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The challenge of diabetes in frail older adults

Jul 20, 2016

Diabetes disproportionately affects older adults, and the clinical presentation of older adults with diabetes is often complex and multi-morbid. Frailty is a distinct health state that is often related to the ageing process, in which multiple systems of the human body begin to fail resulting in a loss of robustness and resilience in those afflicted. Frail older adults are at greater risk of falls and disability, and are more likely to be hospitalised than their non-frail counterparts meaning that outcomes are generally poorer for older adults who are frail. Diabetes is associated with an increased risk of becoming frail, with sarcopenia (the loss of muscle mass and/or function) being a possible link between the two. Glucose homeostasis becomes progressively worse dysregulated with age. Insulin secretion normally decreases at a rate of around 0.7% per year with of life and whilst not obligatory, may individuals see a loss of insulins sensitivity with age, partially due to changes in body composition. Whilst the phenotype of frailty is now more clearly understood, the aetiology remains unclear as do the best therapeutic targets for arresting or reversing decline in these patients. Targets for managing glycaemic control in younger or non-frail individuals with diabetes may not be appropriate in cases of frailty, as there is evidence a desirable HbA1c for a non-frail individual may be harmful for a frail one. This has led to suggestions that more ‘liberal’ or ‘personalised’ blood glucose targets relative to the extent of frailty could be beneficial in these cases. The increasing incidence of diabetes and increasing longevity partly due to improvements in management of cardiovascular morbidity in diabetes will undoubtedly increase direct and indirect health-related costs in the years to come, meaning that a clearer understanding of frailty in diabetes is urgently required.

Should we routinely screen for frailty in all older adults with diabetes? At what age cut off? Do we need specific, evidence based targets/regimen for older adults with diabetes instead of using more general ones? How can exercise be safely introduced in less independent older adults with diabetes?

Information about the discussion leader

The discussion will be moderated by Dr James Brown, lecturer at the School of Life and Health Sciences, Aston University, UK.


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