 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 study stated: “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 academics concluded: “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.”

Read the full study here.

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