Abstract
Frail older people are largely excluded from clinical trials and therefore glycaemic
targets and optimum hypoglycaemic therapy in this group has not been fully investigated.
Guidelines generally recommend tight glycaemic control in functionally fit individuals
and relaxed targets in frail ones mainly due to the fear of hypoglycaemia. The newly
introduced sodium glucose cotransporter-2 inhibitors and the glucagon like peptide-1
receptor agonists have shown benefit that is independent of glycaemic control and
a minimal risk of hypoglycaemia. However, guidelines still express caution about its
use in frail older people due to fear of other side effects such as weight loss, hypotension
and falls. Some frail older people will miss out on the benefits of this new therapy
if frailty is considered as a one entity with a blanket application of guidelines.
We propose that frailty should be viewed as two distinct metabolically different phenotypes,
the sarcopenic-obese, in which new therapy will improve their metabolic profile and
should be liberally used if no contraindications, and the anorexic-malnourished phenotype
in which the new therapy should be cautiously considered. In other words, glycaemic
targets should be driven by individual’s overall function but the use of new therapy
should be driven by frailty phenotype.
Keywords
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Article info
Publication history
Published online: September 10, 2020
Accepted:
September 8,
2020
Received in revised form:
August 20,
2020
Received:
June 27,
2020
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
