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1. 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

Author

Boccardi, Virginia, Bahat, Gülistan, Balci, Cafer, Bourdel-Marchasson, Isabelle, Christiaens, Antoine, Donini, Lorenzo Maria, Cavdar, Sibel, Maggi, Stefania, Özkök, Serdar, Pavic, Tajana, Perkisas, Stany, Volpato, Stefano, Zaidi, Muhammad Shoaib, Zeyfang, Andrej, and Sinclair, Alan J.

Published
2025
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3. The optimal second-line therapy for older adults with type 2 diabetes mellitus: protocol for a systematic review and network meta-analysis using individual participant data (IPD)

Author

Wang, Jingya, Nirantharakumar, Krishnarajah, Sainsbury, Christopher, Moore, David J., Sinclair, Alan, Thomas, G. Neil, Hanif, Wasim, Singh, Megha, Tan, Luyuan, Wang, Zhaonan, Simms-Williams, Nikita, Yao, Mi, Gunathilaka, M. Niluka, Singh, Pushpa, Toulis, Konstantinos, Tsapas, Apostolos, Coomar, Dyuti, and Price, Malcolm James

Published
2024
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4. The Growing Role of Technology in the Care of Older Adults With Diabetes.

Author

Huang, Elbert, Sinclair, Alan, Conlin, Paul, Cukierman-Yaffe, Tali, Hirsch, Irl, Huisingh-Scheetz, Megan, Kahkoska, Anna, Laffel, Lori, Lee, Alexandra, Lee, Sei, Lipska, Kasia, Meneilly, Graydon, Pandya, Naushira, Peek, Monica, Peters, Anne, Pratley, Richard, Sherifali, Diana, Toschi, Elena, Umpierrez, Guillermo, Weinstock, Ruth, and Munshi, Medha

Subjects
Humans, Aged, Diabetes Mellitus, Blood Glucose, Caregivers, Insulin Infusion Systems, Costs and Cost Analysis
Abstract

The integration of technologies such as continuous glucose monitors, insulin pumps, and smart pens into diabetes management has the potential to support the transformation of health care services that provide a higher quality of diabetes care, lower costs and administrative burdens, and greater empowerment for people with diabetes and their caregivers. Among people with diabetes, older adults are a distinct subpopulation in terms of their clinical heterogeneity, care priorities, and technology integration. The scientific evidence and clinical experience with these technologies among older adults are growing but are still modest. In this review, we describe the current knowledge regarding the impact of technology in older adults with diabetes, identify major barriers to the use of existing and emerging technologies, describe areas of care that could be optimized by technology, and identify areas for future research to fulfill the potential promise of evidence-based technology integrated into care for this important population.

Published
2023

7. Essential steps in primary care management of older people with Type 2 diabetes: an executive summary on behalf of the European geriatric medicine society (EuGMS) and the European diabetes working party for older people (EDWPOP) collaboration

Author

Bourdel-Marchasson, Isabelle, Maggi, Stefania, Abdelhafiz, Ahmed, Bellary, Sri, Demurtas, Jacopo, Forbes, Angus, Ivory, Philip, Rodríguez-Mañas, Leocadio, Sieber, Cornel, Strandberg, Timo, Tessier, Daniel, Vergara, Itziar, Veronese, Nicola, Zeyfang, Andrej, Christiaens, Antoine, and Sinclair, Alan

Published
2023
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9. Development of an international glossary for clinical guidelines collaboration

