Frailty Dimensions as Predictors of Quality of Life in Older Adults with Type 2 Diabetes Mellitus: A Cross-Sectional Study

Frailty Dimensions as Predictors of Quality of Life in Older Adults with Type 2 Diabetes Mellitus: A Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Frailty Dimensions as Predictors of Quality of Life in Older Adults with Type 2 Diabetes Mellitus: A Cross-Sectional Study Dimitra Natsina, Fotini Malli, Maria Malliarou, Georgios Tsioumanis, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9234683/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Introduction: Frailty is increasingly recognized as a clinically relevant condition in older adults with Type 2 Diabetes Mellitus (T2DM), with important implications for functional outcomes and individualized care. This study investigated the association between multidimensional frailty and quality of life in older adults with T2DM. Methods: A cross-sectional study was conducted among 112 community-dwelling adults aged ≥ 65 years in Trikala Regional Unit, Central Greece. Frailty was assessed using the Tilburg Frailty Indicator (TFI), and quality of life was measured with the Older People’s Quality of Life Questionnaire (OPQOL-35). Pearson correlation and multiple linear regression analyses were performed. Results: The sample demonstrated a moderate level of frailty ( M = 7.88, SD = 2.78), exceeding the commonly used cut-off point for frailty. Physical fatigue and upper limb weakness were among the most prevalent issues. All frailty dimensions (physical, psychological, and social) were significantly associated with poorer quality of life ( p < .01). The regression model explained 77.2% of the variance in quality of life ( R ² = .772), with physical (health – related) frailty emerging as the strongest predictor (β = .459, p < .001), followed by social (β = .303, p < .001) and psychological components (β = .202, p = .005). Conclusions: Frailty is a strong multidimensional predictor of quality of life in older adults with T2DM. These findings support the clinical value of early frailty screening and the implementation of individualized, multidisciplinary management strategies in primary care settings to preserve functional ability and overall well-being in this vulnerable population. Type 2 diabetes mellitus frailty older adults geriatric assessment quality of life Introduction Population ageing represents one of the most defining demographic and social transformations of the 21st century. Advances in medical science, public health, and socioeconomic development have led to a substantial increase in life expectancy worldwide, resulting in a rapid expansion of the population aged 60 and 65 years and older [ 1 , 2 , 3 ]. However, increased longevity is not necessarily accompanied by proportional improvements in functional health. Additional years of life are frequently characterized by chronic diseases, multimorbidity, and limitations in autonomy [ 4 , 5 ]. Within this context, contemporary scientific discourse has progressively shifted from the mere extension of survival toward the preservation of functional ability, independence, and quality of life in older adults [ 5 ], reflecting a central priority of geriatric medicine which is the prevention of disability and maintenance of functional independence. Greece is among the most rapidly ageing countries in Europe, exhibiting a particularly high proportion of individuals aged 65 years and older, an increased median age, and an unfavorable old-age dependency ratio [ 6 , 7 ]. Persistently low fertility rates, combined with the emigration of younger age groups and increasing life expectancy, have resulted in an increasingly inverted population pyramid. Concurrently, data on Healthy Life Years indicate that a substantial proportion of later life is experienced with functional limitations and chronic morbidity, imposing a considerable burden not only on health and social care systems but also on individual autonomy and well-being [ 8 , 6 , 9 ]. These demographic trends underscore the clinical importance of identifying modifiable factors that contribute to vulnerability in older adults. Within this framework, type 2 diabetes mellitus (T2DM) emerges as a key disease of ageing, demonstrating particularly high prevalence in older age groups and close biological links to ageing processes [ 10 , 11 , 12 ]. Age-related alterations in pancreatic β-cell function, chronic low-grade inflammation, mitochondrial dysfunction, and cellular senescence constitute a pathophysiological substrate that promotes the development and progression of T2DM [ 13 , 14 ]. Consequently, diabetes is frequently conceptualized as a model of accelerated ageing, with important implications for functional capacity, resilience to stressors, and overall well-being in older individuals [ 15 , 16 ]. Beyond glycemic dysregulation, older adults with T2DM often present with multimorbidity, polypharmacy, and increased susceptibility to adverse clinical outcomes. The global prevalence of diabetes mellitus continues to rise, with a disproportionate burden observed among individuals aged 65 years and older [ 17 , 18 ]. In Greece, available epidemiological data indicate high rates of diabetes and prediabetes, marked geographical variation, and an increasing economic burden on the healthcare system [ 19 , 20 , 21 ]. However, beyond its economic and epidemiological dimensions, diabetes in later life is closely associated with the development of frailty, a multidimensional geriatric syndrome characterized by reduced physiological reserve and increased vulnerability to internal and external stressors [ 22 , 23 ]. Frailty occurs more frequently among older adults with diabetes compared to their non-diabetic counterparts and is associated with increased risks of functional decline, hospitalization, treatment-related complications, and reduced quality of life [ 24 , 25 ]. Given its multidimensional nature, frailty requires reliable and clinically applicable assessment tools. The Tilburg Frailty Indicator (TFI) captures physical, psychological, and social domains of frailty through structured self-report measures, allowing a comprehensive evaluation of vulnerability beyond purely biomedical parameters [ 26 ]. This multidimensional approach is particularly relevant in geriatric diabetes care, as psychological distress and social isolation may amplify physical vulnerability, thereby influencing treatment outcomes and daily functioning [ 5 ]. In parallel, quality of life constitutes a fundamental outcome in geriatric assessment, reflecting the cumulative impact of chronic disease burden, frailty, and psychosocial factors on autonomy and overall well-being [ 27 , 28 ]. Despite well-documented international evidence linking frailty and quality of life in older populations, evidence specifically addressing the multidimensional contribution of frailty domains to quality of life in older adults with T2DM remain limited, while the Greek literature in this field is particularly scarce. Moreover, most existing studies predominantly emphasize the physical dimension of frailty, often overlooking its psychological and social components and their independent as well as combined influence on quality of life. Addressing this gap is clinically relevant, as comprehensive frailty assessment may inform individualized management strategies and multidisciplinary interventions in older adults with diabetes. Therefore, the present study aimed to investigate the association between multidimensional frailty and quality of life among older adults diagnosed with T2DM and explore potential implications for frailty screening and individualized management in geriatric diabetes care. Methodology Study Design and Participants A cross-sectional study design was employed. A convenience sample of 112 community-dwelling older adults aged ≥ 65 years with a confirmed diagnosis of Type 2 Diabetes Mellitus (T2DM) was recruited from hospitals and outpatient clinics in Trikala Region Unit, Central Greece. Eligibility criteria included: (a) age ≥ 65 years, (b) confirmed diagnosis of T2DM, (c) fluency in the Greek language, and (d) sufficient cognitive capacity to complete the questionnaires independently. Individuals with severe cognitive impairment or acute medical conditions at the time of assessment were excluded to ensure data validity. The study was conducted in accordance with the principles of the Declaration of Helsinki, and ethical approval was obtained from the relevant institutional ethics committee. Written informed consent was obtained from all participants prior to data collection. Study Objectives The primary objective was to investigate the association between multidimensional frailty and quality of life in older adults with T2DM. Specifically, the study aimed to assess frailty levels, evaluate quality of life, and examine the independent contribution of physical, psychological, and social frailty components to health-related quality of life. The study further sought to underscore the clinical importance of early frailty detection within Primary Health Care settings to inform individualized and multidisciplinary management strategies. Data Collection and Instruments Data were collected between November 2025 and December 2025, using an anonymous structured questionnaire comprising demographic variables, the