Optimizing drug therapy in frail patients with type 2 diabetes mellitus



Type 2 diabetes mellitus (T2DM) is closely linked with ageing. In frail diabetic patients, the risks of intensive antidiabetic therapy outweigh the potential benefits.


To study the prevalence of T2DM in frail elderly patients, to identify inappropriate prescription (IP) of antidiabetic drugs and to study the relationship between patients’ frailty index (FI) with polypharmacy and IP.


This was a prospective, descriptive, observational study of elderly patients. Each patient’s antidiabetic treatment was analysed by applying the patient-centred prescription model (PCP), which centres therapeutic decisions on the patient’s global assessment and individual therapeutic goal.


210 patients with T2DM were included (25.15% prevalence). They were characterised by high multimorbidity and frailty. 93.3% presented polypharmacy and 51% excessive polypharmacy. IP was identified in 66.2% of patients. A statistically significant relationship was found between the progression in FI degree and IP prevalence (p < 0.05. During the admission, drug therapy regimens were modified in 97.1% of cases with IP (n = 136).


These results suggest that in clinical practice T2DM treatment is not individualised, but rather is based on the same general recommendations for the population as a whole.


There is a high prevalence of T2DM in the elderly. As the frailty of patients increases, so does the prevalence of IP. The application of PCP model enables drug therapy optimization in frail patients according to their main therapeutic goal, and contributes to provide clinical evidences on the applicability of a set of knowledge areas from the theoretical framework to the daily clinical practice.

This is a preview of subscription content, log in to check access.

Fig. 1


  1. 1.

    Clua-Espuny JL, González-Henares MA, Queralt-Tomas MLL et al (2017) Mortality and cardiovascular complications in older complex chronic patients with type 2 diabetes. Biomed Res Int. https://doi.org/10.1155/2017/6078498

    PubMed  PubMed Central  Article  Google Scholar 

  2. 2.

    Gómez Huelgas R, Díez-Espino J, Formiga F et al (2013) Tratamiento de la diabetes tipo 2 en el paciente anciano. Med Clin (Barc) 140:134.e1–134.e12. https://doi.org/10.1016/j.medcli.2012.10.003

    Article  Google Scholar 

  3. 3.

    Soriguer F, Goday A, Bosch-Comas A et al (2012) Prevalence of diabetes mellitus and impaired glucose regulation in Spain: the Diabetes Study. Diabetologia 55:88–93. https://doi.org/10.1007/s00125-011-2336-9

    CAS  PubMed  Article  Google Scholar 

  4. 4.

    Gómez-Huelgas R, Gómez Peralta F, Rodríguez Mañas L et al (2018) Tratamiento de la diabetes mellitus tipo 2 en el paciente anciano. Rev Esp Geriatr Gerontol 53:89–99. https://doi.org/10.1016/j.regg.2017.12.003

    PubMed  Article  Google Scholar 

  5. 5.

    Schernthaner G, Schernthaner-Reiter MH (2018) Diabetes in the older patient: heterogeneity requires individualisation of therapeutic strategies. Diabetologia 61:1503–1516. https://doi.org/10.1007/s00125-018-4547-9

    PubMed  PubMed Central  Article  Google Scholar 

  6. 6.

    Mooradian AD (2018) Evidence-based management of diabetes in older adults. Drugs Aging 35:1065–1078. https://doi.org/10.1007/s40266-018-0598-3

    CAS  PubMed  Article  Google Scholar 

  7. 7.

    Lipska KJ, Ross JS, Miao Y et al (2015) Potential overtreatment of diabetes mellitus in older adults with tight glycemic control. JAMA Intern Med 175:356. https://doi.org/10.1001/jamainternmed.2014.7345

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  8. 8.

    Budnitz DS, Lovegrove MC, Shehab N et al (2011) Emergency hospitalizations for adverse drug events in older americans. N Engl J Med 365:2002–2012. https://doi.org/10.1056/NEJMsa1103053

    CAS  PubMed  Article  Google Scholar 

  9. 9.

    Sevilla-Sanchez D, Molist-Brunet N, Amblàs-Novellas J et al (2017) Adverse drug events in patients with advanced chronic conditions who have a prognosis of limited life expectancy at hospital admission. Eur J Clin Pharmacol 73:79–89. https://doi.org/10.1007/s00228-016-2136-8

    CAS  PubMed  Article  Google Scholar 

  10. 10.

