2176-P: Frailty-Guided Glycaemic Management in an Elderly Diabetic Population Based in the United Kingdom

Introduction and Objective: Diabetes can contribute to functional decline, which may, in turn, affect disease prognosis. The importance of considering frailty in the treatment of diabetes in the elderly is emphasised, yet formal recommendations on achieving targets are lacking. As life-expectancy increases, early detection of frailty and functional preservation in the diabetic population is vital. We aimed to use frailty assessments to screen for pre-frailty, monitor existing frailty, and help guide treatment intensity. Methods: Across four General Practices in the UK, frailty assessments were incorporated into the diabetic reviews of 489 diabetic adults ≥ 65 years. Mean age was 77 years (SD=8.1), 47% female. Patients were deemed 'frail', 'pre-frail', or 'not frail' using the frailty phenotype. Frail patients also received a Comprehensive Geriatric Assessment. Patients were assessed for 'frailty indicators’ (FIs) including: malnutrition, bone health, sarcopenia, poly-pharmacy, microvascular (MV) complications, co-morbidities. A personalised HbA1c target, reflecting baseline functional status, was documented for each patient. Results: Frailty assessments led to a new target HbA1c in 43% of patients. We coded 45% of patients as frail and 29% as pre-frail. The most common FIs in frail adults were MV (n=126), with retinopathy, nephropathy, and peripheral neuropathy present in 53%, 38% and 32% of frail individuals, respectively. Retinopathy was the most common MV complication in pre-frail adults. Mean age of frail patients with MV complications was 73 years—8 years younger than those without MV complications. Poly-pharmacy was associated with frailty and poorly controlled diabetes: OR 2.03 (95% CI: 1.27-3.29) and 2.11 (CI 95% 1.07-4.22), respectively. De-prescribing occurred in 13.3% of patients. Conclusion: Diabetes can accelerate biological ageing, leading to frailty that manifests earlier than chronological age alone would predict. Frailty-focused diabetic reviews aid tailored glycaemic targets, disease monitoring, and holistic care. Disclosure K. Warsame: None. S.N. Sharief: None. R. Rasheed: None.