The search and screening strategy.

<div><p>Objective</p><p>This systematic review and meta-analysis aimed to evaluate the prevalence of frailty and pre-frailty in older adults with diabetes; and to identify the risk factors associated with frailty in this population.</p><p>Design</p><p>Systematic review and meta-analysis.</p><p>Participants</p><p>24,332 people aged 60 years and older with diabetes.</p><p>Methods</p><p>Six databases were searched (PubMed, Embase, the Cochrane Library, Web of Science, China Knowledge Resource Integrated Database, and Chinese Biomedical Database) up to 15 January 2024. Random effects models were used in instances of significant heterogeneity. Subgroup analysis and meta-regression were conducted to identify the potential source of heterogeneity. The Agency for Healthcare Research and Quality (AHRQ) and the Newcastle-Ottawa Scale (NOS) were applied to assess the quality of included studies.</p><p>Results</p><p>3,195 abstracts were screened, and 39 full-text studies were included. In 39 studies with 24,332 older people with diabetes, the pooled prevalence of frailty among older adults with diabetes was 30.0% (95% CI: 23.6%-36.7%). Among the twenty-one studies involving 7,922 older people with diabetes, the pooled prevalence of pre-frailty was 45.1% (95% CI: 38.5%-51.8%). The following risk factors were associated with frailty among older adults with diabetes: older age (OR = 1.08, 95% CI: 1.04–1.13, <i>p</i><0.05), high HbA1c (OR = 2.14, 95% CI: 1.30–3.50, <i>p</i><0.001), and less exercise (OR = 3.11, 95% CI: 1.36–7.12, <i>p</i><0.001).</p><p>Conclusions</p><p>This suggests that clinical care providers should be vigilant in identifying frailty and risk factors of frailty while screening for and intervening in older adults with diabetes. However, there are not enough studies to identify comprehensive risk factors of frailty in older adults with diabetes.</p><p>Trial registration</p><p><b>PROSPERO registration number:</b><a href="https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023470933" target="_blank">CRD42023470933</a>.</p></div>