Author

Christensen, Rachel E., Yi, Michael D., Kang, Bianca Y., Ibrahim, Sarah A., Anvery, Noor, Dirr, McKenzie, Adams, Stephanie, Amer, Yasser S., Bisdorff, Alexandre, Bradfield, Lisa, Brown, Steve, Earley, Amy, Fatheree, Lisa A., Fayoux, Pierre, Getchius, Thomas, Ginex, Pamela, Graham, Amanda, Green, Courtney R., Gresele, Paolo, Hanson, Helen, Haynes, Norrisa, Hegedüs, Laszlo, Hussein, Heba, Jakhmola, Priya, Kantorova, Lucia, Krishnasamy, Rathika, Krist, Alex, Landry, Gregory, Lease, Erika D., Ley, Luis, Marsden, Gemma, Meek, Tim, Meremikwu, Martin, Moga, Carmen, Mokrane, Saphia, Mujoomdar, Amol, Newton, Skye, O'Flynn, Norma, Perkins, Gavin D., Smith, Emma-Jane, Prematunge, Chatura, Rychert, Jenna, Saraco, Mindy, Schünemann, Holger J., Senerth, Emily, Sinclair, Alan, Shwayder, James, Stec, Carla, Tanni, Suzana, Taske, Nichole, Temple-Smolkin, Robyn L., Thomas, Louise, Thomas, Sherene, Tonnessen, Britt, Turner, Amy S., Van Dam, Anne, van Doormaal, Mitchell, Wan, Yung Liang, Ventura, Christina B., McFarlane, Emma, Morgan, Rebecca L., Ogunremi, Toju, and Alam, Murad

Published
2023
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12. The Use of SGLT-2 Inhibitors and GLP-1RA in Frail Older People with Diabetes: A Personalised Approach Is Required.

Author

Sinclair, Alan J. and Abdelhafiz, Ahmed H.

Subjects
FRAIL elderly, PEOPLE with diabetes, CARDIOVASCULAR diseases risk factors, FRAILTY, OLDER people
Abstract

Background: Frailty is an increasingly recognised complication of diabetes in older people and should be taken into consideration in management plans, including the use of the new therapies of sodium glucose cotransporter-2 (SGLT-2) inhibitors and glucagon like peptide-1 receptor agonists (GLP-1RA). The frailty syndrome appears to span across a spectrum, from a sarcopenic obese phenotype at one end, characterised by obesity, insulin resistance, and prevalent cardiovascular risk factors, to an anorexic malnourished phenotype at the other end, characterised by significant weight loss, reduced insulin resistance, and less prevalent cardiovascular risk factors. Therefore, the use of the new therapies may not be suitable for every frail older individual with diabetes. Objectives: To review the characteristics and phenotype of frail older people with diabetes who should benefit from the use of SGLT-2 inhibitors or GLP-1RA. Methods: A narrative review of the studies investigating the benefits of SGLT-2 inhibitors and GLP-1RA in frail older people with diabetes. Results: The current evidence is indirect, and the literature suggests that the new therapies are effective in frail older people with diabetes and the benefit appears to be proportional with the severity of frailty. However, frail patients described in the literature who benefited from such therapy appeared to be either overweight or obese, and to have a higher prevalence of unfavourable metabolism and cardiovascular risk factors such as dyslipidaemia, gout, and hypertension compared to non-frail subjects. They also have a higher prevalence of established cardiovascular disease compared with non-frail individuals. In absolute terms, their higher cardiovascular baseline risk meant that they benefited the most from such therapy. The characteristics of this group of frail patients fulfil the criteria of the sarcopenic obese frailty phenotype, which is likely to benefit most from the new therapies due to the unfavourable metabolic profile of this phenotype. There is no current evidence to suggest the benefit of the new therapies in the anorexic malnourished phenotype, which is underrepresented or totally excluded from these studies, such as in patients living in care homes. This phenotype is likely to be intolerant to such therapy due to its associated risk of inducing further weight loss, dehydration, and hypotension. Conclusions: Clinicians should consider the early use of the new therapies in frail older people with diabetes who are either of normal weight, overweight, or obese with prevalent cardiovascular risk factors, and avoid their use in those frail subjects who ae underweight, anorexic, and malnourished. [ABSTRACT FROM AUTHOR]

Published
2025
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18. List of contributors

