Frailty severity at the time of T2DM diagnosis was associated with higher risks of DFU and mortality. In a large population-based analysis published in Diabetes Research and Clinical Practice, frailty showed a graded relationship with adverse outcomes over more than two decades of follow-up.

The analysis included 186 473 individuals with T2DM identified from primary care records linked to hospital admissions and mortality data between 2000 and 2021. Frailty status was categorized using the electronic frailty index. Parametric multistate models were used to evaluate transitions between T2DM, DFU, and death during follow-up.

The median age at cohort entry was 62 years, and 50.9% of individuals were women. Over a median follow-up of 8.8 years, 3 551 individuals (1.9%) developed DFU and 53118 (28.5%) died. Increasing frailty was associated with higher rates of DFU and markedly higher mortality.

Among women diagnosed at age 60, the 10-year adjusted probability of DFU was 2.1 % in those classified as fit, 1.9% with mild frailty, 2.9% with moderate frailty, and 3.2 % with severe frailty. Corresponding probabilities in men were 2.6%, 2.7%, 3.7%, and 4.4%, respectively.

These findings indicate that frailty status at T2DM diagnosis is associated with subsequent DFU risk and long-term mortality. Incorporating frailty assessment may enhance risk stratification for diabetic foot complications.