As we are increasingly practicing realistic medicine, we need to tailor our diabetic reviews and treatment in our frailer populations. Consider de-escalating therapy appropriately, as per the expert consensus statement below.
What HbA1c targets should be aimed for in T2DM?
Healthy/pre-frail/mild frailty
• ≤48 mmol/mol for individuals managed with therapies that do not cause hypoglycaemia
• 53-58 mmol/mol for individuals who require treatments that can cause hypoglycaemia (insulin and/or sulphonylureas).
Moderate frailty
• 58-64 mmol/mol
Severe frailty
• 58-69 mmol/mol
What are the recommendations for deprescribing?
The following figures reproduced from the above consensus statement outline a pragmatic approach to deprescribing as appropriate. This is an area that continues to evolve and we will continue to add further information as agreed locally.
Images Reference (a, b & c)
Strain, W.D., Down, S., Brown, P. et al. Diabetes and Frailty: An Expert Consensus Statement on the Management of Older Adults with Type 2 Diabetes. Diabetes Ther 12, 1227–1247 (2021). https://doi.org/10.1007/s13300-021-01035-9
SS & MA 27.11.25