Author

Akinci, Gulcin, primary, Andersen, Henning, additional, Boulton, Andrew J.M., additional, Bowling, Frank Lee, additional, Bril, Vera, additional, Calcutt, Nigel A., additional, Callaghan, Brian C., additional, Carmichael, Josie, additional, Chandrasekaran, Krish, additional, Colombo, Joseph, additional, Ejskjaer, Niels, additional, Fadavi, Hassan, additional, Feldman, Eva L., additional, Foley, Keeley Jane, additional, Gallagher, Gary, additional, Harno, Hanna, additional, Ishibashi, Fukashi, additional, Karlsson, Páll, additional, Kavarthapu, Venu, additional, Lim, Joyce, additional, Marshall, Andrew G., additional, Marshall, Anne, additional, Menon, Deepak, additional, Pafili, Kalliopi, additional, Papanas, Nikolaos, additional, Peltier, Amanda C., additional, Putko, Brendan N., additional, Rodríguez-Sánchez, Beatriz, additional, Røikjer, Johan, additional, Rosengård-Bärlund, Milla, additional, Russell, James W., additional, Savelieff, Masha G., additional, Selvarajah, Dinesh, additional, Shore, Angela C., additional, Sinclair, Alan, additional, Stouge, Anders, additional, Tavakoli, Mitra, additional, Tesfaye, Solomon, additional, Vas, Prashanth R.J., additional, Yagihashi, Soroku, additional, Yavuz, Dilek Gogas, additional, Yorek, Mark, additional, Zilliox, Lindsay A., additional, and Zochodne, Douglas W., additional

Published
2022
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26. Glycaemic outcomes in people living with diabetes under 65 and over 65 years old using an intermittently scanned continuous glucose monitoring system

Author

Wong, Carol, De Bray, Anne, Ul Hassan, Naeem, Almohandes, Ahmed, Thant, Kyi Zin, Gill, Sofia, Gill, Dayna, Forsdick, Hayley, Sinclair, Alan J., Karamat, Muhammad Ali, Bellary, Srikanth, Wong, Carol, De Bray, Anne, Ul Hassan, Naeem, Almohandes, Ahmed, Thant, Kyi Zin, Gill, Sofia, Gill, Dayna, Forsdick, Hayley, Sinclair, Alan J., Karamat, Muhammad Ali, and Bellary, Srikanth

Published
2024

27. Response rates and associated factors after a multicomponent intervention in frail older adults with diabetes

Author

Álvarez-Bustos, Alejandro, Laosa, Olga, Marzetti, Emanuele, Carnicero, Jose Antonio, Castro-Rodriguez, Marta, Landi, Francesco, Sinclair, Alan J, Rodriguez-Mañas, Leocadio, Marzetti, Emanuele (ORCID:0000-0001-9567-6983), Landi, Francesco (ORCID:0000-0002-3472-1389), Álvarez-Bustos, Alejandro, Laosa, Olga, Marzetti, Emanuele, Carnicero, Jose Antonio, Castro-Rodriguez, Marta, Landi, Francesco, Sinclair, Alan J, Rodriguez-Mañas, Leocadio, Marzetti, Emanuele (ORCID:0000-0001-9567-6983), and Landi, Francesco (ORCID:0000-0002-3472-1389)

Abstract

Background: Type 2 diabetes mellitus (T2DM) and frailty are associated with functional decline in older population. Objective: To explore the individual response to a multimodal intervention on functional performance. Design: A cluster-randomised multicentre clinical trial. Setting: Outpatients in hospital or primary care. Subjects: 843 (77.83 years, 50.65% men) prefrail and frail individuals ≥70 years with T2DM. Methods: Participants were allocated to usual care group (UCG) or a multicomponent intervention group (IG): 16-week progressive resistance training, seven nutritional and diabetological educational sessions and achievement of glycated haemoglobin (7-8%) and blood pressure (<150 mmHg) targets. Functional performance was assessed with the Short Physical Performance Battery (SPPB) at 1 year. We used multivariate binomial and multinomial logistic regression models to explore the effect of the IG, and adherence on the outcomes studied, in several adjusted models. Results: 53.7% in the IG versus 38.0% in the UCG improved by at least 1 point in their SPPB score [OR (95% CI): 2.07 (1.43, 2.98), P value <0.001]. Age, SPPB score and number of frailty criteria met decreased the probability of improving the SPPB score. Factors associated with worsening were pertaining to IG (decreased), age, SPPB score and the number of frailty criteria (increased). An adherence ≥84% was needed to achieve benefits, reaching the peak in the probability of improving SPPB when this was ≥85% [OR(95%CI): 2.38 (1.29, 4.79), P value 0.014]. Conclusions: Factors predicting the likelihood of improvement in a multimodal programme in pre-frail and frail older adults with diabetes are age, basal SPPB score, the number of frailty criteria and adherence.

