Diabetes through transitions in life; from fit to frail

The accelerated ageing that occurs in diabetes results in earlier appearance of the geriatric phenotype, including frailty. Recent guidelines have stressed the need for assessing frailty in the evaluation of older adults living with diabetes. Once evaluated and identified, however, the presence of frailty marks a significant change for the individual. Treatments that have been continued and encouraged often for many years, may be discontinued. Life-prolonging medications such GLP-1 analogues, and SGLT-2 inhibitors are replaced with therapies designed to improve quality of life, reduce glycaemic variability and stabilise the sarcopaenia that characterises frailty, such as insulin. With this, however, comes new problems, such as the risk of hypoglycaemia, the need to for capillary glucose monitoring and sub cutaneous administration. Additionally, new diagnoses that are more common in people in diabetes, such as stroke, heart disease, dementia, falls and fractures will result in further changes, with the need for care and possibly even institutionalisation.