Endocrine Abstracts

Introduction: Older age and diabetes are both risk factors for frailty. Functional decline and disability in older, frail adults with diabetes results in an increased susceptibility to falls and hospital admission. Hypoglycaemia is common and more likely to result in hospital admission in older adults with diabetes and frailty. An Hb_A1c of below 7% (53 mmol/mol) is likely to represent overtreatment of hyperglycaemia. JBDS has recommended a review of Hb_A1c in the previous 6-12 months for patients with diabetes and frailty. Hospital admission presents an opportunity for clinical evaluation including medication review to deintensify blood glucose lowering treatment. This audit aimed to assess the prevalence and characteristics of patients with type 2 diabetes (T2DM) and frailty admitted to the hospital as an emergency.

Method: We collected data on frailty using the Clinical Frailty Scale (CFS) in older adults with and T2DM admitted to the acute medicine unit(AMU). Their Hb_A1c prior and upon admission were noted. Data including gender, body mass index (BMI), medications, and co-morbidities were also collected. Patients were categorized as overtreated if they had an Hb_A1c prior to admission of ≤ 7%. Chi-squared test, t-test and Mann-Whitney U-test were used to compare categorical data and continuous data between groups, respectively.

Results: Out of 667 patients admitted to the AMU, 67 patients with T2DM and CFS of ≥6 were identified representing a prevalence of 10% of acute medical admissions. Fifty-four percent (n=36/67) were female and mean age was 78.3±9.6 years. The median BMI was 27.5kg/m2 (23.5-32.8) with 36.7%(n=22/60) of normal weight and 63.3%(n=38/60) overweight/obese. Median Hb_A1c prior to admission was 6.9%;52mmol/mol (6.0-7.7%;42-61mmol/mol) whilst56.7% (n=38/67) had Hb_A1c >7.0% upon admission. Sixty-five percent(n=44/67) had their Hb_A1c checked in the last 6 months. Of the older adults with an Hb_A1c of <7.0%, 13%(n=5/38) were treated with insulin or sulphonylurea therapy. The overtreated group had lower BMI, required less medications, and had less co-morbidities, compared to patients who were not overtreated.

Conclusion: Our preliminary results showed that older adults with T2DM and frailty represent a high proportion of older adults admitted to hospital acutely. Despite recommendations, one third of patients had not had their Hb_A1c measured in the preceding 6 months. Those patients who had an Hb_A1c of below 7% whilst taking insulin or sulphonylureas could be considered overtreated and at risk of severe hypoglycaemia. Admission to the hospital presents an opportunity for deintensification of blood glucose lowering treatment in this group.