    Barranco RJ, Gomez-Peralta F, Abreu C et al (2015) Incidence and care-related costs of severe hypoglycaemia requiring emergency treatment in Andalusia (Spain): the PAUEPAD project. Diabet Med 32:1520–1526. https://doi.org/10.1111/dme.12843

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  11. 11.

    Sue Kirkman M, Briscoe VJ, Clark N et al (2012) Diabetes in older adults: a consensus report. J Am Geriatr Soc 60:2342–2356. https://doi.org/10.1111/jgs.12035

    PubMed  Article  Google Scholar 

  12. 12.

    Formiga F, Franch-Nadal J, Rodriguez L, Ávila L, Fuster E (2017) Inadequate glycaemic control and therapeutic management of adults over 65 years old with type 2 diabetes mellitus in Spain. J Nutr Health Aging 21:1365–1370. https://doi.org/10.1007/s12603-017-0869-4

    CAS  PubMed  Article  Google Scholar 

  13. 13.

    Meneilly GS, Berard LD, Cheng AYY et al (2018) Insights into the current management of older adults with type 2 diabetes in the Ontario primary care setting. Can J Diabetes 42:23–30. https://doi.org/10.1016/j.jcjd.2017.03.003

    PubMed  Article  Google Scholar 

  14. 14.

    Adults Older (2018) Standards of medical care in diabetes—2018. Diabetes Care 41:S119–S125. https://doi.org/10.2337/dc18-S011

    Article  Google Scholar 

  15. 15.

    Mooradian AD (2018) Evidence-based management of diabetes in older adults. Drugs Aging 35:1065–1078. https://doi.org/10.1007/s40266-018-0598-3

    CAS  PubMed  Article  Google Scholar 

  16. 16.

    Granger CV, Albretch GLH (1979) Outcome of comprehensive medical rehabilitation: measurement by PULSES profile and the Barthel index. Arch Phys Med Rehabil 60:145–154

    CAS  PubMed  Google Scholar 

  17. 17.

    Reisberg B, Ferris S, De Leon M et al (1982) The global deterioration scale for assessment of primary degenerative dementia. Am J Psychiatry 139:1136–1139. https://doi.org/10.1176/ajp.139.9.1136

    CAS  PubMed  Article  Google Scholar 

  18. 18.

    Woolf C, Slavin MJ, Draper B et al (2016) Can the clinical dementia rating Scale identify mild cognitive impairment and predict cognitive and functional decline? Dement Geriatr Cogn Disord 41:292–302. https://doi.org/10.1159/000447057

    PubMed  Article  Google Scholar 

  19. 19.

    Amblàs-Novellas J, Martori JC, Molist Brunet N et al (2017) Índice frágil-VIG: diseño y evaluación de un índice de fragilidad basado en la Valoración Integral Geriátrica. Rev Esp Geriatr Gerontol 52:119–127. https://doi.org/10.1016/j.regg.2016.09.003

    PubMed  Article  Google Scholar 

  20. 20.

    Gómez-Batiste X, Martínez-Muñoz M, Blay C et al (2014) Prevalence and characteristics of patients with advanced chronic conditions in need of palliative care in the general population: a cross-sectional study. Palliat Med 28:302–311. https://doi.org/10.1177/0269216313518266

    PubMed  Article  Google Scholar 

  21. 21.

    Molist Brunet N, Espaulella Panicot J, Sevilla-Sánchez D et al (2015) A patient-centered prescription model assessing the appropriateness of chronic drug therapy in older patients at the end of life. Eur Geriatr Med 6:565–569. https://doi.org/10.1016/j.eurger.2015.07.008

    Article  Google Scholar 

  22. 22.

    Lee SJ, Kim CM (2018) Individualizing prevention for older adults. J Am Geriatr Soc 66:229–234. https://doi.org/10.1111/jgs.15216

    PubMed  Article  Google Scholar 

  23. 23.

    Jones DM, Song X, Rockwood K (2004) Operationalizing a frailty index from a standardized comprehensive geriatric assessment. J Am Geriatr Soc 52:1929–1933. https://doi.org/10.1111/j.1532-5415.2004.52521.x

    PubMed  Article  Google Scholar 

  24. 24.

    O’Mahony D, O’Connor MN (2011) Pharmacotherapy at the end-of-life. Age Ageing 40:419–422. https://doi.org/10.1093/ageing/afr059

    PubMed  Article  Google Scholar 

  25. 25.

