Abstract
Introduction Type 2 diabetes mellitus (T2D) is associated with poor health outcomes and tight glycaemic targets are questionable in those aged over 70 years. Methods The Older Persons Assessment Service (OPAS) is a local emergency department service which accepts patients on frailty criteria. The OPAS databank was retrospectively analysed for people with T2D admitted with a fall between June 2020-September 2022. We examined clinical outcomes relating to medication, age, Charlson co-morbidity index (CCI) and clinical frailty score (CFS). Results 1081 patients were included: 294 (27.2%) with T2D and a mean HbA1c of 53.9 (±15.8) mmol/mol [7.1%]. People with T2D had a similar mean CFS and age compared to those without T2D, but higher mean CCI (7.0±2.2 vs 5.9±2.1, p001 of those people with t2d, 175 (59.5%) and 240 (81.6%) had a hba1c ≤53 mmol />mol [7.0%] and ≤64 mmol/mol [8.0%], respectively. In total, 48 (16.3%) people with T2D were identified to have a capillary blood glucose below 4.0 mmol/L on admission to the emergency department. People with T2D treated with insulin and/or gliclazide had a greater mortality (36.6% vs 23.6%, p05 greater frequency of hypoglycaemia (35.4% vs 11.8%, p0.001), and hba1c (65.5±17.2 mmol />mol [8.2] vs 48.9±12.1 mmol/mol [6.6%]) compared to those who used other agents. People with T2D were not more likely to live in deprived areas. Conclusion Falls are a significant burden, and hypoglycaemia-inducing agents may contribute to the greater mortality observed in people with T2D. People with T2D had a similar CFS, were more likely to be male, prescribed more concomitant medicines and have greater deprivation. Clinician awareness can support de-prescribing for frail patients with HbA1c less than 64mmol/mol. There should be increased awareness of the impact of hypoglycaemia, especially in those using insulin or gliclizade.