Diabetes and Frail Older Patients: Glycemic Control and Prescription Profile in Real Life

Abstract

(1) Background: The latest recommendations for diabetes management adapt the objectives of glycemic control to the frailty profile in older patients. The purpose of this study was to evaluate the proportion of older patients with diabetes whose treatment deviates from the recommendations. (2) Methods: This cross-sectional observational study was conducted in older adults with known diabetes who underwent an outpatient frailty assessment in 2016. Glycated hemoglobin (HbA1c) target is between 6% and 7% for nonfrail patients and between 7% and 8% for frail patients. Frailty was evaluated using the Fried criteria. Prescriptions of glucose-lowering drugs were analyzed based on explicit and implicit criteria. (3) Results: Of 110 people with diabetes with an average age of 81.7 years, 67.3% were frail. They had a mean HbA1c of 7.11%. Of these patients, 60.9% had at least one drug therapy problem in their diabetes management and 40.9% were potentially overtreated. The HbA1c distribution in relation to the targets varied depending on frailty status (p < 0.002), with overly strict control in frail patients (p < 0.001). (4) Conclusions: Glycemic control does not seem to be routinely adjusted to the health of frail patients. Several factors can lead to overtreatment of these patients.

Hypoglycaemic therapy in frail older people with type 2 diabetes mellitus—a choice determined by metabolic phenotype

“…In routine clinical practice, even in specialist centres, frailty still does not seem to be taken into consideration when deciding on diabetes management, glycaemic control and HbA1c targets [ 140 , 141 ]. We have demonstrated that frailty is a complex metabolic condition with a spectrum of metabolic phenotypes with variation in insulin sensitivity that may affect the choice of hypoglycaemic therapy.…”

Association between Self-Reported Chewing Status and Glycemic Control in Japanese Adults

“…In addition, we defined HbA1c level ≥6.5% as high HbA1c levels. In elderly and frail diabetic patients, it is recommended to set higher HbA1c thresholds than in young patients [21,22]. Therefore, separate HbA1c cutoffs for different age groups may be more appropriate [22].…”

What are the consequences of over and undertreatment of type 2 diabetes mellitus in a frail population? A systematic review

“…We assessed 98 full-text articles for inclusion and identified 11 studies that met our inclusion criteria. [19][20][21][22][23][24][25][26][27][28][29] two were cross-sectional studies 19,20 with a mix of prospective [19][20][21][22][23][24][25] and retrospective 19,21,25 studies. One study was post-hoc analysis of a large randomised controlled trial.…”

“…26 A range of care settings were included with 6 studies 20,21,[24][25][26]29 from primary care settings, 4 from hospital inpatients [22][23][24]27 and 1 from a hospital outpatient department. 19 Studies were from a wide range of geographical locations 3 from the USA, 25,27,28 with 2 each from Italy, 20,24 Spain 21,22 and 1 each from the UK 23 Australia, 26 France 19 and the Netherlands. 29 Four studies specifically related to type 2 diabetes, 21,23,26,27 with the others only specifying a general diabetes diagnosis rather than type of diabetes.…”