Tilburg Frailty Indicator (TFI), and the Older People’s Quality of Life Questionnaire (OPQOL-35). The TFI is a 15-item self-reported multidimensional instrument assessing physical, psychological, and social domains of frailty. Total scores range from 0 to 15, with higher scores indicating greater frailty severity. A score ≥ 5 is commonly used to indicate frailty [ 26 ]. The OPQOL-35 consists of 35 items across eight domains of quality of life, rated on a five-point Likert scale (1 = Strongly Agree to 5 = Strongly Disagree). Higher scores indicate lower perceived quality of life. Negatively worded items were reverse-coded prior to analysis in accordance with established scoring guidelines [ 29 ]. Statistical Analysis Data were analyzed using IBM SPSS Statistics (version 26). Internal consistency reliability was evaluated using Cronbach’s alpha ( α ), yielding acceptable reliability for the TFI ( α = .69) and excellent reliability for the OPQOL-35 ( α = .96). Descriptive statistics were calculated for demographic characteristics and scale scores. Pearson correlation coefficients were used to examine associations between frailty dimensions and quality of life. Multiple linear regression analysis was conducted with quality of life as the dependent variable and physical, psychological, and social frailty components as independent predictors. Assumptions of normality, linearity, and multicollinearity were examined prior to model estimation. The sample size of 112 participants was deemed sufficient for the multiple linear regression analysis, as it exceeds the commonly recommended minimum of 10–15 observations per predictor variable (3 predictors), ensuring adequate statistical power to detect meaningful effects. Statistical significance was set at p < .05. Results 3.1 Demographic Characteristics of the Sample The study sample consisted of 112 older patients with Type 2 Diabetes Mellitus. The majority of participants belonged to the 71–80 and 65–70 age groups, while approximately one-fifth of the sample was aged over 80 years. Women outnumbered men, accounting for nearly two-thirds of the total sample. Regarding marital status, the majority of participants were married, while about one-third were widowed. In terms of educational attainment, more than half of the participants had completed primary education or less, a finding that reflects the educational profile of older cohorts. Most participants resided in urban areas and lived with their spouse, while approximately one-quarter lived alone. Regarding therapeutic management for Type 2 Diabetes, nearly half were receiving exclusively oral antidiabetic medication, while a significant proportion followed a combination therapy of insulin and tablets. The detailed demographic and clinical characteristics of the sample are presented in Table 1 . Table 1 Demographic Characteristics Variable Category n (%) Age (years) 65–70 35 (31.3) 71–80 53 (47.3) 81–90 21 (18.8) > 90 3 (2.7) Gender Female 64 (57.7) Male 47 (42.3) Marital Status Married 67 (60.4) Widowed 32 (28.8) Single 6 (5.4) Divorced 6 (5.4) Education Primary 47 (42.0) Secondary 12 (10.7) Tertiary 27 (24.1) Some primary school 17 (15.2) No formal education 9 (8.0) Place of Residence City 72 (69.9) Town 18 (17.5) Village 13 (12.6) Living Arrangement With spouse 61 (55.5) Alone 28 (25.5) With children 15 (13.6) Nursing home 6 (5.5) T2DM Treatment Tablets 54 (48.6) Insulin 16 (14.4) Combination 41 (36.9) Notes : n = 112. Percentages may not total 100 due to rounding or missing values in specific categories. Frailty of Older Adults (Tilburg Frailty Indicator) The frequency distributions of the 15 items of the Tilburg Frailty Indicator (TFI) are presented. The majority of participants reported good perceived physical health (73.2%) and an absence of recent unintentional weight loss (64.0%). Most did not report difficulties in walking (55.4%) or maintaining balance (76.6%), nor did they report vision (91.8%) or hearing (78.2%) problems. However, a significant proportion of the sample reported physical fatigue (65.2%) and upper limb weakness (50.0%), elements suggesting the presence of physical limitations in a segment of the population. At the psychological level, most participants stated that they experienced memory problems "sometimes" (43.1%), while symptoms of low mood (51.8%) and anxiety or nervousness (47.3%) were also reported primarily on an occasional basis. Nevertheless, the majority stated that they cope well with their problems (71.3%). At the social level, most participants did not live alone (73.6%) and reported adequate social support (89.2%). A sense of lack of social companionship was reported mainly "sometimes" (43.1%) or not at all (42.2%). Overall, the mean Tilburg Frailty Indicator (TFI) score was 7.88 ( SD = 2.78), indicating a moderate to high level of frailty in the study population. Based on the established cut-off point (TFI ≥ 5), 91 participants (81.3%) were classified as frail. These findings are consistent with the observed frequency of physical limitations within the sample. Quality of Life of Older Adults The quality of life of the participants was assessed using the OPQOL-35 questionnaire. Descriptive statistics (means and standard deviations) were calculated for the individual dimensions of the questionnaire in a sample of 112 individuals. Responses were recorded on a five-point Likert scale (1 = Strongly Agree to 5 = Strongly Disagree), with higher values indicating lower perceived quality of life. Negatively worded items were reverse-coded prior to the calculation of total indices. Table 2 Mean values of Quality of Life dimensions (OPQOL-35) Dimension M SD Life overall 2.23 0.85 Life in general 2.74 0.91 Health 2.80 1.04 Social relationships 2.06 0.79 Independence, control over life, freedom 2.42 0.91 Home and neighborhood 2.12 0.79 Psychological & emotional well-being 2.15 0.92 Financial situation 3.07 0.86 Leisure time & activities 2.90 0.92 Note : M = Mean, SD = Standard Deviation. As presented in Table 2 , the overall quality of life of the participants was recorded at moderate to positive levels ( Μ = 2.23, SD = 0.85). Particularly positive perceptions were observed in the dimensions of social relationships ( M = 2.06, SD = 0.79), psychological and emotional well-being ( M = 2.15, SD = 0.92), and home and neighborhood ( M = 2.12, SD = 0.79). Conversely, higher mean values, indicating lower perceived quality of life, were recorded for financial situation ( M = 3.07, SD = 0.86) and leisure time and activities ( M = 2.90, SD = 0.92), highlighting areas where participants experience more limitations. Overall, the results show that despite the presence of a chronic disease, older adults with diabetes in the sample maintain satisfactory levels of quality of life, with social and psychological dimensions appearing more protected compared to financial status and leisure activities. Correlation Analysis: Frailty – Quality of Life To examine the relationship between frailty and quality of life in older adults with Type 2 Diabetes Mellitus, a Pearson correlation analysis was performed between overall quality of life and the individual components of frailty (physical/health, psychological, and social). Table 3 Correlation between Quality of Life and Frailty Components (Pearson r) Quality of Life Overall Quality of Life Overall Health Problems Psychological Components Social Components 1 .690** .486** .582** Sig. (2-tailed) .000 .000 .000 N 111 109 106 108 Health Problems .690** 1 .442** .472** Sig. (2-tailed) .000 .000 .000 N 109 109 106 108 Psychological Components .486** .442** 1 .269** Sig. (2-tailed) .000 .000 .005 N 106 106 106 106 Social Components .582** .472** .269** 1 Sig. (2-tailed) .000 .000 .005 N 108 108 106 109 Note : Higher scores in the quality of life scale indicate lower perceived quality of life, whereas higher scores in frailty components indicate greater frailty. ** Correlation is significant at p < .01 level (2-tailed). As shown in Table 3 , all components of frailty are positively and statistically significantly correlated with overall quality of life ( p < .01) indicating that higher levels of frailty are associated with poorer perceived quality of life. Specifically, the strongest correlation is observed between quality of life and health problems ( r = .690, p < .001), suggesting that increased physical frailty is strongly associated with a significant decline in perceived quality of life. Moderate but statistically significant correlations are also observed with social ( r = .582, p < .001) and psychological components ( r = .486, p < .001). These findings demonstrate that beyond the physical dimension, both social and psychological factors contribute substantially to reduced quality of life in older adults with T2DM. Multiple Linear Regression To further investigate the effect of individual frailty components on quality of life, a multiple linear regression analysis was conducted, with overall quality of life as the dependent variable and physical (health problems), psychological, and social components of frailty as independent variables. Table 4 Multiple linear regression with Quality of Life as the dependent variable (Constant) B Std. Error Beta t Sig. 1.574 .070 22.397 < .001 Health Problems .866 .147 .459*** 5.894 < .001 Psychological Components .202 .070 .202** 2.869 .005 Social Components .399 .095 .303*** 4.182 < .001 Notes : * p < .05, ** p < .01, *** p < .001. Dependent Variable: Quality of Life (total score). R ² = .772. The proposed regression model explains 77.2% of the variance in overall quality of life ( R 2 = .772), indicating a strong explanatory capacity of the model. All components of frailty showed a positive and statistically significant association with quality of life, indicating that higher frailty levels are associated with poorer perceived quality of life. Specifically, health problems are the strongest predictor (β = .459, p < .001), followed by social (β = .303, p < .001) and psychological components ( β = .202, p = .005). All frailty components remained independently associated with quality of life after adjustment within the model. The positive direction of the coefficients, combined with the scale coding, implies that an increase in frailty in any dimension is associated with lower perceived quality of life. The regression equation is as follows: Quality of Life = 1.574 + 0.866(Health Problems) + 0.202(Psychological Components) + 0.399(Social Components) The findings confirm that frailty is a multidimensional and clinically significant determinant of quality of life in older adults with T2DM, highlighting the need for comprehensive, multidisciplinary management approaches. Discussion The present study investigated the relationship between frailty and quality of life among older adults with Type 2 Diabetes Mellitus in the Trikala Region Unit, Central Greece. Focusing on this specific population is particularly relevant, as aging is accompanied by an increased incidence of diabetes and a greater burden on functional status and healthcare requirements [ 11 , 30 , 8 ]. In Greece, the prevalence of diabetes increases significantly with age, necessitating the investigation of factors that influence the well-being of older adults beyond glycemic control [ 19 , 20 ]. A key finding of this study is the statistically significant association between frailty and quality of life. Specifically, increased health problems, as well as the psychological and social components of frailty, were associated with lower levels of quality of life. Multiple linear regression analysis demonstrated that all three dimensions of frailty are independent and statistically significant predictors of quality of life, with the physical dimension exhibiting the most substantial impact. Based on the total TFI score, the sample demonstrated a moderate level of frailty, exceeding the commonly used cut-off point for frailty. This finding indicates that a substantial proportion of participants can be considered frail, despite relatively preserved psychological and social functioning. The higher burden observed in the physical domain, particularly fatigue and upper limb weakness, further supports the clinical relevance of physical vulnerability in this population. These findings are reinforced by recent research on older adults in Crete, where 14.8% of the population was characterized as frail and 34.1% as pre-frail, confirming that a significant proportion of older adults in the Greek provinces maintain a level of functionality but remain at risk of transitioning to a more severe state of frailty. That study also demonstrates a close association between good quality of life, functional independence and lower frailty levels, aligning with the observations of the present work [ 31 ]. Additionally, the results are consistent with the biopsychosocial model of the TFI, which approaches frailty as a multidimensional phenomenon rather than exclusively as physical decline [ 29 ]. Importantly, the use of the TFI in this context supports its applicability as a practical screening tool in clinical settings, enabling early identification of vulnerable older adults with T2DM. This has direct implications for comprehensive geriatric assessment and the implementation of multidisciplinary, patient-centered management strategies aimed at preventing functional decline and optimizing quality of life [ 32 , 31 ]. Regarding quality of life, participants reported a generally good perceived status, with better performance in the dimensions of health, psychological well-being, and social relationships, while dimensions related to financial situation and participation in leisure activities were less favorable. These results are consistent with previous studies indicating that social support and psychological well-being are critical determinants of quality of life in older adults, even in the presence of chronic diseases [ 33 , 34 ]. In this context, Abd Ghafar et al. [ 35 ] emphasize that the combination of diabetes and frailty acts synergistically, causing significant degradation in psychosocial well-being and overall quality of life. Overall, these findings align with international literature documenting that frailty is related to diminished functional capacity, loss of autonomy, increased psychological burden, and limited social participation, elements that directly affect the quality of life of older adults [ 26 ]. Specifically, a study by Lin et al. [ 36 ] reports that among older adults with Type 2 diabetes, the prevalence of frailty reaches 26.6%, with physical decline and comorbidity serving as central aggravating factors. In the population of older adults with diabetes, this relationship appears more pronounced, as diabetes can exacerbate physical frailty through muscle mass loss, inflammation, and frequent hyperglycemic episodes [ 30 , 36 ]. The relationship between diabetes and frailty has been described as bidirectional; diabetes contributes to the development of frailty, while frailty complicates the management of the chronic disease and increases the risk of adverse outcomes [ 30 , 23 ]. Recent research in a sample of Greek older adults highlighted that the presence of chronic diseases, such as Type 2 diabetes, is directly linked to increased frailty levels, confirming the need for early intervention [ 33 ]. The results of the present study reinforce the importance of systematic frailty assessment as an integral part of care for older adults with diabetes. To this end, contemporary guidelines and consensus statements emphasize that the recognition of frailty should lead to the individualization of therapeutic goals, with an emphasis on avoiding hypoglycemia and simplifying medication regimens to ensure patient safety and quality of life [ 30 ]. Conclusions At the population level, the findings of this study acquire particular significance within the context of the rapid aging of the Greek population and the increasing burden of chronic conditions on healthcare systems. However, these findings also have direct clinical relevance, as the systematic integration of frailty assessment into Primary Health Care can facilitate early identification of vulnerable older adults with T2DM and support individualized, multidisciplinary management strategies. Such approaches may contribute to improved functional outcomes, optimized care planning, and the preservation of autonomy in this high-risk population. From this perspective, frailty emerges not only as a clinical concept but also as a meaningful indicator of public health planning and social policy in aging societies. Study Limitations The present study has certain limitations. First, the sample was drawn from a specific geographical area, which may limit the generalizability of the results. Second, the study employed a cross-sectional design, which does not allow for causal inferences regarding the relationship between frailty and quality of life. Third, data collection relied exclusively on self-reported questionnaires, which may be influenced by subjective factors. Directions for Future Research Future studies could utilize a longitudinal design to investigate the causal relationship between frailty and quality of life and to examine whether changes in frailty predict corresponding changes in quality of life over time. Additionally, larger and geographically more representative samples would enhance the generalizability of the findings. Supplementary qualitative research could also provide a deeper understanding of the lived experiences of older adults with diabetes regarding frailty and their daily functionality [ 25 ]. Declarations Ethical Approval The study was conducted in accordance with the Declaration of Helsinki for research involving human participants. The research protocol received approval from the Ethics and Deontology Committee of the Department of Nursing at the University of Thessaly. All participants were fully informed about the purpose and procedures of the research and provided written informed consent prior to their participation. Anonymity and data confidentiality were strictly maintained. Competing Interests The authors declare that they have no competing interests. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Author Contribution D.N. contributed to study conception and design, F.M and M.M. data collection, statistical analysis, and drafting of the manuscript. T.P. and G.T. contributed to study conception and design and provided overall supervision. M.S. and K.T. contributed to methodological support and critical revision of the manuscript. T.P. and G.T. contributed to data interpretation and critical revision of the manuscript for important intellectual content. All authors reviewed, approved the final version of the manuscript, and agree to be accountable for all aspects of the work. Data Availability The datasets generated and analyzed during the current study are not publicly available due to privacy restrictions but are available from the corresponding author on reasonable request. References World Health Organization (2025) Ageing and health. