Abstract
INTRODUCTION
Type 2 diabetes mellitus (T2DM) is associated with poor health outcomes (1) and few people aged >70 years likely benefit from HbA1c <53mmol/mol(2) with ≤64mmol/mol generally accepted in people with moderate-severe frailty. We analysed fallers with T2DM to evaluate their outcomes and frailty status.
METHODS
Older Persons Assessment Service (OPAS) is an Emergency Department service which accepts patients on frailty criteria (aged >70 years, falls, confusion, care dependence, polypharmacy and poor mobility). OPAS databank was retrospectively analysed for people with T2DM admitted with a fall June 2020 to April 2022. Interactions between clinical outcomes with therapeutic agents used, age, Charlson Co-morbidity index (CCMI) and Clinical Frailty Score (CFS) were evaluated.
RESULTS
Six-hundred and seventy-nine patients were assessed; 191 (28.1%) had diabetes with a mean HbA1c 56.7 (IQR: 43.0 – 61.5) mmol/mol, 245 (36.1%) were male. Patients with diabetes had a similar mean CFS (5.3 vs 5.3, p=0.52) and age (83.8 vs 83.2 years, p=0.28) as those without diabetes, but had a higher mean CCMI (5.0 vs 7.0, p<0.001). People with diabetes were more likely to die within 12 months (31.4% vs 25%, p<0.05), and there was a trend to greater mortality in patients with diabetes who used insulin and/or gliclazide compared to those who used other agents (49.6% vs 30.9%, p=0.12).
CONCLUSIONS
Falls are a significant burden, and hypoglycaemic agents may contribute to the greater mortality observed in people with diabetes. Clinician awareness of the poorer prognosis associated with diabetes to support de-prescribing diabetes therapies (2) for patients with significant frailty and HbA1c <64mmol/mol. A frailty assessment should be part of any interaction(3) in the older T2DM patient. We are currently writing a local guideline on Diabetes management in Older Adults in Swansea Bay UHB.