The Emergence of Frailty May Lead to a State of Burnt Out Type 2 Diabetes

Ah, Abdelhafiz; Koay, Luan; Sinclair, AJ

doi:10.14283/jfa.2016.98

Cited by 4 publications

(3 citation statements)

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“…In the AM phenotype, due to malnutrition, frequent episodes of hypoglycaemia are expected [ 19 ] and, deintensification of hypoglycaemic agents is possible [ 21 , 22 ]. The normalisation of HbA1c can occur after the withdrawal of all hypoglycaemic medications, a state called frailty-induced burnt-out diabetes [ 49 ]. The AM frail older people had tight glycaemic control, due to a mismatch between their low body weight and hypoglycaemic drug burden, suggesting the need for deintensification [ 26 , 27 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

Metabolic Characteristics of Frail Older People with Diabetes Mellitus—A Systematic Search for Phenotypes

2023

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Frailty in older people with diabetes is viewed as one homogeneous category. We previously suggested that frailty is not homogeneous and spans across a metabolic spectrum that starts with an anorexic malnourished (AM) frail phenotype and ends with a sarcopenic obese (SO) phenotype. We aimed to investigate the metabolic characteristics of frail older people with diabetes reported in the current literature to explore whether they fit into two distinctive metabolic phenotypes. We performed systematic review of studies published over the last 10 years and reported characteristics of frail older people with diabetes mellitus. A total of 25 studies were included in this systematic review. Fifteen studies reported frail patients’ characteristics that could fit into an AM phenotype. This phenotype is characterised by low body weight, increased prevalence of malnutrition markers such as low serum albumin, low serum cholesterol, low Hb, low HbA1c, and increased risk of hypoglycaemia. Ten studies reported frail patients’ characteristics that describe a SO phenotype. This phenotype is characterised by increased body weight, increased serum cholesterol, high HbA1c, and increased blood glucose levels. Due to significant weight loss in the AM phenotype, insulin resistance decreases, leading to a decelerated diabetes trajectory and reduced hypoglycaemic agent use or deintensification of therapy. On the other hand, in the SO phenotype, insulin resistance increases leading to accelerated diabetes trajectory and increased hypoglycaemic agent use or intensification of therapy. Current literature suggests that frailty is a metabolically heterogeneous condition that includes AM and SO phenotypes. Both phenotypes have metabolically distinctive features, which will have a different effect on diabetes trajectory. Therefore, clinical decision-making and future clinical studies should consider the metabolic heterogeneity of frailty.

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Section: Discussionmentioning

confidence: 99%

Metabolic Characteristics of Frail Older People with Diabetes Mellitus—A Systematic Search for Phenotypes

2023

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“…Frailty, on the other hand, has also been associated with chronic inflammation and insulin resistance and could therefore affect postprandial thermogenesis [ 118 ]. This hypothesis was examined by Goulet et al; no difference was observed in the DIT between frail women and matched controls, although postprandial insulin resistance was impaired in the frail group.…”

Section: Factors That Affect Ditmentioning

confidence: 99%

Diet induced thermogenesis, older and newer data with emphasis on obesity and diabetes mellitus - A narrative review

Tzeravini,

Tentolouris,

Kokkinos

et al. 2024

Metabolism Open

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“…Weight loss is known to improve insulin sensitivity in internal organs such as the liver and skeletal muscles and reduce fat deposition in the pancreas, which may also improve insulin secretion from the β-cells [ 80 , 81 ]. Therefore, some patients with diabetes in this phenotype have shown spontaneous resolution of hyperglycaemia and normalisation of HbA1c [ 82 ].…”

Section: Impact Of Frailty On Diabetes Trajectorymentioning

confidence: 99%

Metabolic Impact of Frailty Changes Diabetes Trajectory

Sinclair

Abdelhafiz

2023

Metabolites

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Diabetes mellitus prevalence increases with increasing age. In older people with diabetes, frailty is a newly emerging and significant complication. Frailty induces body composition changes that influence the metabolic state and affect diabetes trajectory. Frailty appears to have a wide metabolic spectrum, which can present with an anorexic malnourished phenotype and a sarcopenic obese phenotype. The sarcopenic obese phenotype individuals have significant loss of muscle mass and increased visceral fat. This phenotype is characterised by increased insulin resistance and a synergistic increase in the cardiovascular risk more than that induced by obesity or sarcopenia alone. Therefore, in this phenotype, the trajectory of diabetes is accelerated, which needs further intensification of hypoglycaemic therapy and a focus on cardiovascular risk reduction. Anorexic malnourished individuals have significant weight loss and reduced insulin resistance. In this phenotype, the trajectory of diabetes is decelerated, which needs deintensification of hypoglycaemic therapy and a focus on symptom control and quality of life. In the sarcopenic obese phenotype, the early use of sodium-glucose transporter-2 inhibitors and glucagon-like peptide-1 receptor agonists is reasonable due to their weight loss and cardio–renal protection properties. In the malnourished anorexic phenotype, the early use of long-acting insulin analogues is reasonable due to their weight gain and anabolic properties, regimen simplicity and the convenience of once-daily administration.

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The Emergence of Frailty May Lead to a State of Burnt Out Type 2 Diabetes

Cited by 4 publications

References 0 publications

Metabolic Characteristics of Frail Older People with Diabetes Mellitus—A Systematic Search for Phenotypes

Metabolic Characteristics of Frail Older People with Diabetes Mellitus—A Systematic Search for Phenotypes

Diet induced thermogenesis, older and newer data with emphasis on obesity and diabetes mellitus - A narrative review

Metabolic Impact of Frailty Changes Diabetes Trajectory

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