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health . Accessed 27 March 2026 Worldometer (2025) Life expectancy by country and in the world. https://www.worldometers.info/demographics/life-expectancy/ . Accessed 27 March 2026 Roser M (2018) Twice as long — life expectancy around the world. Our World in Data. https://ourworldindata.org/life-expectancy-globally . Accessed 27 March 2026 Divo MJ, Martinez CH, Mannino DM (2014) Ageing and the epidemiology of multimorbidity. 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Adv Exp Med Biol 1489:47–59. https://doi.org/10.1007/978-3-032-03394-9_5 Strain WD, Down S, Brown P et al (2021) Diabetes and frailty: expert consensus. Diabetes Ther 12:1227–1247. https://doi.org/10.1007/s13300-021-01035-9 Patelarou E et al (2024) Frailty status in older adults receiving home care services. Nutrients 16:3982. https://doi.org/10.3390/nu16233982 Bonikowska I, Szwamel K, Uchmanowicz I (2022) Medication adherence and frailty. J Clin Med 11:1707. https://doi.org/10.3390/jcm11061707 Kyvetos A, Kyritsi E, Vrettos I et al (2023) Chronic diseases and frailty. Cureus 15:e48154. https://doi.org/10.7759/cureus.48154 Paralikas T, Dimitriadou I, Plataniti T et al (2025) Meaning in life and well-being. J Appl Gerontol. https://doi.org/10.1177/07334648251386540 Abd Ghafar MZ, O’Donovan M, Sezgin D et al (2022) Frailty and diabetes in older adults. Front Clin Diabetes Healthc 3:895313. https://doi.org/10.3389/fcdhc.2022.895313 Lin CL, Yu NC, Wu HC, Liu YC (2022) Risk factors associated with frailty in T2DM. J Clin Nurs 31:967–974. https://doi.org/10.1111/jocn.15962 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 27 Apr, 2026 Reviews received at journal 26 Apr, 2026 Reviews received at journal 17 Apr, 2026 Reviewers agreed at journal 16 Apr, 2026 Reviewers agreed at journal 07 Apr, 2026 Reviewers agreed at journal 07 Apr, 2026 Reviewers agreed at journal 02 Apr, 2026 Reviewers invited by journal 31 Mar, 2026 Editor assigned by journal 30 Mar, 2026 Submission checks completed at journal 27 Mar, 2026 First submitted to journal 26 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9234683","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":616832709,"identity":"568ec140-d6e1-42b0-9062-fe4a54ca966b","order_by":0,"name":"Dimitra Natsina","email":"","orcid":"","institution":"University of Thessaly","correspondingAuthor":false,"prefix":"","firstName":"Dimitra","middleName":"","lastName":"Natsina","suffix":""},{"id":616832710,"identity":"0a9147c4-3651-46da-a2b9-76f63cd3728d","order_by":1,"name":"Fotini Malli","email":"","orcid":"","institution":"University of Thessaly","correspondingAuthor":false,"prefix":"","firstName":"Fotini","middleName":"","lastName":"Malli","suffix":""},{"id":616832711,"identity":"8f9bc9f6-82e2-4b54-9759-938cdbe6b93d","order_by":2,"name":"Maria Malliarou","email":"","orcid":"","institution":"University of Thessaly","correspondingAuthor":false,"prefix":"","firstName":"Maria","middleName":"","lastName":"Malliarou","suffix":""},{"id":616832712,"identity":"d37fac00-05d7-44e9-9d7d-98b26ab382d6","order_by":3,"name":"Georgios Tsioumanis","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABGklEQVRIiWNgGAWjYDADNgglwcAPohIKCGowQGiRbABpMSBCC4J5AE0AHci7Nx/7+KXijz0fe4/php87LOyNz69O/PDAgEGeX+wAVi2GZ44lz5Y5Y5DYxnPG7GbvGYnEbTfebpYAOsxw5uwE7Fpm5BgzS7YZJLBJ5Jjd4G2TSDC7cXYDSEuCwW0cWua/AWr5Z2AP0nLzb5uEvfGMs5t/4NMiL8FjzPixwYCxDajlNtAWxg38vdvw2mLAk5bMzHDMGOiXY2W3ZdskEmfc4N1mkWAggdMv8u2HDzP+qJGzl29v3nbzbVudPX//2c03f1TYyPNL47DlAAMDMw+KkARYpQRW5WBbGhgYGH+gCPEfwKl6FIyCUTAKRiYAAJXAXSCZCTiEAAAAAElFTkSuQmCC","orcid":"","institution":"University of Thessaly","correspondingAuthor":true,"prefix":"","firstName":"Georgios","middleName":"","lastName":"Tsioumanis","suffix":""},{"id":616832713,"identity":"bfda0555-a855-435f-9bdd-5269fb5ffa82","order_by":4,"name":"Maria Saridi","email":"","orcid":"","institution":"University of Thessaly","correspondingAuthor":false,"prefix":"","firstName":"Maria","middleName":"","lastName":"Saridi","suffix":""},{"id":616832714,"identity":"aa632300-fba2-4c1a-bcd7-6cf1ef7ecb63","order_by":5,"name":"Katerina Toska","email":"","orcid":"","institution":"University of Thessaly","correspondingAuthor":false,"prefix":"","firstName":"Katerina","middleName":"","lastName":"Toska","suffix":""},{"id":616832715,"identity":"554649d5-f7a3-4e7e-9700-9ef130d39dea","order_by":6,"name":"Theodosios Paralikas","email":"","orcid":"","institution":"University of Thessaly","correspondingAuthor":false,"prefix":"","firstName":"Theodosios","middleName":"","lastName":"Paralikas","suffix":""}],"badges":[],"createdAt":"2026-03-26 13:23:44","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9234683/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9234683/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107704787,"identity":"8d4ccc5d-7114-4139-b8a9-23a2ba9755de","added_by":"auto","created_at":"2026-04-24 08:58:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":360910,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9234683/v1/e51cd9d7-791c-4ab1-a5dc-ba7926fd4404.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Frailty Dimensions as Predictors of Quality of Life in Older Adults with Type 2 Diabetes Mellitus: A Cross-Sectional Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePopulation ageing represents one of the most defining demographic and social transformations of the 21st century. Advances in medical science, public health, and socioeconomic development have led to a substantial increase in life expectancy worldwide, resulting in a rapid expansion of the population aged 60 and 65 years and older [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, increased longevity is not necessarily accompanied by proportional improvements in functional health. Additional years of life are frequently characterized by chronic diseases, multimorbidity, and limitations in autonomy [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Within this context, contemporary scientific discourse has progressively shifted from the mere extension of survival toward the preservation of functional ability, independence, and quality of life in older adults [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], reflecting a central priority of geriatric medicine which is the prevention of disability and maintenance of functional independence.\u003c/p\u003e \u003cp\u003eGreece is among the most rapidly ageing countries in Europe, exhibiting a particularly high proportion of individuals aged 65 years and older, an increased median age, and an unfavorable old-age dependency ratio [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Persistently low fertility rates, combined with the emigration of younger age groups and increasing life expectancy, have resulted in an increasingly inverted population pyramid. Concurrently, data on Healthy Life Years indicate that a substantial proportion of later life is experienced with functional limitations and chronic morbidity, imposing a considerable burden not only on health and social care systems but also on individual autonomy and well-being [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. These demographic trends underscore the clinical importance of identifying modifiable factors that contribute to vulnerability in older adults.\u003c/p\u003e \u003cp\u003eWithin this framework, type 2 diabetes mellitus (T2DM) emerges as a key disease of ageing, demonstrating particularly high prevalence in older age groups and close biological links to ageing processes [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Age-related alterations in pancreatic β-cell function, chronic low-grade inflammation, mitochondrial dysfunction, and cellular senescence constitute a pathophysiological substrate that promotes the development and progression of T2DM [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Consequently, diabetes is frequently conceptualized as a model of accelerated ageing, with important implications for functional capacity, resilience to stressors, and overall well-being in older individuals [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Beyond glycemic dysregulation, older adults with T2DM often present with multimorbidity, polypharmacy, and increased susceptibility to adverse clinical outcomes.