{"id":25755,"date":"2025-11-27T16:11:01","date_gmt":"2025-11-27T16:11:01","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=25755"},"modified":"2026-04-23T09:11:18","modified_gmt":"2026-04-23T08:11:18","slug":"diabetes-frailty","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/diabetes-frailty\/","title":{"rendered":"Diabetes &amp; Frailty"},"content":{"rendered":"\n<p>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.<\/p>\n\n\n\n<p><a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC8099963\/pdf\/13300_2021_Article_1035.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Diabetes and Frailty: An Expert Consensus Statement on the Management of Older Adults with Type 2 Diabetes<\/a><\/p>\n\n\n\n<p>What <strong><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/HbA1c-targets-2025.pdf\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/HbA1c-targets-2025.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">HbA1c targets<\/a><\/strong> should be aimed for in T2DM?<\/p>\n\n\n\n<p><em>Healthy\/pre-frail\/mild frailty<\/em><\/p>\n\n\n\n<p>\u2022 \u226448 mmol\/mol for individuals managed with therapies that do not cause hypoglycaemia<\/p>\n\n\n\n<p>\u2022 53-58 mmol\/mol for individuals who require treatments that can cause hypoglycaemia (insulin and\/or sulphonylureas).<\/p>\n\n\n\n<p><em>Moderate frailty<\/em><\/p>\n\n\n\n<p>\u2022 58-64 mmol\/mol<\/p>\n\n\n\n<p><em>Severe frailty<\/em><\/p>\n\n\n\n<p>\u2022 58-69 mmol\/mol<\/p>\n\n\n\n<p><\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"652\" height=\"891\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/HbA1c-targets-2025.png\" alt=\"HbA1c targets 2025\" class=\"wp-image-27727\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/HbA1c-targets-2025.png 652w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/HbA1c-targets-2025-220x300.png 220w\" sizes=\"auto, (max-width: 652px) 100vw, 652px\" \/><figcaption><span class=\"media-credit\">NHS Lothian<\/span><\/figcaption><\/figure>\n<\/div>\n\n\n<p>What are the recommendations for <strong>deprescribing<\/strong>?<\/p>\n\n\n\n<p>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.<\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"911\" height=\"557\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Image-a.png\" alt=\"Image a\" class=\"wp-image-25765\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Image-a.png 911w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Image-a-300x183.png 300w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Image-a-768x470.png 768w\" sizes=\"auto, (max-width: 911px) 100vw, 911px\" \/><figcaption class=\"wp-element-caption\">Image a &#8211; Healthy\/Pre-frail\/Mild Frailty<\/figcaption><\/figure>\n<\/div>\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"921\" height=\"558\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Image-b.png\" alt=\"Image b\" class=\"wp-image-25766\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Image-b.png 921w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Image-b-300x182.png 300w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Image-b-768x465.png 768w\" sizes=\"auto, (max-width: 921px) 100vw, 921px\" \/><figcaption class=\"wp-element-caption\">Image b &#8211; Moderately Frail<\/figcaption><\/figure>\n<\/div>\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"911\" height=\"553\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Image-c.png\" alt=\"Image c flowchart for evaluating severely frail\" class=\"wp-image-25767\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Image-c.png 911w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Image-c-300x182.png 300w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Image-c-768x466.png 768w\" sizes=\"auto, (max-width: 911px) 100vw, 911px\" \/><figcaption class=\"wp-element-caption\"><span class=\"media-credit\">Diabetes &amp; Frailty<\/span> Image c &#8211; Severely Frail<\/figcaption><\/figure>\n<\/div>\n\n\n<p><strong>Images Reference (a, b &amp; c)<\/strong><\/p>\n\n\n\n<p>Strain, W.D., Down, S., Brown, P.&nbsp;<em>et al.<\/em>&nbsp;Diabetes and Frailty: An Expert Consensus Statement on the Management of Older Adults with Type&nbsp;2 Diabetes.&nbsp;<em>Diabetes Ther<\/em>&nbsp;<strong>12<\/strong>, 1227\u20131247 (2021). https:\/\/doi.org\/10.1007\/s13300-021-01035-9  <\/p>\n\n\n\n<p>SS &amp; MA 27.11.25<\/p>\n","protected":false},"excerpt":{"rendered":"<p>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. Diabetes and Frailty: An Expert Consensus Statement on the Management of Older Adults with Type 2 Diabetes What HbA1c targets should be aimed for<\/p>\n","protected":false},"author":7,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[],"class_list":["post-25755","page","type-page","status-publish","hentry"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"aparnaamanna","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/aparnaamanna\/"},"rttpg_comment":0,"rttpg_category":false,"rttpg_excerpt":"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. Diabetes and Frailty: An Expert Consensus Statement on the Management of Older Adults with Type 2 Diabetes What HbA1c targets should be aimed for","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/25755","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=25755"}],"version-history":[{"count":5,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/25755\/revisions"}],"predecessor-version":[{"id":27729,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/25755\/revisions\/27729"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=25755"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=25755"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}