The Relationship Between Frailty and Treatment Compliance in Diabetic and Geriatric Patients Using Insulin

Abstract

Aim: Understanding and detecting frailty makes convenience to healthcare providers for deciding on appropriate therapy and follow-up strategy. In this study, we tried to determine the relationship between compliance to therapy, hypoglycemia and frailty in the elderly diabetic patients under insulin therapy. Materials and Methods:One hundred sixty-seven patients diagnosed with diabetes mellitus and under insulin therapy were recruited for the study. Criteria of frailty according to the Cardiovascular Health Study (CHS) were used to determine frailty. According to CHS, patients fulfilling three or more criteria out of five were regarded as frail elderly. Hypoglycemia rates and compliance to treatment were compared between the groups.Results: 44.3% of our patients were regarded as frail elderly and the rate of hypoglycemia was higher in this group. A dignificant relationship between subgroups of frailty and insulin was detected. Frailty rate was 28.6% in the basal insulin therapy group, 37.1% in the basal-bolus therapy group and 40% in the premixed insulin group. In the frail elderly group, the rate of moderate hypoglycemia was significantly higher than in the non-frail group (40.2% vs 20%). Severe hypoglycemic episodes were observed more frequently in the frail elderly group than in the non-frail group (24.6% vs 12.7%). Conclusion:Frailty increases the risk of moderate and severe hypoglycemia. Before planning and starting insulin therapy, frailty must be detected and taken into consideration.