\u003c/p\u003e \u003cp\u003eThe global prevalence of diabetes mellitus continues to rise, with a disproportionate burden observed among individuals aged 65 years and older [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In Greece, available epidemiological data indicate high rates of diabetes and prediabetes, marked geographical variation, and an increasing economic burden on the healthcare system [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. However, beyond its economic and epidemiological dimensions, diabetes in later life is closely associated with the development of frailty, a multidimensional geriatric syndrome characterized by reduced physiological reserve and increased vulnerability to internal and external stressors [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFrailty occurs more frequently among older adults with diabetes compared to their non-diabetic counterparts and is associated with increased risks of functional decline, hospitalization, treatment-related complications, and reduced quality of life [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Given its multidimensional nature, frailty requires reliable and clinically applicable assessment tools. The Tilburg Frailty Indicator (TFI) captures physical, psychological, and social domains of frailty through structured self-report measures, allowing a comprehensive evaluation of vulnerability beyond purely biomedical parameters [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. This multidimensional approach is particularly relevant in geriatric diabetes care, as psychological distress and social isolation may amplify physical vulnerability, thereby influencing treatment outcomes and daily functioning [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In parallel, quality of life constitutes a fundamental outcome in geriatric assessment, reflecting the cumulative impact of chronic disease burden, frailty, and psychosocial factors on autonomy and overall well-being [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite well-documented international evidence linking frailty and quality of life in older populations, evidence specifically addressing the multidimensional contribution of frailty domains to quality of life in older adults with T2DM remain limited, while the Greek literature in this field is particularly scarce. Moreover, most existing studies predominantly emphasize the physical dimension of frailty, often overlooking its psychological and social components and their independent as well as combined influence on quality of life. Addressing this gap is clinically relevant, as comprehensive frailty assessment may inform individualized management strategies and multidisciplinary interventions in older adults with diabetes.\u003c/p\u003e \u003cp\u003eTherefore, the present study aimed to investigate the association between multidimensional frailty and quality of life among older adults diagnosed with T2DM and explore potential implications for frailty screening and individualized management in geriatric diabetes care.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Participants\u003c/h2\u003e \u003cp\u003eA cross-sectional study design was employed. A convenience sample of 112 community-dwelling older adults aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years with a confirmed diagnosis of Type 2 Diabetes Mellitus (T2DM) was recruited from hospitals and outpatient clinics in Trikala Region Unit, Central Greece.\u003c/p\u003e \u003cp\u003eEligibility criteria included: (a) age\u0026thinsp;\u0026ge;\u0026thinsp;65 years, (b) confirmed diagnosis of T2DM, (c) fluency in the Greek language, and (d) sufficient cognitive capacity to complete the questionnaires independently. Individuals with severe cognitive impairment or acute medical conditions at the time of assessment were excluded to ensure data validity.\u003c/p\u003e \u003cp\u003e The study was conducted in accordance with the principles of the Declaration of Helsinki, and ethical approval was obtained from the relevant institutional ethics committee. Written informed consent was obtained from all participants prior to data collection.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Objectives\u003c/h3\u003e\n\u003cp\u003eThe primary objective was to investigate the association between multidimensional frailty and quality of life in older adults with T2DM. Specifically, the study aimed to assess frailty levels, evaluate quality of life, and examine the independent contribution of physical, psychological, and social frailty components to health-related quality of life. The study further sought to underscore the clinical importance of early frailty detection within Primary Health Care settings to inform individualized and multidisciplinary management strategies.\u003c/p\u003e\n\u003ch3\u003eData Collection and Instruments\u003c/h3\u003e\n\u003cp\u003eData were collected between November 2025 and December 2025, using an anonymous structured questionnaire comprising demographic variables, the Tilburg Frailty Indicator (TFI), and the Older People\u0026rsquo;s Quality of Life Questionnaire (OPQOL-35).\u003c/p\u003e \u003cp\u003eThe TFI is a 15-item self-reported multidimensional instrument assessing physical, psychological, and social domains of frailty. Total scores range from 0 to 15, with higher scores indicating greater frailty severity. A score\u0026thinsp;\u0026ge;\u0026thinsp;5 is commonly used to indicate frailty [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe OPQOL-35 consists of 35 items across eight domains of quality of life, rated on a five-point Likert scale (1\u0026thinsp;=\u0026thinsp;Strongly Agree to 5\u0026thinsp;=\u0026thinsp;Strongly Disagree). Higher scores indicate lower perceived quality of life. Negatively worded items were reverse-coded prior to analysis in accordance with established scoring guidelines [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using IBM SPSS Statistics (version 26). Internal consistency reliability was evaluated using Cronbach\u0026rsquo;s alpha (\u003cem\u003eα\u003c/em\u003e), yielding acceptable reliability for the TFI (\u003cem\u003eα\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.69) and excellent reliability for the OPQOL-35 (\u003cem\u003eα\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.96).\u003c/p\u003e \u003cp\u003eDescriptive statistics were calculated for demographic characteristics and scale scores. Pearson correlation coefficients were used to examine associations between frailty dimensions and quality of life. Multiple linear regression analysis was conducted with quality of life as the dependent variable and physical, psychological, and social frailty components as independent predictors. Assumptions of normality, linearity, and multicollinearity were examined prior to model estimation. The sample size of 112 participants was deemed sufficient for the multiple linear regression analysis, as it exceeds the commonly recommended minimum of 10\u0026ndash;15 observations per predictor variable (3 predictors), ensuring adequate statistical power to detect meaningful effects. Statistical significance was set at \u003cem\u003ep\u003c/em\u003e \u0026lt; .05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e3.1 Demographic Characteristics of the Sample\u003c/p\u003e \u003cp\u003eThe study sample consisted of 112 older patients with Type 2 Diabetes Mellitus. The majority of participants belonged to the 71\u0026ndash;80 and 65\u0026ndash;70 age groups, while approximately one-fifth of the sample was aged over 80 years. Women outnumbered men, accounting for nearly two-thirds of the total sample.\u003c/p\u003e \u003cp\u003eRegarding marital status, the majority of participants were married, while about one-third were widowed. In terms of educational attainment, more than half of the participants had completed primary education or less, a finding that reflects the educational profile of older cohorts.\u003c/p\u003e \u003cp\u003eMost participants resided in urban areas and lived with their spouse, while approximately one-quarter lived alone. Regarding therapeutic management for Type 2 Diabetes, nearly half were receiving exclusively oral antidiabetic medication, while a significant proportion followed a combination therapy of insulin and tablets. The detailed demographic and clinical characteristics of the sample are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eDemographic Characteristics\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65\u0026ndash;70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35 (31.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71\u0026ndash;80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53 (47.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81\u0026ndash;90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21 (18.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (2.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e64 (57.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47 (42.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67 (60.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32 (28.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (5.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (5.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47 (42.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12 (10.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27 (24.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSome primary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17 (15.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo formal education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (8.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlace of Residence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72 (69.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18 (17.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVillage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13 (12.