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Abstract
The accelerated ageing that occurs in diabetes results in earlier appearance of the geriatric phenotype, including frailty. Recent guidelines have stressed the need for assessing frailty in the evaluation of older adults living with diabetes. Once evaluated and identified, however, the presence of frailty marks a significant change for the individual. Treatments that have been continued and encouraged often for many years, may be discontinued. Life-prolonging medications such GLP-1 analogues, and SGLT-2 inhibitors are replaced with therapies designed to improve quality of life, reduce glycaemic variability and stabilise the sarcopaenia that characterises frailty, such as insulin. With this, however, comes new problems, such as the risk of hypoglycaemia, the need to for capillary glucose monitoring and sub cutaneous administration. Additionally, new diagnoses that are more common in people in diabetes, such as stroke, heart disease, dementia, falls and fractures will result in further changes, with the need for care and possibly even institutionalisation.
Highlights
Complications of diabetes in the frail older adultLike any other person living with diabetes, the risk of micro and macrovascular events is increased in the frail population, diabetes contributes to several other components of the frailty syndrome
The accelerated ageing that occurs in diabetes results in earlier appearance of the geriatric phenotype, including frailty
Recent guidelines have stressed the need for assessing frailty in the evaluation of older adults living with diabetes
Summary
Like any other person living with diabetes, the risk of micro and macrovascular events is increased in the frail population, diabetes contributes to several other components of the frailty syndrome. There are competing hypotheses for the observation It may represent impairment in microarchitecture of the bone, in the loadbearing trabeculae, due to underlying microvascular disease. It be a product of the increased falls risk mediated through hypoglycaemia, sarcopaenia, neuropathy or any other component of the frailty syndrome. The interplay between risk of hyperglycaemia and hypoglycaemia is complex In those without diabetes, there is a clear association between higher average glucose and cognitive decline. There is a clear association between higher average glucose and cognitive decline In those with diabetes, a high average glucose is associated with a higher risk of dementia, the risk rises as average glucose falls into a physiological range. In a large population-based study, the risk of dementia increased by 26% after a single major hypoglycaemic episode, and almost doubled after 3 or more episodes in a year after adjustment for potential confounders such as duration of diabetes, insulin use, HbA1c and ethnicity[9]
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