衰弱和多病是2型糖尿病中常见的现象，包括年龄在65岁以下的中年人群。临床指南建议在衰弱或多病的患者中调整治疗目标。然而，指南没有明确规定如何确定衰弱/多病。目前尚不清楚是否应将建议应用于年轻年龄组的衰弱/多病的患者。本研究目的是使用四种不同的方法评估2型糖尿病中年至老年患者的衰弱/多病的患病率和临床影响。研究设计为队列研究，基线收集于2006-2010年，随访中位数为8年。研究对象为英国生物库的2型糖尿病参与者（n=20,566），年龄在40-72岁之间。暴露因素为四种衰弱（衰弱表型和衰弱指数）和多病（Charlson并发症指数和长期疾病（LTCs）的数字计数）测量标准。结果发现，2型糖尿病患者的衰弱和多病普遍存在。使用不同的测量标准鉴定的个体有所不同：至少有一种标准鉴定为42％ 衰弱或多病患者，所有四种标准都鉴定为2.2％。每种测量标准都与增加的死亡风险（所有原因，心血管和癌症相关的死亡率），主要不良心血管事件（MACE），低血糖和跌倒有关。每年5年的死亡率的绝对风险，与一定水平的衰弱（例如，在使用衰弱表型时，45、55和65岁男性的死亡率分别为1.9％，4.4％和9.9％）或多病（例如，在使用4种长期疾病的med 45、55和65岁男性的死亡率分别为1.3％，3.7％和7.8％）有关。化学性葡萄糖(HbA1c)水平则未与任何一种测量标准相关。对于衰弱指数、Charlson并发症指数和LTC计数，HbA1c与死亡率之间的关系在所有衰弱/多病水平上始终保持一致。对于衰弱表型，与衰弱前或强壮的参与者相比，衰弱患者HbA1c与死亡率之间的关系更为陡峭和线性。因此，应将衰弱和多病的评估融入2型糖尿病中年和老年患者的例行管理中。识别方法以及年龄等特征会影响基线风险，这应该影响临床决策（例如，糖尿病控制）。 ©2021家庭医学年鉴公司。

Context: Frailty and multimorbidity are common in type 2 diabetes, including in middle-aged people (<65 years). Clinical guidelines recommend adjustment of treatment targets in people with frailty or multimorbidity. However, guidelines do not specify how frailty/multimorbidity should be identified. It is not clear if recommendations should be applied to people with frailty/multimorbidity at younger ages. Objective: Assess prevalence and clinical implications of frailty/multimorbidity in middle- to older-aged people with type 2 diabetes using four different measures. Design: Cohort, baseline 2006-2010, median 8 years follow-up. Setting: Community Participants: UK Biobank participants (n=20,566) with type 2 diabetes aged 40-72 years. Exposures: Four measures of frailty (frailty phenotype and frailty index) and multimorbidity (Charlson Comorbidity index and numerical count of long-term conditions (LTCs)). Outcomes: Mortality (all-cause, cardiovascular- and cancer-related mortality), Major Adverse Cardiovascular Event (MACE), hospitalization with hypoglycaemia, fall or fracture. Results: Frailty and multimorbidity are prevalent in in people with type 2 diabetes from age 40-72. Individuals identified differed depending on which measure was used: 42% frail of multimorbid by at least one scale; 2.2% were identified by all four scales. Each measure was associated with increased risk of mortality (all-cause, cardiovascular, and cancer-related), MACE, hypoglycaemia and falls. The absolute risk of 5-year mortality was higher in older versus younger participants with a given level of frailty (e.g. 1.9%, 4.4%, and 9.9% in men aged, 45, 55, and 65, respectively, using frailty phenotype) or multimorbidity (e.g. 1.3%, 3.7%, and 7.8% in med with 4 long-term conditions aged 45, 55, and 65, respectively). No measure was associated with baseline HbA1c. For the frailty index, Charlson Comorbidity index, and LTC count, the relationship between HbA1c and mortality was consistent across all levels of frailty/multimorbidity. For the frailty phenotype, the relationship between HbA1c and mortality was steeper and more linear in frail compared with pre-frail or robust participants. Conclusion: Assessment of frailty/multimorbidity should be embedded within routine management of middle-aged and older people with type 2 diabetes. Method of identification as well as features such as age impact baseline risk and should influence clinical decisions (eg. glycaemic control).© 2021 Annals of Family Medicine, Inc.