Study title: What are the consequences of over and undertreatment of type 2 diabetes mellitus in a frail population? A systematic review
Quick-read summary
This study reviews what the evidence is for over and undertreatment of type 2 diabetes mellitus in frail older people with the aim to be able to recommend targets for blood glucose levels in this population.
The results showed that there was a large difference in outcomes between the 11 studies and that many only looked at small numbers of people.
Both over and undertreatment were shown to increase unwanted outcomes in frail older people, and further research is needed before the best levels of blood sugar in frail older people living with diabetes are decided.
Who is this evidence useful for?
People living with or interested in treating diabetes, especially in the older person.
What is the issue
Older people with diabetes have higher rates of early death, disability, other illnesses and are at greater risk of developing things such as confusion, falls and frailty.
Failure to spot and think about frailty in older people can lead to treatments that may do more harm than good. The number of people with both diabetes and frailty increases with age.
As people become frailer, diabetes targets often are not changed, and this can lead to overtreatment. Overtreatment of diabetes can lead to repeated hypoglycaemia (low blood sugar), which can cause long-term confusion, falls and increased risk of death.
Under-treatment should be avoided as high blood sugar levels can cause needing to go to the toilet more often, thirst and needing to get up to go to the toilet through the night.
In older people there is also an increased risk of infections, hospital admissions, strokes, heart attacks and death.
Research summary
A systematic review is a research method that summarises existing evidence on a specific topic. This research was a systematic review of studies which looked at treatment of diabetes.
The results showed that there was a large difference in outcomes between the 11 studies identified, and that many looked at small numbers of people.
Both over and undertreatment were shown to increase unwanted outcomes in frail older people.
Recently it has become more widely accepted that hypoglycaemia (low blood sugar) in frail people should be avoided to reduce harm, but, some of the studies showed that even people with a low blood sugar did not have medications reduced.
Hyperglycaemia (high blood sugar) in frail older people can also cause harm, but there seems to be less focus on making this better.
More research around the best levels of blood sugar for frail older people living with diabetes is needed with a goal of showing the best target ranges.
After this, the research should be used to make practical clinical guidelines to help reach these targets.
What the research found
- Across all studies, frailty was linked to worse outcomes.
- Studies show people living with diabetes are more likely to become frail.
- Frailty can be slowed or reversed with the right treatment, and therefore, it is important to identify frailty as early as possible.
- The management of diabetes itself can also affect frailty risk and the likelihood of worse outcomes.
- Currently, the only practical guidelines of how to manage diabetes in frail older people are consensus guidelines.
- The review shows there is not enough evidence in this area, showing the need for further research in this population to aid evidence‐based care.
Why is this important?
Both frailty and diabetes are more common as people get older. Not treating people to the correct targets for blood glucose may cause harm which includes hospital admissions, falls, confusion, heart attacks, strokes and even death.
Acknowledgments
This work was led by ARC Practice Fellow, Helen O’Neil
Helen is a practising Senior Medicines Optimisation Pharmacist.
Read the full paper