The prevalence of type 2 diabetes mellitus increases with age and is associated with a high prevalence of frailty1. Therefore, we read with great interest the update to the consensus document Type 2 diabetes mellitus in elderly or frail individuals2, written by experts in type 2 diabetes mellitus. We believe that the participation of experts in frailty and older adults would have allowed for incorporating important concepts into the document, such as a differentiated approach recommended according to the frailty phenotype which, in turn, is associated with different metabolic phenotypes.

As an example, there is the phenotype of a malnourished anorexic patient with reduced insulin resistance and a high risk of hypoglycemia, in which the approach would prioritize treatment deintensification, and the phenotype of an obese sarcopenic individual with greater insulin resistance and a lower risk of hypoglycemia, which would allow for treatment intensification3.

We would also like to emphasize that by understanding frailty as an ongoing, multisystemic, dynamic, and potentially reversible process, intensifying measures to avoid, halt, or try to reverse its onset is fundamental in patients with type 2 diabetes mellitus1. Therefore, it is important to disseminate the results of the MID-Frail study, a multicenter, cluster-randomized clinical trial, which support this premise. Participants in the intervention group received a multimodal intervention that entailed an individualized, progressive resistance exercise program for 16 weeks; a structured diabetes and nutritional education program taught in seven sessions; and training to ensure optimal diabetes care. After 12 months, the intervention group participants had significantly higher scores on the Short Physical Performance Battery (SPPB) and the program was cost-effective4.

These and other aspects related to older adult patients which seriously compromise their clinical management should be incorporated into future editions of the consensus document, in accordance with internationally accepted recommendations5.