Published
2024

30. Corrigendum to “Development of an international glossary for clinical guidelines collaboration” “[Journal of Clinical Epidemiology 158 (2023) 84-91]”

Author

Christensen, Rachel E., Yi, Michael D., Kang, Bianca Y., Ibrahim, Sarah A., Anvery, Noor, Dirr, McKenzie, Adams, Stephanie, Amer, Yasser S., Bisdorff, Alexandre, Bradfield, Lisa, Brown, Steve, Earley, Amy, Fatheree, Lisa A., Fayoux, Pierre, Getchius, Thomas, Ginex, Pamela, Graham, Amanda, Green, Courtney R., Gresele, Paolo, Hanson, Helen, Haynes, Norrisa, Hegedüs, Laszlo, Hussein, Heba, Jakhmola, Priya, Kantorova, Lucia, Krishnasamy, Rathika, Krist, Alex, Landry, Gregory, Lease, Erika D., Ley, Luis, Marsden, Gemma, Meek, Tim, Meremikwu, Martin, Moga, Carmen, Mokrane, Saphia, Mujoomdar, Amol, Newton, Skye, O'Flynn, Norma, Perkins, Gavin D., Smith, Emma-Jane, Prematunge, Chatura, Rychert, Jenna, Saraco, Mindy, Schünemann, Holger J., Senerth, Emily, Sinclair, Alan, Shwayder, James, Stec, Carla, Tanni, Suzana, Taske, Nichole, Temple-Smolkin, Robyn L., Thomas, Louise, Thomas, Sherene, Tonnessen, Britt, Turner, Amy S., Van Dam, Anne, van Doormaal, Mitchell, Wan, Yung Liang, Ventura, Christina B., McFarlane, Emma, Morgan, Rebecca L., Ogunremi, Toju, and Alam, Murad

Published
2024
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32. Association between sarcopenia and diabetes: a systematic review and meta-analysis of observational studies

Author

Veronese, Nicola, Pizzol, Damiano, Demurtas, Jacopo, Soysal, Pinar, Smith, Lee, Sieber, Cornel, Strandberg, Timo, Bourdel-Marchasson, Isabelle, Sinclair, Alan, Petrovic, Mirko, Maggi, Stefania, and on behalf of the Special Interest Groups of Systematic Reviews and Meta-Analysis for Healthy Ageing, Diabetes, Sarcopenia of European Geriatric Medicine Society (EuGMS)

Published
2019
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33. Effectiveness of a randomized intervention by a geriatric team in frail hospital inpatients in non‐geriatric settings: FRAILCLINIC project

Author

Checa‐López, Marta, primary, Costa‐Grille, Alba, additional, Álvarez‐Bustos, Alejandro, additional, Carnicero‐Carreño, Jose A., additional, Sinclair, Alan, additional, Scuteri, Angelo, additional, Landi, Francesco, additional, Solano‐Jaurrieta, Juan José, additional, Bellary, Srikanth, additional, and Rodríguez‐Mañas, Leocadio, additional

Published
2023
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34. Impact of deintensifying hypoglycaemic drugs in older adults with type 2 diabetes: protocol for an emulation of a target trial