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiving Arrangement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWith spouse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61 (55.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28 (25.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWith children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15 (13.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNursing home\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (5.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT2DM Treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTablets\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54 (48.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInsulin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16 (14.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCombination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41 (36.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003cem\u003eNotes\u003c/em\u003e: n\u0026thinsp;=\u0026thinsp;112. Percentages may not total 100 due to rounding or missing values in specific categories.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eFrailty of Older Adults (Tilburg Frailty Indicator)\u003c/h2\u003e \u003cp\u003eThe frequency distributions of the 15 items of the Tilburg Frailty Indicator (TFI) are presented. The majority of participants reported good perceived physical health (73.2%) and an absence of recent unintentional weight loss (64.0%). Most did not report difficulties in walking (55.4%) or maintaining balance (76.6%), nor did they report vision (91.8%) or hearing (78.2%) problems.\u003c/p\u003e \u003cp\u003eHowever, a significant proportion of the sample reported physical fatigue (65.2%) and upper limb weakness (50.0%), elements suggesting the presence of physical limitations in a segment of the population.\u003c/p\u003e \u003cp\u003eAt the psychological level, most participants stated that they experienced memory problems \"sometimes\" (43.1%), while symptoms of low mood (51.8%) and anxiety or nervousness (47.3%) were also reported primarily on an occasional basis. Nevertheless, the majority stated that they cope well with their problems (71.3%).\u003c/p\u003e \u003cp\u003eAt the social level, most participants did not live alone (73.6%) and reported adequate social support (89.2%). A sense of lack of social companionship was reported mainly \"sometimes\" (43.1%) or not at all (42.2%).\u003c/p\u003e \u003cp\u003eOverall, the mean Tilburg Frailty Indicator (TFI) score was 7.88 (\u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.78), indicating a moderate to high level of frailty in the study population. Based on the established cut-off point (TFI\u0026thinsp;\u0026ge;\u0026thinsp;5), 91 participants (81.3%) were classified as frail. These findings are consistent with the observed frequency of physical limitations within the sample.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eQuality of Life of Older Adults\u003c/h3\u003e\n\u003cp\u003eThe quality of life of the participants was assessed using the OPQOL-35 questionnaire. Descriptive statistics (means and standard deviations) were calculated for the individual dimensions of the questionnaire in a sample of 112 individuals. Responses were recorded on a five-point Likert scale (1\u0026thinsp;=\u0026thinsp;Strongly Agree to 5\u0026thinsp;=\u0026thinsp;Strongly Disagree), with higher values indicating lower perceived quality of life. Negatively worded items were reverse-coded prior to the calculation of total indices.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eMean values of Quality of Life dimensions (OPQOL-35)\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDimension\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLife overall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLife in general\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial relationships\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndependence, control over life, freedom\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHome and neighborhood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychological \u0026amp; emotional well-being\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFinancial situation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeisure time \u0026amp; activities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003cem\u003eNote\u003c/em\u003e: M\u0026thinsp;=\u0026thinsp;Mean, SD\u0026thinsp;=\u0026thinsp;Standard Deviation.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAs presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, the overall quality of life of the participants was recorded at moderate to positive levels (\u003cem\u003eΜ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.23, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.85). Particularly positive perceptions were observed in the dimensions of social relationships (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.06, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.79), psychological and emotional well-being (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.15, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.92), and home and neighborhood (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.12, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.79).\u003c/p\u003e \u003cp\u003eConversely, higher mean values, indicating lower perceived quality of life, were recorded for financial situation (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.07, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.86) and leisure time and activities (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.90, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.92), highlighting areas where participants experience more limitations. Overall, the results show that despite the presence of a chronic disease, older adults with diabetes in the sample maintain satisfactory levels of quality of life, with social and psychological dimensions appearing more protected compared to financial status and leisure activities.\u003c/p\u003e\n\u003ch3\u003eCorrelation Analysis: Frailty – Quality of Life\u003c/h3\u003e\n\u003cp\u003eTo examine the relationship between frailty and quality of life in older adults with Type 2 Diabetes Mellitus, a Pearson correlation analysis was performed between overall quality of life and the individual components of frailty (physical/health, psychological, and social).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eCorrelation between Quality of Life and Frailty Components (Pearson r)\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eQuality of Life Overall\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQuality of Life Overall\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHealth Problems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePsychological Components\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSocial Components\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.690**\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.486**\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.582**\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSig. (2-tailed)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e108\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealth Problems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.690**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.442**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.472**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSig. (2-tailed)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e108\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychological Components\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.486**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.442**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.269**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSig. (2-tailed)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial Components\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.582**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.472**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.269**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSig. (2-tailed)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e109\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003eNote\u003c/em\u003e: Higher scores in the quality of life scale indicate lower perceived quality of life, whereas higher scores in frailty components indicate greater frailty. ** Correlation is significant at p \u0026lt; .01 level (2-tailed).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, all components of frailty are positively and statistically significantly correlated with overall quality of life (\u003cem\u003ep\u003c/em\u003e \u0026lt; .01) indicating that higher levels of frailty are associated with poorer perceived quality of life. Specifically, the strongest correlation is observed between quality of life and health problems (\u003cem\u003er\u003c/em\u003e = .690, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001), suggesting that increased physical frailty is strongly associated with a significant decline in perceived quality of life. Moderate but statistically significant correlations are also observed with social (\u003cem\u003er\u003c/em\u003e = .582, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001) and psychological components (\u003cem\u003er\u003c/em\u003e = .486, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001). These findings demonstrate that beyond the physical dimension, both social and psychological factors contribute substantially to reduced quality of life in older adults with T2DM.