# Type 1 diabetes, ageing and frailty: an underexplored intersection

## TL;DR

This paper explores how type 1 diabetes may accelerate aging and lead to frailty, highlighting the need for more research on this underexplored area.

## Contribution

The paper provides a comprehensive review of the emerging link between type 1 diabetes and frailty, emphasizing the lack of focus on type 1 diabetes in current literature.

## Key findings

- Type 1 diabetes may accelerate aging and increase susceptibility to frailty.
- Frailty in type 1 diabetes is linked to hyperglycaemia, hormonal changes, and comorbidities.
- Current research on diabetes and frailty predominantly focuses on type 2 diabetes.

## Abstract

Over recent decades, the life expectancy of individuals with type 1 diabetes has steadily improved due to advances in therapies that enhance metabolic control alongside better prevention and management of complications. However, this extended survival brings new challenges. Type 1 diabetes, through sustained hyperglycaemia and recurrent hypoglycaemia, may act as an accelerator of ageing, predisposing individuals to the development of geriatric syndromes such as frailty. Frailty, defined as a state of reduced physiological reserve that heightens susceptibility to stressors and impairs the ability to restore homeostasis after acute events, has emerged as a recognised complication of diabetes and has been associated with several adverse outcomes including increased risks of hypoglycaemia, hospitalisation, disability, institutionalisation and death. The putative pathophysiology of frailty in type 1 diabetes is complex and multifactorial. It reflects the direct effects of chronic exposure to hyperglycaemia and consequent micro- and macrovascular complications, superimposed on age- and diabetes-related hormonal changes. Additional contributors include sarcopenia, cognitive decline and other comorbidities. Currently, most of the literature on diabetes and frailty focuses on type 2 diabetes, while the relationship with type 1 diabetes and the impact on outcomes remain to be fully elucidated. In this review we discuss the growing evidence on the link between frailty and type 1 diabetes, explore its underlying pathophysiological mechanisms, discuss assessment and treatment strategies, and highlight the key knowledge gaps and suggest future research directions in this evolving field.

The online version contains slideset of the figures for download  available at 10.1007/s00125-026-06681-x.