March 16, 2016
A new study published in Future Science OA suggests that older adults with diabetes who are malnourished, underweight, or frail should reduce or discontinue their use of diabetes medications.
Researchers led by Ahmed H Abdelhafiz, FRCP, MD, Rotherham General Hospital, Rotherham, UK, examined articles from 1969 to 2015 to review the impact of frailty on blood glucose level normalization and its implications for clinical management of type 2 diabetes. In old age, diabetes is associated with high comorbidity burden and increased prevalence of geriatric syndromes, including frailty. Weight loss and malnutrition are characteristic of frailty, because frail older adults have a reduced appetite and reduce their food intake as a result of lack of exercise and diminished energy consumption. As a result, hyperglycemia tends to decrease and blood glucose levels tend to normalize in frail older adults with diabetes—a state termed "burnt-out diabetes". Thus, regular doses of diabetes medications may be too strong for this population.
Dr Abdelhafiz cautioned, “Although guidelines have suggested a relaxed glycemic control in frail elderly with diabetes, this may not be enough and complete withdrawal of hypoglycemic medications may be necessary in these frail populations.”
The researchers advocate for regular medication reviews and considering gradual reduction or complete withdrawal when frailty and significant weight loss emerge. “The main determinants of successful withdrawals of hypoglycemic medications were significant weight loss and development of multiple comorbidities including dementia,” explained Dr Abdelhafiz.
The authors also highlighted the need for future research to investigate the effect of frailty on glucose–insulin dynamics and the possible amelioration of hyperglycemia. —Amanda Del Signore