Do We Need To Reconsider The Guidelines For Treatment Of Older People With Diabetes?

In old age, diabetes is associated with high comorbidity burden and increased prevalence of geriatric syndromes, including frailty. Weight loss and malnutrition are characteristic of frailty, which may lead to decreased hyperglycemia and normalization of blood glucose levels, a state that may be termed "burnt out diabetes". As a result, the emergence of frailty may change the natural history of type 2 diabetes from a progressive to a regressive course with increased risk of hypoglycemia. Current guidelines suggest relaxed glycemic control in diabetic, frail elderly patients.

“The natural history of Type 2 diabetes is progressive with increasing demands of hypoglycemic medications. Increasing age and weight gain promote the progressive nature of its course. However, in the frail older people, particularly in those with chronic wasting diseases and significant weight loss, blood glucose levels tend to normalize with increased risk of hypoglycemia. Recurrent hypoglycemia in frail older people with diabetes is a marker of vulnerability and hypoglycemic medication review or even complete withdrawal is appropriate in this group of patients.

Frailty is an emerging complication in older people with diabetes and will need interventions beyond glycemic control. Although it may have a positive impact on reducing hypoglycemic medications’ need due to the significant weight loss, it has an overall a negative effect on the outcome with increased mortality. The effect of frailty on glucose/insulin dynamics and its relation with insulin sensitivity/resistance and possible amelioration of hyperglycemia will need further research. There is a need for studies exploring interventions to delay or prevent frailty and disability in older people with diabetes. Improvement in functional level may be more relevant than glycemic control in this population. The multimodal intervention (resistance exercise training, diet and education) proposed by the MID-Frail study in the frail and pre-frail individuals aged ≥70 years with Type 2 diabetes may improve function and preserve self-autonomy.”

To read the article “The effect of frailty should be considered in the management plan of older people with Type 2 diabetes” by authors Ahmed H Abdelhafiz, Luan Koay & Alan J Sinclair, Click Here