Journal article 281 views
Diabetes management in older adults who fall: a study amongst older adults presenting to the emergency department
Alexandra J. Burgess ,
David M. Williams,
Kyle Collins,
Richard Roberts,
David J. Burberry,
Jeffrey Stephens ,
Elizabeth A. Davies
European Geriatric Medicine
Swansea University Author: Jeffrey Stephens
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...
Published in: | European Geriatric Medicine |
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ISSN: | 1878-7657 |
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Springer Science and Business Media LLC
2023
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URI: | https://cronfa.swan.ac.uk/Record/cronfa64140 |
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<?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 < 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.</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> |
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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 |
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5219d126f97f8f884bdb622099bd41de |
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5219d126f97f8f884bdb622099bd41de_***_Jeffrey Stephens |
author |
Jeffrey Stephens |
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Alexandra J. Burgess David M. Williams Kyle Collins Richard Roberts David J. Burberry Jeffrey Stephens Elizabeth A. Davies |
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European Geriatric Medicine |
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http://dx.doi.org/10.1007/s41999-023-00848-0 |
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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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11.01628 |