Challenges, current innovations, and opportunities for managing type 2 diabetes in frail older adults: a position paper of the European Geriatric Medicine Society (EuGMS)-Special Interest Group in Diabetes

Abstract

Purpose: This position paper aims to address the challenges of managing type 2 diabetes mellitus (T2DM) in frail older adults, a diverse and growing demographic with significant variability in health status. The primary research questions are: How can frailty assessment be effectively integrated into diabetes care? What strategies can optimize glycaemic control and outcomes for frail older adults? How can innovative tools and technologies, including artificial intelligence (AI), improve the management of this population?

Methods: The paper uses the 5 I's framework (Identification, Innovation, Individualization, Integration, Intelligence) to integrate frailty into diabetes care, proposing strategies such as frailty tools, novel therapies, digital technologies, and AI systems. It also examines metabolic heterogeneity, highlighting anorexic-malnourished and sarcopenic-obese phenotypes.

Results: The proposed framework highlights the importance of tailoring glycaemic targets to frailty levels, prioritizing quality of life, and minimizing treatment burden. Strategies such as leveraging AI tools are emphasized for their potential to enhance personalized care. The distinct management needs of the two metabolic phenotypes are outlined, with specific recommendations for each group.

Conclusion: This paper calls for a holistic, patient-centered approach to diabetes care for frail older adults, ensuring equity in access to innovations and prioritizing quality of life. It highlights the need for research to fill evidence gaps, refine therapies, and improve healthcare integration for better outcomes in this vulnerable group.

Keywords: Aging; Diabetes; Frailty; Geriatrics; Novel; Technology.

Fig. 1

The five “I” pillars of advancing diabetes care in frail older adults: Identification, Innovation, Individualization, Integration, and Intelligence. The figure illustrates the five critical pillars of diabetes management advancements in frail adults with T2DM: (1) Identification of frailty, (2) Innovation in pharmacological treatments, (3) Individualization of care tailored to patient-specific needs, (4) Integration of digital health technologies to optimize management, and (5) Intelligence through AI-driven solutions for personalized and efficient care. (Created with BioRender)

Fig. 2

Comprehensive diabetes management in frail older adults. Comprehensive diabetes management in frail older adults integrates key steps to address the unique challenges of aging populations. The framework starts with identifying frailty, complexity, and disability, followed by advancements in pharmacological treatments like GLP-1 receptor agonists, SGLT2 inhibitors, and double agonists. Personalized interventions focus on tailored glycaemic targets and care plans. The adoption of digital technologies, such as continuous glucose monitoring (CGM) and telehealth platforms, enhances real-time patient monitoring. Finally, AI-driven solutions enable personalized treatment plans, advanced data analytics, and decision support tools, ensuring a holistic and patient-centered approach to care. (Created with BioRender)

Fig. 3

SWOT analysis (Strengths, Weaknesses, Opportunities, Threats) regarding the use of SGLT2 inhibitors (SGLT2i) in frail older adults. DKA diabetic ketoacidosis, UTI urinary tract infection. (Created with BioRender)

Fig. 4

SWOT analysis (Strengths, Weaknesses, Opportunities, Threats) regarding the use of GLP-1 RA in frail older adults. (Created with BioRender)

Fig. 5

SWOT analysis (Strengths, Weaknesses, Opportunities, Threats) in technology and AI in diabetes management for frail populations. CGM continuous glucose monitoring, AI artificial intelligence. (Created with BioRender)