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Diabetes management in older adults who fall: a study amongst older adults presenting to the emergency department

Alexandra J. Burgess Orcid Logo, David M. Williams, Kyle Collins, Richard Roberts, David J. Burberry, Jeffrey Stephens Orcid Logo, Elizabeth A. Davies

European Geriatric Medicine

Swansea University Author: Jeffrey Stephens Orcid Logo

  • Accepted Manuscript under embargo until: 23rd August 2024

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DOI (Published version): 10.1007/s41999-023-00848-0

Abstract

IntroductionType 2 diabetes mellitus (T2D) is associated with poor health outcomes whilst tight glycaemic targets are questionable in those aged over 70 years with increased frailty. Our aim was to examine whether people with T2D admitted to hospital with a fall, were more likely to have greater fra...

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Published in: European Geriatric Medicine
ISSN: 1878-7657
Published: Springer Science and Business Media LLC 2023
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URI: https://cronfa.swan.ac.uk/Record/cronfa64140
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fullrecord <?xml version="1.0" encoding="utf-8"?><rfc1807 xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:xsd="http://www.w3.org/2001/XMLSchema"><bib-version>v2</bib-version><id>64140</id><entry>2023-08-25</entry><title>Diabetes management in older adults who fall: a study amongst older adults presenting to the emergency department</title><swanseaauthors><author><sid>5219d126f97f8f884bdb622099bd41de</sid><ORCID>0000-0003-2228-086X</ORCID><firstname>Jeffrey</firstname><surname>Stephens</surname><name>Jeffrey Stephens</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2023-08-25</date><deptcode>BMS</deptcode><abstract>IntroductionType 2 diabetes mellitus (T2D) is associated with poor health outcomes whilst tight glycaemic targets are questionable in those aged over 70 years with increased frailty. Our aim was to examine whether people with T2D admitted to hospital with a fall, were more likely to have greater frailty, increased mortality and co-morbidity burden, or risk factors for falls than people without T2D, and whether these differences were associated with medications used for the treatment of T2D.MethodsThe Older Persons Assessment Service (OPAS) is a local emergency department (ED) service, which accepts patients on frailty criteria. The OPAS accepts patients primarily aged over 70 years who present with frailty and geriatric syndromes such as falls, with retrieval from the ED department directly to the service from triage. The OPAS databank was 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).Results1081 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, p &lt; 0.001). 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 ED. At 12 months’ follow-up, 831 (76.9%) patients were alive and 250 (23.1%) had died. People with T2D treated with insulin and/or gliclazide had a greater 1-year mortality (36.6% vs 23.6%, p &lt; 0.05), greater frequency of hypoglycaemia (35.4% vs 11.8%, p &lt; 0.001), and greater 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. Logistic regression confirmed a diagnosis of T2D was associated with 1-year mortality, but mortality was not significantly associated with hypoglycaemic-inducing agents. People with T2D were not more likely to live in deprived areas.ConclusionsA diagnosis of T2D is associated with greater 1-year mortality, and may be influenced by use of hypoglycaemia-inducing diabetes medications. Clinician awareness can support de-prescribing for patients with frailty and HbA1c &lt; 64 mmol/mol.</abstract><type>Journal Article</type><journal>European Geriatric Medicine</journal><volume/><journalNumber/><paginationStart/><paginationEnd/><publisher>Springer Science and Business Media LLC</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic>1878-7657</issnElectronic><keywords>Emergency Department; Falls; Frailty; Older adults; Type 2 Diabetes Mellitus (T2D).