Abstract
Introduction
Type 2 diabetes mellitus (T2DM) is associated with poor health outcomes and few people aged >70 years likely benefit from HbA1c
Methods
Older Persons Assessment Service (OPAS) is an Emergency Department service which accepts patients on frailty criteria. OPAS databank was retrospectively analysed for people with T2DM admitted with a fall, June 2020 to September 2022. Interactions between clinical outcomes with therapeutic agents used, age, Charlson Co-morbidity index (CCMI) and Clinical Frailty Score (CFS) were evaluated.
Results 1000 patients; 294 (29.4%) had diabetes with a mean HbA1c was 52.6 (±16) mmol/mol. Patients with diabetes had a similar mean CFS (5.3 vs 5.3, p=0.45) and age (83.4 vs 84.1 years, p=0.12) as those without diabetes, but a higher mean CCMI (6.8 vs 5.6, p<0.001).
In the diabetes group, significantly greater mortality in those who used insulin and/or gliclazide compared to those who used other agents (p=0.02), 49/294 (16.7%) had a glucose reading below 4mmol/L. Of these 178/294 (60.5%) and 245/294 (83.3%) had a HbA1c <53 and 64 mmol/mol, respectively. People with diabetes lived in more deprived areas on the postcode deprivation index.
Conclusion - Falls are a significant burden, and hypoglycaemic agents may contribute to the greater mortality observed in people with diabetes. Diabetes patients had a similar CFS, were more likely to be male, prescribed more concomitant medicines and higher deprivation score. Clinician awareness can support de-prescribing for patients with frailty and HbA1c <64mmol/mol. We have written a guideline on Diabetes management in Older Adults in SBUHB.