[Management of type 2 diabetes mellitus in frail patients from the Perspective of Real-World Clinical Practice].

OBJECTIVES

To describe the population with type 2 diabetes mellitus (T2DM) meeting frailty criteria and assess their management based on clinical guidelines (CGL). Patient characteristics, prescribed treatments, adherence to recommendations, and overtreatment prevalence were analyzed.

DESIGN

Cross-sectional observational study using retrospective data.

SETTING

SIDIAP database (primary care records, Catalonia, Spain).

PARTICIPANTS

594,777 T2DM patients; other diabetes types were excluded.

MAIN MEASURES: Sociodemographic, clinical, and treatment characteristics were assessed. Frailty was defined using consensus criteria as the presence of one or more major criteria or two or more minor criteria. Major criteria were defined as a Charlson index>4, a Barthel index <60, weight status alterations, and cognitive impairment. Minor criteria included age>75 years, MEDEA U4 or U5, established cardiovascular disease, and chronic kidney disease. Medications were classified as indicated or not recommended, based on CGL. Not recommended treatments included insulin and sulfonylureas due to their hypoglycemia risk. Glycemic control (HbA1c) and inappropriate treatments in frail patients were examined. Overtreatment was defined as use of not recommended treatments in patients with correct metabolic control (HbA1c<7%).

RESULTS

A total of 22.8% of individuals with T2DM met clinical criteria for frailty. Sulfonylureas were the second most frequently prescribed class of glucose-lowering agents after metformin across all groups. Among frail patients, 14% were treated with therapies not recommended by clinical guidelines, primarily insulin (39.4%) and sulfonylureas (29.2%). Overtreatment was observed in over 20% of frail individuals.

CONCLUSIONS

Almost 1 every 4 people with T2DM meet frailty criteria. Low adherence to guidelines and a high prevalence of inappropriate treatments and overtreatment were observed. These findings emphasize the need for increased awareness and better guideline implementation to improve care for this vulnerable population.