Effects of hypoglycaemic therapy on frailty: a multi-dimensional perspective

ABSTRACT

Introduction

The prevalence of diabetes is increasing in older people. With increasing age, frailty emerges as a new complication leading to disability. Frailty does not only include physical dysfunction but also involves negative impact on cognition and mood. Triad of impairments (TOI) is a new concept that includes physical frailty, dementia and depression to reflect the wider spectrum of frailty.

Areas covered

Little is known about effects of hypoglycaemic agents on frailty syndrome. A literature search was performed on studies, which reported effects of hypoglycaemic agents on the component of the TOI.

Expert opinion

It appears that most hypoglycaemic agents have some effects on frailty, although the results of clinical studies are inconsistent. Metformin seems to have a consistent and a positive effect on physical frailty. Its effects on cognitive function, however, are inconclusive but tend to be positive. Metformin appeared to improve depressive symptoms. Other agents such as incretins, thiazolidinediones, and sodium glucose transporter-2 inhibitors have some positive effects on cognition and depression. Sulfonylureas, glinides, or insulin have either negative or neutral effects on TOI components. The negative effects of insulin could be partially explained by the negative psychological factors and the frequent episodes of hypoglycemia associated with such therapy.

KEYWORDS:

• Older people
• diabetes
• frailty
• hypoglycaemic agents
• dementia
• depression

Article highlights

• Triad of impairments (TOI) of physical frailty, dementia, and depression, is a new concept that reflects a wider aspect of frailty syndrome.

• Most hypoglycaemic agents have some effects on the component of TOI, although clinical studies’ results are inconsistent.

• Metformin appears to have a consistent positive effects on physical frailty but inconsistent effects on cognition and depression.

• Incretins, thiazolidinediones, and sodium glucose trasporte-2 inhibitors have some positive effects on cognition and depression.

• Sulfonylureas, glinides, and insulin have either negative or neutral effects on the TOI components.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership, or options, expert testimony, grants, or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.