</keywords><publishedDay>25</publishedDay><publishedMonth>8</publishedMonth><publishedYear>2023</publishedYear><publishedDate>2023-08-25</publishedDate><doi>10.1007/s41999-023-00848-0</doi><url>http://dx.doi.org/10.1007/s41999-023-00848-0</url><notes/><college>COLLEGE NANME</college><department>Biomedical Sciences</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>BMS</DepartmentCode><institution>Swansea University</institution><apcterm>Not Required</apcterm><funders>Not applicable.</funders><projectreference>Not applicable.</projectreference><lastEdited>2023-09-29T16:14:49.2957842</lastEdited><Created>2023-08-25T10:22:44.3609591</Created><path><level id="1">Swansea University Medical School</level><level id="2">Medicine</level></path><authors><author><firstname>Alexandra J.</firstname><surname>Burgess</surname><orcid>0000-0002-0187-5429</orcid><order>1</order></author><author><firstname>David M.</firstname><surname>Williams</surname><order>2</order></author><author><firstname>Kyle</firstname><surname>Collins</surname><order>3</order></author><author><firstname>Richard</firstname><surname>Roberts</surname><order>4</order></author><author><firstname>David J.</firstname><surname>Burberry</surname><order>5</order></author><author><firstname>Jeffrey</firstname><surname>Stephens</surname><orcid>0000-0003-2228-086X</orcid><order>6</order></author><author><firstname>Elizabeth A.</firstname><surname>Davies</surname><order>7</order></author></authors><documents><document><filename>Under embargo</filename><originalFilename>Under embargo</originalFilename><uploaded>2023-08-25T10:35:23.6806518</uploaded><type>Output</type><contentLength>134784</contentLength><contentType>application/pdf</contentType><version>Accepted Manuscript</version><cronfaStatus>true</cronfaStatus><embargoDate>2024-08-23T00:00:00.0000000</embargoDate><documentNotes>© The Author(s), under exclusive licence to European Geriatric Medicine Society 2023</documentNotes><copyrightCorrect>true</copyrightCorrect><language>eng</language></document></documents><OutputDurs/></rfc1807>
spelling v2 64140 2023-08-25 Diabetes management in older adults who fall: a study amongst older adults presenting to the emergency department 5219d126f97f8f884bdb622099bd41de 0000-0003-2228-086X Jeffrey Stephens Jeffrey Stephens true false 2023-08-25 BMS IntroductionType 2 diabetes mellitus (T2D) is associated with poor health outcomes whilst tight glycaemic targets are questionable in those aged over 70 years with increased frailty. Our aim was to examine whether people with T2D admitted to hospital with a fall, were more likely to have greater frailty, increased mortality and co-morbidity burden, or risk factors for falls than people without T2D, and whether these differences were associated with medications used for the treatment of T2D.MethodsThe Older Persons Assessment Service (OPAS) is a local emergency department (ED) service, which accepts patients on frailty criteria. The OPAS accepts patients primarily aged over 70 years who present with frailty and geriatric syndromes such as falls, with retrieval from the ED department directly to the service from triage. The OPAS databank was 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).Results1081 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, p < 0.001). 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 ED. At 12 months’ follow-up, 831 (76.9%) patients were alive and 250 (23.1%) had died. People with T2D treated with insulin and/or gliclazide had a greater 1-year mortality (36.6% vs 23.6%, p < 0.05), greater frequency of hypoglycaemia (35.4% vs 11.8%, p < 0.001), and greater 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. Logistic regression confirmed a diagnosis of T2D was associated with 1-year mortality, but mortality was not significantly associated with hypoglycaemic-inducing agents. People with T2D were not more likely to live in deprived areas.ConclusionsA diagnosis of T2D is associated with greater 1-year mortality, and may be influenced by use of hypoglycaemia-inducing diabetes medications. Clinician awareness can support de-prescribing for patients with frailty and HbA1c < 64 mmol/mol. Journal Article European Geriatric Medicine Springer Science and Business Media LLC 1878-7657 Emergency Department; Falls; Frailty; Older adults; Type 2 Diabetes Mellitus (T2D). 25 8 2023 2023-08-25 10.1007/s41999-023-00848-0 http://dx.doi.org/10.1007/s41999-023-00848-0 COLLEGE NANME Biomedical Sciences COLLEGE CODE BMS Swansea University Not Required Not applicable. Not applicable. 2023-09-29T16:14:49.2957842 2023-08-25T10:22:44.3609591 Swansea University Medical School Medicine Alexandra J. Burgess 0000-0002-0187-5429 1 David M. Williams 2 Kyle Collins 3 Richard Roberts 4 David J. Burberry 5 Jeffrey Stephens 0000-0003-2228-086X 6 Elizabeth A. Davies 7 Under embargo Under embargo 2023-08-25T10:35:23.6806518 Output 134784 application/pdf Accepted Manuscript true 2024-08-23T00:00:00.0000000 © The Author(s), under exclusive licence to European Geriatric Medicine Society 2023 true eng
