Abstract
Recurrent hypoglycemia is common in older people with diabetes and is likely to be less recognized and under reported by patients and health care professionals. Hypoglycemia in this age group is associated with significant morbidities leading to both physical and cognitive dysfunction. Repeated hospital admissions due to frequent hypoglycemia are also associated with further deterioration in patients' general health. This negative impact of hypoglycemia is likely to eventually lead to frailty, disability and poor outcomes. It appears that the relationship between hypoglycemia and frailty is bidirectional and mediated through a series of influences including under nutrition. Therefore, attention should be paid to the management of under nutrition in the general elderly population by improving energy intake and maintaining muscle mass. Increasing physical activity and having a more conservative approach to glycemic targets in frail older people with diabetes may be worthwhile.
Highlights
The incidence of hypoglycemia in older people (>75 years) with diabetes is difficult to estimate due to the limited number of clinical studies and the lack of standardization in hypoglycemia diagnosis
In a retrospective study of 16,667 older people with diabetes, mean age 65 years, the risk of dementia increased by 26% (HR 1.26, 95% confidence interval (CI) 1.10 to 1.49), 80% (1.80, 1.37 to 2.36) and 94% (1.94, 1.42 to 2.64) in patients with a history of one, two and three or more severe hypoglycemic episodes respectively independent of glycemic control, medications and comorbidities
The findings of this study suggest that older age, use of multiple medications reflecting multiple comorbidities and frequent hospitalizations which are marker of underlying frailty are associated with increased risk of hypoglycemia [10]
Summary
The phenotype of frailty is thought to develop as a result of abnormalities at molecular, cellular, and physiological levels. The findings of this study suggest that older age, use of multiple medications reflecting multiple comorbidities and frequent hospitalizations which are marker of underlying frailty are associated with increased risk of hypoglycemia [10]. Ageing is associated with hyperglycemic tendency due to the change in body composition with the accumulation of visceral fat increasing insulin resistance, in frail elderly there may be a tendency towards hypoglycemia due to malnutrition and comorbidities This metabolic change towards hypoglycemia rather than hyperglycemia has been supported by the evidence of successful withdrawal of diabetes medications in nursing home older patients without deterioration in glycemic control suggesting diminished hyperglycemic or increased hypoglycemic tendency in the frail elderly [64]. Patients who have erratic eating patterns and unpredictable caloric intake could be managed with a regime where short acting insulin analogues are administered only after meal consumption, preventing insulin-induced hypoglycemia if a meal is missed or only partly consumed
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