Dr Kevin Fernando Stresses the Importance of Considering Frailty When Managing Diabetes in Older People, Which He Discussed in a Talk at Guidelines Live 2022
The quote ‘it’s not the years in your life, it’s the life in your years’, often misattributed to Abraham Lincoln,1 certainly applies to the treatment of older adults living with type 2 diabetes. Appropriate management goals for older adults living with diabetes can vary significantly according to a person’s functional status and their level of frailty.2 This variation in treatment goals is often further complicated by comorbidities such as atherosclerotic cardiovascular disease, heart failure, sarcopenia, and chronic kidney disease.2 Patients may struggle to adhere to their treatment plan because of these comorbid conditions, or their comorbidities may affect glycated haemoglobin (HbA1c) levels.2
Furthermore, older patients often have different or exaggerated consequences when experiencing adverse effects of medication (for example, greater negative impacts of hypoglycaemia), in part because of age-related changes in pharmacodynamics and pharmacokinetics.2 As a person living with diabetes gets older, clinicians need to consider deintensification of treatment regimens, depending on the person’s level of frailty and HbA1c level, to avoid negative effects;2 as always, the first principle of medicine is primum non nocere—first, do no harm.
An expert consensus statement on the management of older adults living with type 2 diabetes was published in 2021, focusing on frailty and diabetes.2 This consensus statement discusses the use of currently available glucose‑lowering medications in older adults, and provides pragmatic recommendations for simplifying glycaemic management according to frailty status.2
Join me at 09.00 on 22 November at Guidelines Live 2022, when I will be discussing key take-home messages from this expert consensus statement, as well as general principles for supporting older adults living with diabetes.
At 09.00 on 22 November at Guidelines Live 2022, Dr Kevin Fernando discussed key take-home messages from this expert consensus statement, as well as general principles for supporting older adults living with diabetes. To access resources and presentations related to Guidelines Live 2022, click here. You can also view our Guidelines Live 2022 special companion editions of Guidelines and Guidelines in Practice, produced to provide further information on sessions covered in the main agenda.
Guidelines Live is a must-attend live event focussed on essential guidance-related continuing professional development (CPD). Developed by specialist GPs and GP appraisers, Guidelines Live 2023 will feature 12 clinical streams of educational sessions on the latest clinical guidance for the whole primary care team, including GPs, nurses, and pharmacists. To dedicate time to your continuing professional development, book now for Guidelines Live 2023 on 21 and 22 November at ExCeL London. Guidelines Live is an educational event made possible by sponsorship from organisations including pharmaceutical companies. Sponsors have had no input into the agenda of the meeting unless through sponsored session(s) as indicated on the main programme.
Headline Speakers from Guidelines Live 2022
This article was originally published in November 2022 in anticipation of Guidelines Live 2022