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eMultiple Linear Regression\u003c/h2\u003e \u003cp\u003eTo further investigate the effect of individual frailty components on quality of life, a multiple linear regression analysis was conducted, with overall quality of life as the dependent variable and physical (health problems), psychological, and social components of frailty as independent variables.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eMultiple linear regression with Quality of Life as the dependent variable\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e(Constant)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStd. Error\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBeta\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSig.\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.574\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.070\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.397\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealth Problems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.866\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.459***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5.894\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychological Components\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.070\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.202**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.869\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial Components\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.399\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.095\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.303***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cem\u003eNotes\u003c/em\u003e: * \u003cem\u003ep\u003c/em\u003e \u0026lt; .05, ** \u003cem\u003ep\u003c/em\u003e \u0026lt; .01, *** \u003cem\u003ep\u003c/em\u003e \u0026lt; .001. Dependent Variable: Quality of Life (total score). \u003cem\u003eR\u003c/em\u003e\u0026sup2; = .772.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe proposed regression model explains 77.2% of the variance in overall quality of life (\u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e = .772), indicating a strong explanatory capacity of the model. All components of frailty showed a positive and statistically significant association with quality of life, indicating that higher frailty levels are associated with poorer perceived quality of life. Specifically, health problems are the strongest predictor (β\u0026thinsp;=\u0026thinsp;.459, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001), followed by social (β\u0026thinsp;=\u0026thinsp;.303, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001) and psychological components (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.202, \u003cem\u003ep\u003c/em\u003e = .005). All frailty components remained independently associated with quality of life after adjustment within the model.\u003c/p\u003e \u003cp\u003eThe positive direction of the coefficients, combined with the scale coding, implies that an increase in frailty in any dimension is associated with lower perceived quality of life. The regression equation is as follows:\u003c/p\u003e \u003cp\u003eQuality of Life\u0026thinsp;=\u0026thinsp;1.574\u0026thinsp;+\u0026thinsp;0.866(Health Problems)\u0026thinsp;+\u0026thinsp;0.202(Psychological Components)\u0026thinsp;+\u0026thinsp;0.399(Social Components)\u003c/p\u003e \u003cp\u003eThe findings confirm that frailty is a multidimensional and clinically significant determinant of quality of life in older adults with T2DM, highlighting the need for comprehensive, multidisciplinary management approaches.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study investigated the relationship between frailty and quality of life among older adults with Type 2 Diabetes Mellitus in the Trikala Region Unit, Central Greece. Focusing on this specific population is particularly relevant, as aging is accompanied by an increased incidence of diabetes and a greater burden on functional status and healthcare requirements [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In Greece, the prevalence of diabetes increases significantly with age, necessitating the investigation of factors that influence the well-being of older adults beyond glycemic control [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA key finding of this study is the statistically significant association between frailty and quality of life. Specifically, increased health problems, as well as the psychological and social components of frailty, were associated with lower levels of quality of life. Multiple linear regression analysis demonstrated that all three dimensions of frailty are independent and statistically significant predictors of quality of life, with the physical dimension exhibiting the most substantial impact.\u003c/p\u003e \u003cp\u003eBased on the total TFI score, the sample demonstrated a moderate level of frailty, exceeding the commonly used cut-off point for frailty. This finding indicates that a substantial proportion of participants can be considered frail, despite relatively preserved psychological and social functioning. The higher burden observed in the physical domain, particularly fatigue and upper limb weakness, further supports the clinical relevance of physical vulnerability in this population. These findings are reinforced by recent research on older adults in Crete, where 14.8% of the population was characterized as frail and 34.1% as pre-frail, confirming that a significant proportion of older adults in the Greek provinces maintain a level of functionality but remain at risk of transitioning to a more severe state of frailty. That study also demonstrates a close association between good quality of life, functional independence and lower frailty levels, aligning with the observations of the present work [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Additionally, the results are consistent with the biopsychosocial model of the TFI, which approaches frailty as a multidimensional phenomenon rather than exclusively as physical decline [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Importantly, the use of the TFI in this context supports its applicability as a practical screening tool in clinical settings, enabling early identification of vulnerable older adults with T2DM. This has direct implications for comprehensive geriatric assessment and the implementation of multidisciplinary, patient-centered management strategies aimed at preventing functional decline and optimizing quality of life [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRegarding quality of life, participants reported a generally good perceived status, with better performance in the dimensions of health, psychological well-being, and social relationships, while dimensions related to financial situation and participation in leisure activities were less favorable. These results are consistent with previous studies indicating that social support and psychological well-being are critical determinants of quality of life in older adults, even in the presence of chronic diseases [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. In this context, Abd Ghafar et al. [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] emphasize that the combination of diabetes and frailty acts synergistically, causing significant degradation in psychosocial well-being and overall quality of life.\u003c/p\u003e \u003cp\u003eOverall, these findings align with international literature documenting that frailty is related to diminished functional capacity, loss of autonomy, increased psychological burden, and limited social participation, elements that directly affect the quality of life of older adults [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Specifically, a study by Lin et al. [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] reports that among older adults with Type 2 diabetes, the prevalence of frailty reaches 26.6%, with physical decline and comorbidity serving as central aggravating factors. In the population of older adults with diabetes, this relationship appears more pronounced, as diabetes can exacerbate physical frailty through muscle mass loss, inflammation, and frequent hyperglycemic episodes [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe relationship between diabetes and frailty has been described as bidirectional; diabetes contributes to the development of frailty, while frailty complicates the management of the chronic disease and increases the risk of adverse outcomes [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Recent research in a sample of Greek older adults highlighted that the presence of chronic diseases, such as Type 2 diabetes, is directly linked to increased frailty levels, confirming the need for early intervention [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. The results of the present study reinforce the importance of systematic frailty assessment as an integral part of care for older adults with diabetes. To this end, contemporary guidelines and consensus statements emphasize that the recognition of frailty should lead to the individualization of therapeutic goals, with an emphasis on avoiding hypoglycemia and simplifying medication regimens to ensure patient safety and quality of life [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eAt the population level, the findings of this study acquire particular significance within the context of the rapid aging of the Greek population and the increasing burden of chronic conditions on healthcare systems. However, these findings also have direct clinical relevance, as the systematic integration of frailty assessment into Primary Health Care can facilitate early identification of vulnerable older adults with T2DM and support individualized, multidisciplinary management strategies. Such approaches may contribute to improved functional outcomes, optimized care planning, and the preservation of autonomy in this high-risk population. From this perspective, frailty emerges not only as a clinical concept but also as a meaningful indicator of public health planning and social policy in aging societies.