Photo Credit: Halfpoint

 A recent review suggests that combining exercise, diet, and education can help older adults effectively manage glucose and frailty in T2D.

New research highlights the effectiveness of combining physical exercise, education, and behavioral therapy in managing frailty and blood glucose variability in older adults with T2D.

While exercise protocols show measurable improvements in mobility and physical performance, the role of dietary strategies—such as a Mediterranean-style diet—remains underexplored. According to the authors of a paper published in the Journal of Cardiovascular Development and Disease, this creates opportunities for further study of tailored nutritional interventions.

“Frailty is a frequent clinical syndrome in people with this condition, and it is the greatest determining factor for disability in diabetic people,” wrote German C. Giraldo-Gonzalez, PhD, and colleagues. “Food intake is frequently underestimated by older people, who also have a pro-inflammatory state and chronic diseases, facilitating caloric protein depletion; therefore, the diet should be sufficient, complete, and balanced.”

The researchers conducted a systematic scoping review to document the objectives, characteristics, and results of nutritional interventions in older people with T2D and frailty.

The study team examined articles published in English, Spanish, or Portuguese between January 2018 and October 2022, focusing on nutrition and diet interventions. The review relied on four databases—PubMed, Web of Science, Scopus, and ScienceDirect—with search terms related to frailty, diabetes, nutrition, and older adults.

Of the 301 initial results, 295 were screened after removing duplicates, and 27 articles were identified as relevant based on their abstracts. The final sample included nine studies, which were then independently evaluated by six health professionals from diverse fields to ensure the integrity of the selection process.

Of the nine studies selected, most were conducted in Europe, primarily Spain, followed by the U.S. and Japan. The studies reflected three key research approaches:

• experimental studies combining physical and nutritional interventions;
• observational studies exploring the relationship between diet and frailty stages; and
• one review updating pharmacological and non-pharmacological management strategies for frail older adults with T2D.

Functional improvements were a major outcome, and multiple studies have demonstrated long-term benefits from tools like the Short Performance Physical Battery (SPPB).

For example, interventions led to sustained improved balance and mobility, with some participants transitioning from frail to prefrail conditions over time. These studies also significantly improved functional markers, such as muscle strength and power.

Some studies reported modest improvements in A1C and fasting blood glucose, although long-term glycemic control outcomes varied.

Nutritional interventions, particularly those aligned with the Mediterranean diet, were associated with lower frailty risks. One study “assessed the association of the Mediterranean diet with low frailty risk in older women with T2D and reported that the increase in consuming the Mediterranean diet was associated with a 28% reduction in the risk of frailty (95% CI, 19–36%). This was especially observed in diets reported to have high fruit and vegetable content,” the authors noted.

Another study highlighted that limited dietary variety increased the odds of frailty 5-fold. The reviewers noted that recommendations include tailored A1C targets (7.5%–8.5%) and adequate protein intake to preserve muscle mass in older adults.

“The nutritional intervention is a diet of 30 kcal/kg of body weight/day, with a protein quantity of 1.0 to 1.2 g/kg of body weight per day to maintain and restore muscle mass in those over 65 years old [and] maintain normal vitamin D levels,” the authors said, adding that the Mediterranean diet was highly recommended. “Physical exercise was recommended in different modalities and adapted to the functional conditions (including severe physical disability) and health of each person with T2D.”

Cost-effectiveness analyses also showed promising results, with the MID FRAIL study reporting significantly lower healthcare costs driven by reduced hospitalizations among participants in the intervention group compared with those receiving usual care.

“Management of T2D in older adults with frailty requires goals and interventions tailored to their functional capacity and health condition,” concluded the authors. “The exercise, diet, and education programs reviewed have demonstrated their effectiveness in improving physical performance, reducing the risk of frailty or progression to more advanced stages, and achieving better glycemic control.”