    Vijan S, Sussman JB, Yudkin JS et al (2014) Effect of patients’ risks and preferences on health gains with plasma glucose level lowering in type 2 diabetes mellitus. JAMA Intern Med 174:1227. https://doi.org/10.1001/jamainternmed.2014.2894

    PubMed  PubMed Central  Article  Google Scholar 

  26. 26.

    O’Mahony D, O’Sullivan D, Byrne S et al (2014) STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing 44:213–218. https://doi.org/10.1093/ageing/afu145

    PubMed  PubMed Central  Article  Google Scholar 

  27. 27.

    Gomez-Peralta F, Abreu C, Lecube A et al (2017) Practical approach to initiating SGLT2 inhibitors in type 2 diabetes. Diabetes Ther 8:953–962. https://doi.org/10.1007/s13300-017-0277-0

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  28. 28.

    Della-Morte D, Palmirotta R, Rehni AK et al (2014) Pharmacogenomics and pharmacogenetics of thiazolidinediones: role in diabetes and cardiovascular risk factors. Pharmacogenomics 15:2063–2082. https://doi.org/10.2217/pgs.14.162

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  29. 29.

    Durán Alonso JC (2012) Prevalencia de diabetes mellitus en pacientes geriátricos institucionalizados en la provincia de Cádiz, Estudio Diagerca. Rev Esp Geriatr Gerontol 47:114–118. https://doi.org/10.1016/j.regg.2011.11.003

    PubMed  Article  Google Scholar 

  30. 30.

    Cheng YJ, Imperatore G, Geiss LS et al (2013) Secular changes in the age-specific prevalence of diabetes among US adults: 1988–2010. Diabetes Care 36:2690–2696. https://doi.org/10.2337/dc12-2074

    PubMed  PubMed Central  Article  Google Scholar 

  31. 31.

    Barnett KN, Ogston SA, McMurdo MET et al (2010) A 12-year follow-up study of all-cause and cardiovascular mortality among 10 532 people newly diagnosed with Type 2 diabetes in Tayside, Scotland. Diabet Med 27:1124–1129. https://doi.org/10.1111/j.1464-5491.2010.03075.x

    CAS  PubMed  Article  Google Scholar 

  32. 32.

    Cacciatore F, Testa G, Galizia G et al (2013) Clinical frailty and long-term mortality in elderly subjects with diabetes. Acta Diabetol 50:251–260. https://doi.org/10.1007/s00592-012-0413-2

    PubMed  Article  Google Scholar 

  33. 33.

    Molist Brunet N, Sevilla-Sánchez D, Amblàs Novellas J et al (2014) Optimizing drug therapy in patients with advanced dementia: a patient-centered approach. Eur Geriatr Med 5:66–71. https://doi.org/10.1016/j.eurger.2013.10.011

    Article  Google Scholar 

  34. 34.

    Formiga F, Vidal X, Agustí A et al (2016) Inappropriate prescribing in elderly people with diabetes admitted to hospital. Diabet Med 33:655–662. https://doi.org/10.1111/dme.12894

    CAS  PubMed  Article  Google Scholar 

  35. 35.

    Frankenthal D, Lerman Y, Lerman Y (2015) The impact of hospitalization on potentially inappropriate prescribing in an acute medical geriatric division. Int J Clin Pharm 37:60–67. https://doi.org/10.1007/s11096-014-0040-9

    PubMed  Article  Google Scholar 

  36. 36.

    Onder G, Vetrano DL, Marengoni A et al (2018) Accounting for frailty when treating chronic diseases. Eur J Intern Med 56:49–52. https://doi.org/10.1016/j.ejim.2018.02.021

    PubMed  Article  Google Scholar 

Download references


We thank the team of nurses and team coordinators who serve elders and their caregivers in the ACE Unit, Hospital Universitari de Vic.


No competing financial interests exist.

Author information



Corresponding author

Correspondence to N. Molist-Brunet.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Statement of human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Local Ethics Committee of Hospital Universitari de Vic.

Informed consent

The study was based on the collection of data generated by clinical practice. Thus, informed consent was not considered necessary because inclusion in this study did not constitute a specific intervention.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Molist-Brunet, N., Sevilla-Sánchez, D., Puigoriol-Juvanteny, E. et al. Optimizing drug therapy in frail patients with type 2 diabetes mellitus. Aging Clin Exp Res 32, 1551–1559 (2020). https://doi.org/10.1007/s40520-019-01342-z

Download citation


  • Patient-centred care
  • Frailty
  • Polypharmacy
  • Inappropriate prescription