New study finds that age and frailty considerably impact prescribing strategies for people with Type 2 Diabetes

A new study led by Monash University has - for the first time - investigated how age, frailty and dementia predict hospital discharge prescribing for people with Type 2 Diabetes (T2D), with the researchers finding that people aged 80+ are considerably less likely to receive glucose lowering drugs than those aged between 65 – 80.

Moreover, frail people were 35 per cent less likely than robust people to be discharged on intensive combination treatment, which is encouraging as it is now widely accepted that the risks of intensive treatment may outweigh the benefits in frail older populations.

Elderly

The study, published in The Journal of Frailty and Ageing, was led by Monash University’s Centre for Medicine Use and Safety (CMUS) in partnership with Eastern Health. The researchers analysed a cohort of 3,067 patients aged 65 – 99 years with T2D and related complications, discharged from hospital between 2012 and 2016.

Lead author and CMUS PhD candidate Stephen Wood, who is also a registered pharmacist, said: “Australian guidelines advise that less intensive treatment is advised for patients with T2D who are older and living with a complex health status, which is what led us to investigate clinical prescribing behaviour amongst this specific cohort.”

“Our primary aim was to determine whether clinicians adjust their prescribing according to patients’ age, frailty or dementia and, based off our findings, we can say that these key factors are informing prescribing decisions.”

Frailty is characterised by vulnerability to stressors and a reduced ability to maintain homeostasis. Frailty increases the risk of adverse drug events, including falls, disability and death. This means that the benefits and risks of treatment may be different for frail and robust people with T2D.

Furthermore, older people with diabetes and dementia have three times the risk of hypoglycaemia compared to people with diabetes who do not have dementia. Hypoglycaemia is a potentially serious condition caused by low blood glucose levels.

“There have been calls for frailty status to guide treatment selection, with frail people with diabetes at 71% higher risk of all-cause hospitalisation and twice the risk of mortality than non-frail people,” said Mr Wood.

CMUS Senior Research Fellow Dr Jenni Ilomaki and Mr Wood are now working with researchers in 10 countries through the Neurological and Mental Health Global Epidemiology Network (NeuroGEN) to investigate the safety and effectiveness of treating diabetes in people who are frail and have dementia.

The present study involved collaboration between the Department of Epidemiology and Preventive Medicine, Monash University; National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Frailty and Healthy Ageing; Baker Heart and Diabetes Institute and the Istituti Clinici Scientifici Maugeri University of Milan