The overtreatment of type 2 diabetes in frail older people

It is estimated that over half of all those living with diabetes are over 65 years of age (Diabetes UK, 2010). Despite this, optimal glucose management remains poorly defined in this population, with many clinical trials routinely excluding people in this age group. The lack of heterogeneity in health status of older people, which ranges from active and otherwise healthy individuals, to those with frailty and multiple comorbidities makes diabetes management in older adults increasingly challenging (Kalyani et al, 2017). Many older people with diabetes will continue to live independently with good quality of life and life expectancy; however, others will suffer from progressive physical and/or mental health issues, frailty and cognitive decline, increasing their dependency and vulnerability (Hambling et al, 2019).

Whilst achieving an HbA1c target of 48 mmol/mol (6.5%) is the mainstay of treatment for those who are younger, with recent onset of diabetes and a low burden of co-morbidities, for those who are older and frail with complex comorbidities and/or limited life expectancy, the benefits of tight glycaemic control are often outweighed by the risk of harms (Du et al, 2014). A person centred holistic approach must be adapted, tailoring treatment targets and therapies on an individual basis.