title Diabetes management in older adults who fall: a study amongst older adults presenting to the emergency department
spellingShingle Diabetes management in older adults who fall: a study amongst older adults presenting to the emergency department
Jeffrey Stephens
title_short Diabetes management in older adults who fall: a study amongst older adults presenting to the emergency department
title_full Diabetes management in older adults who fall: a study amongst older adults presenting to the emergency department
title_fullStr Diabetes management in older adults who fall: a study amongst older adults presenting to the emergency department
title_full_unstemmed Diabetes management in older adults who fall: a study amongst older adults presenting to the emergency department
title_sort Diabetes management in older adults who fall: a study amongst older adults presenting to the emergency department
author_id_str_mv 5219d126f97f8f884bdb622099bd41de
author_id_fullname_str_mv 5219d126f97f8f884bdb622099bd41de_***_Jeffrey Stephens
author Jeffrey Stephens
author2 Alexandra J. Burgess
David M. Williams
Kyle Collins
Richard Roberts
David J. Burberry
Jeffrey Stephens
Elizabeth A. Davies
format Journal article
container_title European Geriatric Medicine
publishDate 2023
institution Swansea University
issn 1878-7657
doi_str_mv 10.1007/s41999-023-00848-0
publisher Springer Science and Business Media LLC
college_str Swansea University Medical School
hierarchytype
hierarchy_top_id swanseauniversitymedicalschool
hierarchy_top_title Swansea University Medical School
hierarchy_parent_id swanseauniversitymedicalschool
hierarchy_parent_title Swansea University Medical School
department_str Medicine{{{_:::_}}}Swansea University Medical School{{{_:::_}}}Medicine
url http://dx.doi.org/10.1007/s41999-023-00848-0
document_store_str 0
active_str 0
description IntroductionType 2 diabetes mellitus (T2D) is associated with poor health outcomes whilst tight glycaemic targets are questionable in those aged over 70 years with increased frailty. Our aim was to examine whether people with T2D admitted to hospital with a fall, were more likely to have greater frailty, increased mortality and co-morbidity burden, or risk factors for falls than people without T2D, and whether these differences were associated with medications used for the treatment of T2D.MethodsThe Older Persons Assessment Service (OPAS) is a local emergency department (ED) service, which accepts patients on frailty criteria. The OPAS accepts patients primarily aged over 70 years who present with frailty and geriatric syndromes such as falls, with retrieval from the ED department directly to the service from triage. The OPAS databank was 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).Results1081 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, p < 0.001). 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 ED. At 12 months’ follow-up, 831 (76.9%) patients were alive and 250 (23.1%) had died. People with T2D treated with insulin and/or gliclazide had a greater 1-year mortality (36.6% vs 23.6%, p < 0.05), greater frequency of hypoglycaemia (35.4% vs 11.8%, p < 0.001), and greater 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. Logistic regression confirmed a diagnosis of T2D was associated with 1-year mortality, but mortality was not significantly associated with hypoglycaemic-inducing agents. People with T2D were not more likely to live in deprived areas.ConclusionsA diagnosis of T2D is associated with greater 1-year mortality, and may be influenced by use of hypoglycaemia-inducing diabetes medications. Clinician awareness can support de-prescribing for patients with frailty and HbA1c < 64 mmol/mol.
published_date 2023-08-25T16:14:51Z
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