Author

Christiaens, Antoine, primary, Simon-Tillaux, Noémie, additional, Thompson, Wade, additional, Sinclair, Alan J., additional, Henrard, Séverine, additional, Boland, Benoit B., additional, Slaouti-Jégou, Yannis, additional, Lekens, Béranger, additional, Bonnet-Zamponi, Dominique, additional, Tubach, Florence, additional, and Zerah, Lorène, additional

Published
2023
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38. The Growing Role of Technology in the Care of Older Adults With Diabetes

Author

Huang, Elbert S., primary, Sinclair, Alan, additional, Conlin, Paul R., additional, Cukierman-Yaffe, Tali, additional, Hirsch, Irl B., additional, Huisingh-Scheetz, Megan, additional, Kahkoska, Anna R., additional, Laffel, Lori, additional, Lee, Alexandra K., additional, Lee, Sei, additional, Lipska, Kasia, additional, Meneilly, Graydon, additional, Pandya, Naushira, additional, Peek, Monica E., additional, Peters, Anne, additional, Pratley, Richard E., additional, Sherifali, Diana, additional, Toschi, Elena, additional, Umpierrez, Guillermo, additional, Weinstock, Ruth S., additional, and Munshi, Medha, additional

Published
2023
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44. Effectiveness of a randomized intervention by a geriatric team in frail hospital inpatients in non‐geriatric settings: FRAILCLINIC project

Author

Checa‐López, Marta, Costa‐Grille, Alba, Álvarez‐Bustos, Alejandro, Carnicero‐Carreño, Jose A., Sinclair, Alan, Scuteri, Angelo, Landi, Francesco, Solano‐Jaurrieta, Juan José, Bellary, Srikanth, Rodríguez‐Mañas, Leocadio, Checa‐López, Marta, Costa‐Grille, Alba, Álvarez‐Bustos, Alejandro, Carnicero‐Carreño, Jose A., Sinclair, Alan, Scuteri, Angelo, Landi, Francesco, Solano‐Jaurrieta, Juan José, Bellary, Srikanth, and Rodríguez‐Mañas, Leocadio

Abstract

Background: Little research has been undertaken on the benefits of frailty management within different hospital settings. The objective of this study is to provide evidence on the viability and effectiveness of frailty management in non‐geriatric hospital settings on mortality and functional decline after discharge. Methods: Data from the FRAILCLINIC (NCT02643069) study were used. FRAILCLINIC is a randomized controlled trial developed in non‐geriatric hospital inpatient settings (emergency room, cardiology and surgery) from Spain (2), Italy (2) and the United Kingdom (1). Inpatients must met frailty criteria (according to the Frailty Phenotype and/or FRAIL scale), ≥75 years old. The control group (CG) received usual care. The intervention group (IG) received comprehensive geriatric assessment (CGA) and a coordinated intervention consisting in recommendations to the treating physician about polypharmacy, delirium, falls, nutrition and physical exercise plus a discharge plan. The main outcomes included functional decline (worsening ≥5 points in Barthel Index) and mortality at 3 months. We used multivariate logistic regression models adjusted by age, gender and the Charlson index. Intention‐to‐treat (ITT) and per‐protocol (PP) analyses were used. Results: Eight hundred twenty one participants (IG: 416; mean age 83.00 ± 4.91; 51.44% women; CG: 405; mean age 82.46 ± 6.03; 52.35% women) were included. In the IG, 77.16% of the participants followed the geriatric team's recommendations as implemented by the treating physicians. The intervention showed a benefit on functional decline and mortality [OR: 0.67(0.47–0.96), P‐value 0.027 and 0.29(0.14–0.57), P‐value < 0.001, respectively) when fully followed by the treating physician. A trend to benefit (close to statistical significance) in functional decline and mortality were also observed when any of the recommendations were not followed [OR (95% CI): 0.72 (0.51–1.01), P‐value: 0.055; and 0.64 (0.37–1.10), P‐value: 0.105, res

