The Effect of Frailty Should Be Considered in the Management Plan of Older People With Type 2 Diabetes

Figures & data

Figure 1.  Phenotypes of frailty.

Presence of 0–1 phenotype = not frail, two phenotypes = pre-frail, ≥three phenotypes = frail [5].

Figure 2.  Glycemic targets in older people with diabetes mellitus.

^†Short-term targets of daily blood glucose monitoring between >4 but <15 mmol/l are more relevant than the long-term HbA1c due to the limited life expectancy in this population group.

Figure 3.  The emergence of frailty may alter the natural history of diabetes from a progressive to a regressive course leading to downregulation or withdrawal of hypoglycemic medications.

Table 1.  Comparison of demographics on and at end of hypoglycemic treatment.

Parameter	On treatment	Treatment withdrawn	Difference (95% CI)	p-value
Comorbidities, mean (SD)	4.1 (0.9)	6.8 (1.6)	2.7 (1.3–3.9)	0.002
Patients with dementia	None	4 (50%)	–
Medications, mean (SD)	6.4 (1.9)	10.1 (2.2)	3.7 (1.4–6.1)	0.01
bodyweight (kg), mean (SD)	88 (22.4)	75.4 (21.2)	12.6 (5.9–19.3)	0.003
Mean (SD) ALT	16.8 (4.3)	18.4 (3.3)	1.6 (2.4–5.7)	0.4
Mean (SD) eGFR	46.9 (10.3)	45.1 (10.8)	1.8 (9.5–13.0)	0.7
Mean (SD) HbA1c	6.2% (0.8)	6.5% (0.7)	0.3% (-1.1–0.5)	0.4

The stable liver and kidney functions suggest that successful withdrawal of hypoglycemic medications was not due to deteriorating organ function.

ALT: Alanine transaminase; eGFR: Estimated glomerular filtration rate SD: Standard deviation.

Data taken from [50].

Table 2.  Weight loss as a determinant of hypoglycemic medication withdrawal.

Patients	First weight (kg)^†	Second weight (kg)	First HbA1c (%)	Second HbA1c (%)
1	100	70	6.3	6.5
2	95	88	7.1	6.6
3	58	50	6.0	6.8
4	74	64	7.4	7.9
5	127	114	6.0	6.6
6	102	94	5.8	6.1
7	66	60	4.6	5.3
8	82	64	6.3	6.3

First HbA1c = HbA1c at the time of medications withdrawal, second HbA1c = HbA1c after 1 year follow-up off medications. The significant weight loss appears to contribute to the successful withdrawal of hypoglycemic medications.

† First weight = peak weight during treatment, second weight = weight at the time of medications withdrawal.

Data taken with permission from [50].

Fried LP , TangenCM, WalstonJet al. Frailty in older adults: evidence for a phenotype. J. Gerontol. A Biol. Sci. Med. Sci.56A, M146–M156 (2001).

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Abdelhafiz AH , ChakravortyP, GuptaSet al. Can hypoglycaemic medications be withdrawn in older people with Type 2 diabetes? Int. J. Clin. Pract. 68, 790–792 (2014).

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