Hypoglycemia in Older People - A Less Well Recognized Risk Factor for Frailty

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.

Frailty and sarcopenia as the basis for the phenotypic manifestation of chronic diseases in older adults

“…Additional longitudinal studies have revealed that diabetes increases the risk for frailty in older adults (60 years or more) (García-Esquinas et al, 2015a). Importantly, hypoglycemia, which is common in older people with diabetes, is also associated with physical and cognitive dysfunction in this population, being this association related to under nutrition (Abdelhafiz et al, 2015). In addition to the associated comorbidities, a direct effect of diabetes on skeletal muscle seems to contribute to mobility reduction process in older individuals with diabetes (Kalyani et al, 2014).…”

The emergence of frailty and sarcopaenia in diabetes mellitus: description of inter-relationships and clinical importance

“…Published data on the prevalence of frailty Hypoglycaemia and frailty -risk factors, complications and consequences (Abdelhafiz et al[24]). …”

Características diferenciales de la diabetes mellitus tipo 2 en el paciente anciano. Papel de los inhibidores de la dipeptidil peptidasa 4

“…Los pacientes ancianos con diabetes son especialmente vulnerables a la hipoglucemia debido a la coexistencia habitual de varios factores de riesgo: cambios en los mecanismos reguladores asociados al propio proceso de envejecimiento, comorbilidades como la insuficiencia renal, medicación múltiple que aumenta tanto la presencia de interacciones como de falta de adherencia al tratamiento, mayor duración de la diabetes, automonitorización infrecuente y falta de educación diabetológica (tabla 3) 1,8,27,28 .…”