{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T15:23:20Z","timestamp":1790522600143,"version":"4.1.0"},"reference-count":43,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2019,4,23]],"date-time":"2019-04-23T00:00:00Z","timestamp":1555977600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J cachexia sarcopenia muscle"],"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Type 2 diabetes, a highly prevalent chronic disease, is associated with increasing frailty and functional decline in older people. We aimed to evaluate the effectiveness of a multimodal intervention on functional performance in frail and pre\u2010frail participants aged \u226570\u00a0years with type 2 diabetes mellitus.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The MID\u2010Frail study was a cluster\u2010randomized multicenter clinical trial conducted in 74 trial sites across seven European countries. The trial recruited 964 participants who were aged &gt;70\u00a0years [mean age in intervention group, 78.4 (SD 5.6)\u00a0years, 49.2% male and 77.6 (SD 5.29)\u00a0years, 52.4% male in usual care group], with type diabetes mellitus and determined to be frail or pre\u2010frail using Fried's frailty phenotype. Participants were allocated by trial site to follow either usual care (UCG) or intervention procedures (IG). Intervention group participants received a multimodal intervention composed of (i) an individualized and progressive resistance exercise programme for 16\u00a0weeks; (ii) a structured diabetes and nutritional educational programme over seven sessions; and (iii) Investigator\u2010linked training to ensure optimal diabetes care. Short Physical Performance Battery (SPPB) scores were used to assess change in functional performance at 12\u00a0months between the groups. An analysis of the cost\u2010effectiveness of the intervention was undertaken using the incremental cost\u2010effectiveness ratio (ICER). Secondary outcomes included mortality, hospitalization, institutionalization, quality of life, burden on caregivers, the frequency and severity of hypoglycaemia episodes, and the cost\u2010effectiveness of the intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After 12\u00a0months, IG participants had mean SPPB scores 0.85 points higher than those in the UCG (95% CI, 0.44 to 1.26,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a00.0001). Dropouts were higher in frail participants and in the intervention group, but significant differences in SPPB between treatment groups remained consistent after sensitivity analysis. Estimates suggest a mean saving following intervention of 428.02 EUR (2016) per patient per year, with ICER analysis indicating a consistent benefit of the described health care intervention over usual care. No statistically significant differences between groups were detected in any of the other secondary outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We have demonstrated that a 12\u00a0month structured multimodal intervention programme across several clinical settings in different European countries leads to a clinically relevant and cost\u2010effective improvement in the functional status of older frail and pre\u2010frail participants with type 2 diabetes mellitus.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jcsm.12432","type":"journal-article","created":{"date-parts":[[2019,4,23]],"date-time":"2019-04-23T22:04:17Z","timestamp":1556057057000},"page":"721-733","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":164,"title":["Effectiveness of a multimodal intervention in functionally impaired older people with type 2 diabetes mellitus"],"prefix":"10.1002","volume":"10","author":[{"given":"Leocadio","family":"Rodriguez\u2010Ma\u00f1as","sequence":"first","affiliation":[{"name":"Servicio de Geriatr\u00eda Hospital Universitario de Getafe  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga","family":"Laosa","sequence":"additional","affiliation":[{"name":"Foundation for Biomedical Research\u2014Hospital Universitario de Getafe  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Vellas","sequence":"additional","affiliation":[{"name":"Centre Hospitalier Universitaire de Toulouse  Toulouse France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Paolisso","sequence":"additional","affiliation":[{"name":"University of Campania\u2010Luigi Vanvitelli  Naples 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