The emergence of frailty may burn out type 2 diabetes-a hypothesis

Abdelhafiz, Ahmed H.; Koay, Luan; Sinclair, AJ

doi:10.1111/ijcp.12796

Cited by 2 publications

(3 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There has always been an argument that, despite functional impairment, these individuals do not present symptoms. This may, at least in part, be due to a senile frailty meaning that these elderly individuals adapt their eating habits and in turn their entire metabolism . As stated earlier, malnutrition based on reduced food intake is generally accepted as the main cause of undernutrition in the elderly .…”

Section: Systematic Literature Review Of Age‐related Pancreatic Functmentioning

confidence: 99%

The ageing pancreas: a systematic review of the evidence and analysis of the consequences

et al. 2018

View full text Add to dashboard Cite

Senior people constitute the fastest growing segment of the population. The elderly are at risk for malnutrition, thought to be caused by reduced food intake or involution of the physiological capacity of the GI tract. Age-related changes are well known in other secretory organs such as liver, kidney and intestine. The pancreas, representing a metabolically active organ with uptake and breakdown of essential nutritional components, changes its morphology and function with age. During childhood, the volume of the pancreas increases, reaching a plateau between 20 and 60 years, and declines thereafter. This decline involves the pancreatic parenchyma and is associated with decreased perfusion, fibrosis and atrophy. As a consequence of these changes, pancreatic exocrine function is impaired in healthy older individuals without any gastrointestinal disease. Five per cent of people older than 70 years and ten per cent older than 80 years have pancreatic exocrine insufficiency (PEI) with a faecal elastase-1 below 200 μg g stool, and 5% have severe PEI with faecal elastase-1 below 100 μg g stool. This may lead to maldigestion and malnutrition. Patients may have few symptoms, for example steatorrhoea, diarrhoea, abdominal pain and weight loss. Malnutrition consists of deficits of fat-soluble vitamins and is affecting both patients with PEI and the elderly. Secondary consequences may include decreased bone mineral density and results from impaired absorption of fat-soluble vitamin D due to impaired pancreatic exocrine function. The unanswered question is whether this age-related decrease in pancreatic function warrants therapy. Therapeutic intervention, which may consist of supplementation of pancreatic enzymes and/or vitamins in aged individuals with proven exocrine pancreas insufficiency, could contribute to healthy ageing.

show abstract

Section: Systematic Literature Review Of Age‐related Pancreatic Functmentioning

confidence: 99%

The ageing pancreas: a systematic review of the evidence and analysis of the consequences

et al. 2018

View full text Add to dashboard Cite

show abstract

“…The diagnoses were all registered by a physician authorized in Denmark and could have been registered many years prior to the index admission. Thus, one potential explanation for our finding could be that type 2 diabetes is not a chronic disease but rather a condition that may in some cases remit with old age -a notion that has been proposed before 32,33 . Hence, Abdelhafiz et al proposed that frailty among older people with type 2 diabetes might lead to the remission of type 2 diabetes with the suggested mechanisms being weight loss accompanied by reduced amounts of visceral fat and thereby improved insulin sensitivity 32 .…”

Section: Discussionmentioning

confidence: 76%

“…Thus, one potential explanation for our finding could be that type 2 diabetes is not a chronic disease but rather a condition that may in some cases remit with old age -a notion that has been proposed before 32,33 . Hence, Abdelhafiz et al proposed that frailty among older people with type 2 diabetes might lead to the remission of type 2 diabetes with the suggested mechanisms being weight loss accompanied by reduced amounts of visceral fat and thereby improved insulin sensitivity 32 . Such a mechanism bears resemblance to that described for patients having bariatric surgery and/or substantial weight loss and afterwards experience remission of their type 2 diabetes 34,35 .…”

Section: Discussionmentioning

confidence: 76%

Glycemic control and use of glucose-lowering medications in hospital-admitted type 2 diabetes patients over 80 years

Gotfredsen

Vinther

Petersen

et al. 2020

Sci Rep

View full text Add to dashboard Cite

Treatment guidelines for type 2 diabetes (T2D) recommend avoidance of hypoglycemia and less stringent glycemic control in older patients. We examined the relation of glycemic control to glucoselowering medications use in a cohort of patients aged>80 years with a diagnosis of T2D and a hospital admission in the Capital Region of Denmark in 2012-2016. We extracted data on medication use, diagnoses, and biochemistry from the hospitals' records. We identified 5,172 T2D patients with high degree of co-morbidity and where 17% had an HbA 1c in the range recommended for frail, comorbid, older patients with type 2 diabetes (58-75 mmol/mol (7.5-9%)). Half of the patients (n = 2,575) had an HbA 1c <48 mmol/mol (<6.5%), and a majority of these (36% of all patients) did not meet the diagnostic criteria for T2D. Of patients treated with one or more glucose-lowering medications (n = 1,758), 20% had HbA 1c -values <42 mmol/mol (<6%), and 1% had critically low Hba 1c values <30 mmol/mol (<4.9%), In conclusion, among these hospitalized T2D patients, few had an HbA 1c within the generally recommended glycemic targets. One third of patients did not meet the diagnostic criteria for T2D, and of the patients who were treated with glucose-lowering medications, one-fifth had HbA 1c -values suggesting overtreatment.For patients with type 2 diabetes, it is important to maintain blood glucose levels as close to normal as possible in order to reduce the risk of micro-and macrovascular complications 1-4 . Treatment should, however, be individualized according to comorbidities, disease duration, risk of adverse events and in particular hypoglycemia, life expectancy as well as the patient's own preferences, resources and support system 1 . Elderly people with type 2 diabetes will generally have co-existing illness and relatively few resources 5 . Life expectancy will often be shorter than the time it takes for micro-and macrovascular disease complications to develop and manifest 6,7 . This is in contrast to the potential adverse effects of glucose-lowering medications that often appear in the short term. Hypoglycemia is the most important example of an acute and potentially fatal adverse effect to which elderly are particularly vulnerable [8][9][10][11][12][13][14][15] . Less effective counterregulatory mechanisms, decreased drug elimination, motor and cognitive impairment as well as unspecific/uncharacteristic symptoms all contribute to the heightened risk in elderly patients 16 . Thus, the overall goal with treatment individualization should be to weigh the typically long-term benefits vs. therapy burden and risk of adverse events on the shorter term 7,15,17,18 . Available evidence from the few clinical trials enrolling elderly patients with type 2 diabetes support that the benefits of intensive glycemic control targeting near-normal glycemia may not outweigh potential risks in this population 8,[19][20][21][22] . This is also reflected in several international guidelines which generally advocate a less stringent treatment approach for older ...

show abstract

The emergence of frailty may burn out type 2 diabetes-a hypothesis

Cited by 2 publications

References 10 publications

The ageing pancreas: a systematic review of the evidence and analysis of the consequences

The ageing pancreas: a systematic review of the evidence and analysis of the consequences

Glycemic control and use of glucose-lowering medications in hospital-admitted type 2 diabetes patients over 80 years

Contact Info

Product

Resources

About