Published
2023

45. Amino Acid Profiles in Older Adults with Frailty: Secondary Analysis from MetaboFrail and BIOSPHERE Studies

Author

Calvani, Riccardo, Picca, Anna, Rodríguez-Mañas, Leocadio, Tosato, Matteo, José Coelho-Júnior, Hélio, Biancolillo, Alessandra, Laosa, Olga, Gervasoni, Jacopo, Primiano, Aniello, Santucci, Lavinia, Giampaoli, Ottavia, Bourdel-Marchasson, Isabelle, Regueme, Sophie C., Sinclair, Alan J., Urbani, Andrea, Landi, Francesco, Gambassi, Giovanni, Marini, Federico, Marzetti, Emanuele, Riccardo Calvani (ORCID:0000-0001-5472-2365), Matteo Tosato, Jacopo Gervasoni, Aniello Primiano, Lavinia Santucci, Andrea Urbani (ORCID:0000-0001-9168-3174), Francesco Landi (ORCID:0000-0002-3472-1389), Giovanni Gambassi (ORCID:0000-0002-7030-9359), Emanuele Marzetti (ORCID:0000-0001-9567-6983), Calvani, Riccardo, Picca, Anna, Rodríguez-Mañas, Leocadio, Tosato, Matteo, José Coelho-Júnior, Hélio, Biancolillo, Alessandra, Laosa, Olga, Gervasoni, Jacopo, Primiano, Aniello, Santucci, Lavinia, Giampaoli, Ottavia, Bourdel-Marchasson, Isabelle, Regueme, Sophie C., Sinclair, Alan J., Urbani, Andrea, Landi, Francesco, Gambassi, Giovanni, Marini, Federico, Marzetti, Emanuele, Riccardo Calvani (ORCID:0000-0001-5472-2365), Matteo Tosato, Jacopo Gervasoni, Aniello Primiano, Lavinia Santucci, Andrea Urbani (ORCID:0000-0001-9168-3174), Francesco Landi (ORCID:0000-0002-3472-1389), Giovanni Gambassi (ORCID:0000-0002-7030-9359), and Emanuele Marzetti (ORCID:0000-0001-9567-6983)

Abstract

An altered amino acid metabolism has been described in frail older adults which may contribute to muscle loss and functional decline associated with frailty. In the present investigation, we compared circulating amino acid profiles of older adults with physical frailty and sarcopenia (PF&S, n = 94), frail/pre-frail older adults with type 2 diabetes mellitus (F-T2DM, n = 66), and robust non-diabetic controls (n = 40). Partial least squares discriminant analysis (PLS-DA) models were built to define the amino acid signatures associated with the different frailty phenotypes. PLS-DA allowed correct classification of participants with 78.2 ± 1.9% accuracy. Older adults with F-T2DM showed an amino acid profile characterized by higher levels of 3-methylhistidine, alanine, arginine, ethanolamine, and glutamic acid. PF&S and control participants were discriminated based on serum concentrations of aminoadipic acid, aspartate, citrulline, cystine, taurine, and tryptophan. These findings suggest that different types of frailty may be characterized by distinct metabolic perturbations. Amino acid profiling may therefore serve as a valuable tool for frailty biomarker discovery.

Published
2023

48. Amino Acid Profiles in Older Adults with Frailty: Secondary Analysis from MetaboFrail and BIOSPHERE Studies

Author

Calvani, Riccardo, primary, Picca, Anna, additional, Rodriguez-Mañas, Leocadio, additional, Tosato, Matteo, additional, Coelho-Júnior, Hélio José, additional, Biancolillo, Alessandra, additional, Laosa, Olga, additional, Gervasoni, Jacopo, additional, Primiano, Aniello, additional, Santucci, Lavinia, additional, Giampaoli, Ottavia, additional, Bourdel-Marchasson, Isabelle, additional, Regueme, Sophie C., additional, Sinclair, Alan J., additional, Urbani, Andrea, additional, Landi, Francesco, additional, Gambassi, Giovanni, additional, Marini, Federico, additional, and Marzetti, Emanuele, additional

Published
2023
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