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Do we need to reconsider the guidelines for treatment of older people with diabetes?

Future Science Group (FSG) today announced the publication of a new article in Future Science OA, reporting data that explore the effect of frailty on the natural history of diabetes and the implications it will have for therapeutic plans in older people.

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.

In a new article, “The effect of frailty should be considered in the management plan of older people with Type 2 diabetes”, Ahmed H Abdelhafiz and Luan Koay from Rotherham General Hospital (UK), joined by Alan J Sinclair (Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, UK), reviewed the impact of frailty on blood glucose level normalization, and its implications for clinical management of Type 2 Diabetes.

“Although guidelines have suggested a relaxed glycemic control in frail elderly with diabetes, this may not be enough and complete withdrawal of hypoglycemic medications may be necessary in these frail populations,” explains Abdelhafiz, corresponding author of the study. “Normoglycemia has been shown in chronic wasting diseases and in frail populations, which led to safe and successful withdrawal of hypoglycemic medications. The main determinants of successful withdrawals of hypoglycemic medications were significant weight loss, and development of multiple comorbidities including dementia.”

“This review therefore outlines the importance of regular medications review with consideration of gradual reduction or complete withdrawal when frailty and significant weight loss emerge. It also highlights the need for future research to investigate the effect of frailty on glucose/insulin dynamics and the possible amelioration of hyperglycemia.”

“The increasing prevalence of diabetes alongside the increased expected life expectancy apparent in many countries means it is important to continually evaluate diabetes guidelines to ensure they are meeting the needs of the patient population,” commented Francesca Lake, Managing Editor. “We hope this work will encourage further research, and improve clinical management, for frail patients suffering diabetes.”