Type 2 diabetes mellitus in older adults: clinical considerations and management

Srikanth Bellary; Ioannis Kyrou; James E. Brown; Clifford J. Bailey

doi:10.1038/s41574-021-00512-2

Type 2 diabetes mellitus in older adults: clinical considerations and management

Srikanth Bellary^*
, Ioannis Kyrou
, James E. Brown
, Clifford J. Bailey

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

516 Citations (SciVal)

Abstract

The past 50 years have seen a growing ageing population with an increasing prevalence of type 2 diabetes mellitus (T2DM); now, nearly half of all individuals with diabetes mellitus are older adults (aged ≥65 years). Older adults with T2DM present particularly difficult challenges. For example, the accentuated heterogeneity of these patients, the potential presence of multiple comorbidities, the increased susceptibility to hypoglycaemia, the increased dependence on care and the effect of frailty all add to the complexity of managing diabetes mellitus in this age group. In this Review, we offer an update on the key pathophysiological mechanisms associated with T2DM in older people. We then evaluate new evidence relating particularly to the effects of frailty and sarcopenia, the clinical difficulties of age-associated comorbidities, and the implications for existing guidelines and therapeutic options. Our conclusions will focus on the effect of T2DM on an ageing society.

Original language	English
Pages (from-to)	534-548
Number of pages	15
Journal	Nature Reviews Endocrinology
Volume	17
Issue number	9
Early online date	25 Jun 2021
DOIs	https://doi.org/10.1038/s41574-021-00512-2
Publication status	Published - Sept 2021

Funding

S.B. has received research grants from The Binding Site Ltd. and Novo Nordisk, UK, Ltd. as well as speaker fees and honoraria from AstraZeneca, Boehringer Ingelheim, MSD, Novo Nordisk, Janssen, Eli Lilly, and Sanofi-Aventis outside of the submitted work. C.J.B. has received personal fees from AstraZeneca, Boehringer Ingelheim, Elcelyx, Lexicon, Poxel, Eli Lilly, Janssen, Merck, Sharpe & Dohme, Novo Nordisk, and Sanofi-Aventis. J.E.B. has received speaker fees from Gilead Biosciences Inc. I.K. has no competing interests to declare.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Age Factors
Aged
Aged, 80 and over
Aging/physiology
Comorbidity
Diabetes Mellitus, Type 2/diagnosis
Frailty/complications
Humans
Prevalence
Sarcopenia/complications

Access to Document

10.1038/s41574-021-00512-2

Cite this

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title = "Type 2 diabetes mellitus in older adults: clinical considerations and management",

abstract = "The past 50 years have seen a growing ageing population with an increasing prevalence of type 2 diabetes mellitus (T2DM); now, nearly half of all individuals with diabetes mellitus are older adults (aged ≥65 years). Older adults with T2DM present particularly difficult challenges. For example, the accentuated heterogeneity of these patients, the potential presence of multiple comorbidities, the increased susceptibility to hypoglycaemia, the increased dependence on care and the effect of frailty all add to the complexity of managing diabetes mellitus in this age group. In this Review, we offer an update on the key pathophysiological mechanisms associated with T2DM in older people. We then evaluate new evidence relating particularly to the effects of frailty and sarcopenia, the clinical difficulties of age-associated comorbidities, and the implications for existing guidelines and therapeutic options. Our conclusions will focus on the effect of T2DM on an ageing society.",

keywords = "Age Factors, Aged, Aged, 80 and over, Aging/physiology, Comorbidity, Diabetes Mellitus, Type 2/diagnosis, Frailty/complications, Humans, Prevalence, Sarcopenia/complications",

author = "Srikanth Bellary and Ioannis Kyrou and Brown, \{James E.\} and Bailey, \{Clifford J.\}",

year = "2021",

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doi = "10.1038/s41574-021-00512-2",

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T2 - clinical considerations and management

AU - Bellary, Srikanth

AU - Kyrou, Ioannis

AU - Brown, James E.

AU - Bailey, Clifford J.

PY - 2021/9

Y1 - 2021/9

N2 - The past 50 years have seen a growing ageing population with an increasing prevalence of type 2 diabetes mellitus (T2DM); now, nearly half of all individuals with diabetes mellitus are older adults (aged ≥65 years). Older adults with T2DM present particularly difficult challenges. For example, the accentuated heterogeneity of these patients, the potential presence of multiple comorbidities, the increased susceptibility to hypoglycaemia, the increased dependence on care and the effect of frailty all add to the complexity of managing diabetes mellitus in this age group. In this Review, we offer an update on the key pathophysiological mechanisms associated with T2DM in older people. We then evaluate new evidence relating particularly to the effects of frailty and sarcopenia, the clinical difficulties of age-associated comorbidities, and the implications for existing guidelines and therapeutic options. Our conclusions will focus on the effect of T2DM on an ageing society.

AB - The past 50 years have seen a growing ageing population with an increasing prevalence of type 2 diabetes mellitus (T2DM); now, nearly half of all individuals with diabetes mellitus are older adults (aged ≥65 years). Older adults with T2DM present particularly difficult challenges. For example, the accentuated heterogeneity of these patients, the potential presence of multiple comorbidities, the increased susceptibility to hypoglycaemia, the increased dependence on care and the effect of frailty all add to the complexity of managing diabetes mellitus in this age group. In this Review, we offer an update on the key pathophysiological mechanisms associated with T2DM in older people. We then evaluate new evidence relating particularly to the effects of frailty and sarcopenia, the clinical difficulties of age-associated comorbidities, and the implications for existing guidelines and therapeutic options. Our conclusions will focus on the effect of T2DM on an ageing society.

KW - Age Factors

KW - Aged

KW - Aged, 80 and over

KW - Aging/physiology

KW - Comorbidity

KW - Diabetes Mellitus, Type 2/diagnosis

KW - Frailty/complications

KW - Humans

KW - Prevalence

KW - Sarcopenia/complications

UR - https://www.nature.com/articles/s41574-021-00512-2

UR - https://www.scopus.com/pages/publications/85108838466

U2 - 10.1038/s41574-021-00512-2

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JO - Nature Reviews Endocrinology

JF - Nature Reviews Endocrinology

IS - 9

ER -

Type 2 diabetes mellitus in older adults: clinical considerations and management

Abstract

Funding

UN SDGs

Keywords

Access to Document

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