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Do we need to reconsider the guidelines for treatment of older people with diabetes?

Future Science OA article explores effect of frailty on natural history and management plans of diabetes in older people.

Future Science Group

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IMAGE: Future Science Group today announced the publication of a new article in Future Science OA, reporting data that explore the effect of frailty on the natural history of diabetes and... view more

Credit: Future Science Group

Future Science Group (FSG) today announced the publication of a new article in Future Science OA, reporting data that explore the effect of frailty on the natural history of diabetes and the implications it will have for therapeutic plans in older people.

In old age, diabetes is associated with high comorbidity burden and increased prevalence of geriatric syndromes, including frailty. Weight loss and malnutrition are characteristic of frailty, which may lead to decreased hyperglycemia and normalization of blood glucose levels, a state that may be termed "burnt out diabetes". As a result, the emergence of frailty may change the natural history of type 2 diabetes from a progressive to a regressive course with increased risk of hypoglycemia. Current guidelines suggest relaxed glycemic control in diabetic, frail elderly patients.

In a new article, "The effect of frailty should be considered in the management plan of older people with Type 2 diabetes", Ahmed H Abdelhafiz and Luan Koay from Rotherham General Hospital (UK), joined by Alan J Sinclair (Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, UK), reviewed the impact of frailty on blood glucose level normalization, and its implications for clinical management of Type 2 Diabetes.

"Although guidelines have suggested a relaxed glycemic control in frail elderly with diabetes, this may not be enough and complete withdrawal of hypoglycemic medications may be necessary in these frail populations," explains Abdelhafiz, corresponding author of the study. "Normoglycemia has been shown in chronic wasting diseases and in frail populations, which led to safe and successful withdrawal of hypoglycemic medications. The main determinants of successful withdrawals of hypoglycemic medications were significant weight loss, and development of multiple comorbidities including dementia."

"This review therefore outlines the importance of regular medications review with consideration of gradual reduction or complete withdrawal when frailty and significant weight loss emerge. It also highlights the need for future research to investigate the effect of frailty on glucose/insulin dynamics and the possible amelioration of hyperglycemia."

"The increasing prevalence of diabetes alongside the increased expected life expectancy apparent in many countries means it is important to continually evaluate diabetes guidelines to ensure they are meeting the needs of the patient population," commented Francesca Lake, Managing Editor. "We hope this work will encourage further research, and improve clinical management, for frail patients suffering diabetes."

The review is available free to read, here: http://www.future-science.com/doi/full/10.4155/fsoa-2015-0016.

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About Future Science OA

Launched in March 2015, Future Science OA is the inaugural gold open access journal from Future Science Group. It publishes articles covering research of application to human health, and utilizes a CC-BY license. Future Science OA embraces the importance of publishing all good-quality research with the potential to further the progress of medical science. Negative and early-phase research will be considered. The journal also features review articles, editorials and perspectives, providing readers with a leading source of commentary and analysis.

About Future Science Group

Founded in 2001, Future Science Group (FSG) is a progressive publisher focused on breakthrough medical, biotechnological, and scientific research. FSG's portfolio includes two imprints, Future Science and Future Medicine. In addition to this core publishing business, FSG develops specialist eCommunities. Key titles and sites include Bioanalysis Zone, Epigenomics, Nanomedicine and the award-winning Regenerative Medicine. The aim of FSG is to service the advancement of clinical practice and drug research by enhancing the efficiency of communications among clinicians, researchers and decision-makers, and by providing innovative solutions to their information needs. This is achieved through a customer-centric approach, use of new technologies, products that deliver value-for-money and uncompromisingly high standards. http://www.futuresciencegroup.com

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