Diabetes and Frailty Professor Richard Lindley, Anandhi Murugesan and Tim Bailey-Coles
This session explores the complexity of managing diabetes in older adults, a demographic where medical success has led to "life extension" with disability rather than a compression of morbidity. Professor Richard Lindley argues that because frailty dominates modern medicine, clinicians must measure it, recommending the Clinical Frailty Scale (CFS) as a quick, essential tool for the electronic medical record. He presents retrospective analyses of major trials, revealing that while intensive blood pressure and glucose lowering can be harmful or attenuated in the frail (as seen in the ADVANCE trial), SGLT2 inhibitors appear to be equally effective and safe, offering significant absolute benefits for this vulnerable group.
Anandhi Murugesan emphasizes the necessity of individualized glycemic targets. While healthy older adults may aim for an HbA1c of 7.0–7.5%, targets for the frail should be relaxed (up to 8.5% or <50% Time in Range) to prioritize the avoidance of hypoglycemia. She notes that hypoglycemia often presents atypically in the elderly as confusion or delirium rather than classic symptoms. The session also covers medication adjustments, such as the potential need to stop long-acting insulin in patients with declining renal function to prevent accumulation and overnight hypos.
Finally, Exercise Physiologist Tim Bailey-Coles addresses fall prevention, noting that one-third of community-dwelling people over 65 fall annually. He highlights grip strength as a powerful marker of frailty that correlates better with outcomes than chronological age. The discussion outlines a proactive approach to testing balance (visual, vestibular, and proprioceptive) and promotes the use of Medicare items for Type 2 Diabetes Group Allied Health Services (1 assessment and 8 group sessions) to support strength and balance training.
This podcast was recorded live at the Western Sydney Diabetes Masterclass in Sydney.
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