\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eStudy Limitations\u003c/h2\u003e \u003cp\u003eThe present study has certain limitations. First, the sample was drawn from a specific geographical area, which may limit the generalizability of the results. Second, the study employed a cross-sectional design, which does not allow for causal inferences regarding the relationship between frailty and quality of life. Third, data collection relied exclusively on self-reported questionnaires, which may be influenced by subjective factors.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eDirections for Future Research\u003c/h2\u003e \u003cp\u003eFuture studies could utilize a longitudinal design to investigate the causal relationship between frailty and quality of life and to examine whether changes in frailty predict corresponding changes in quality of life over time. Additionally, larger and geographically more representative samples would enhance the generalizability of the findings. Supplementary qualitative research could also provide a deeper understanding of the lived experiences of older adults with diabetes regarding frailty and their daily functionality [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":" \u003ch2\u003eEthical Approval\u003c/h2\u003e \u003cp\u003e The study was conducted in accordance with the Declaration of Helsinki for research involving human participants. The research protocol received approval from the Ethics and Deontology Committee of the Department of Nursing at the University of Thessaly. All participants were fully informed about the purpose and procedures of the research and provided written informed consent prior to their participation. Anonymity and data confidentiality were strictly maintained.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting Interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eD.N. contributed to study conception and design, F.M and M.M. data collection, statistical analysis, and drafting of the manuscript. T.P. and G.T. contributed to study conception and design and provided overall supervision. M.S. and K.T. contributed to methodological support and critical revision of the manuscript. T.P. and G.T. contributed to data interpretation and critical revision of the manuscript for important intellectual content. All authors reviewed, approved the final version of the manuscript, and agree to be accountable for all aspects of the work.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and analyzed during the current study are not publicly available due to privacy restrictions but are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization (2025) Ageing and health. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/ageing-and-health\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/fact-sheets/detail/ageing-and-health\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. 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J Clin Nurs 31:967\u0026ndash;974. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/jocn.15962\u003c/span\u003e\u003cspan address=\"10.1111/jocn.15962\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"aging-clinical-and-experimental-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"acer","sideBox":"Learn more about [Aging Clinical and Experimental Research](http://link.springer.com/journal/40520)","snPcode":"40520","submissionUrl":"https://submission.nature.com/new-submission/40520/3","title":"Aging Clinical and Experimental Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Type 2 diabetes mellitus, frailty, older adults, geriatric assessment, quality of life","lastPublishedDoi":"10.21203/rs.3.rs-9234683/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9234683/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction:\u003c/h2\u003e \u003cp\u003eFrailty is increasingly recognized as a clinically relevant condition in older adults with Type 2 Diabetes Mellitus (T2DM), with important implications for functional outcomes and individualized care. This study investigated the association between multidimensional frailty and quality of life in older adults with T2DM.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eA cross-sectional study was conducted among 112 community-dwelling adults aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years in Trikala Regional Unit, Central Greece. Frailty was assessed using the Tilburg Frailty Indicator (TFI), and quality of life was measured with the Older People\u0026rsquo;s Quality of Life Questionnaire (OPQOL-35). Pearson correlation and multiple linear regression analyses were performed.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eThe sample demonstrated a moderate level of frailty (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;7.88, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.78), exceeding the commonly used cut-off point for frailty. Physical fatigue and upper limb weakness were among the most prevalent issues. All frailty dimensions (physical, psychological, and social) were significantly associated with poorer quality of life (\u003cem\u003ep\u003c/em\u003e \u0026lt; .01). The regression model explained 77.2% of the variance in quality of life (\u003cem\u003eR\u003c/em\u003e\u0026sup2; = .772), with physical (health \u0026ndash; related) frailty emerging as the strongest predictor (β\u0026thinsp;=\u0026thinsp;.459, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001), followed by social (β\u0026thinsp;=\u0026thinsp;.303, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001) and psychological components (β\u0026thinsp;=\u0026thinsp;.202, \u003cem\u003ep\u003c/em\u003e = .005).\u003c/p\u003e\u003ch2\u003eConclusions:\u003c/h2\u003e \u003cp\u003eFrailty is a strong multidimensional predictor of quality of life in older adults with T2DM. These findings support the clinical value of early frailty screening and the implementation of individualized, multidisciplinary management strategies in primary care settings to preserve functional ability and overall well-being in this vulnerable population.\u003c/p\u003e","manuscriptTitle":"Frailty Dimensions as Predictors of Quality of Life in Older Adults with Type 2 Diabetes Mellitus: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-06 09:49:24","doi":"10.21203/rs.3.rs-9234683/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-27T07:12:46+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-26T12:49:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-18T01:49:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"112189645118698102124131098670910143969","date":"2026-04-16T07:28:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"116439651033859473363179297091953721924","date":"2026-04-07T09:55:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"96362316231879520843236166657819039760","date":"2026-04-07T07:07:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"86008011924611878783170861081114405455","date":"2026-04-02T15:16:34+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-31T11:10:07+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-30T12:23:34+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-28T01:29:44+00:00","index":"","fulltext":""},{"type":"submitted","content":"Aging Clinical and Experimental Research","date":"2026-03-26T13:18:12+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"aging-clinical-and-experimental-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"acer","sideBox":"Learn more about [Aging Clinical and Experimental Research](http://link.springer.com/journal/40520)","snPcode":"40520","submissionUrl":"https://submission.nature.com/new-submission/40520/3","title":"Aging Clinical and Experimental Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"3014dee8-dddb-4d7e-b14c-38b3e9de0995","owner":[],"postedDate":"April 6th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-01T16:54:02+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-06 09:49:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9234683","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9234683","identity":"rs-9234683","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}