Type 2 Diabetes Mellitus in Older Adults - Clinical Considerations and Management - Nature Reviews Endocrinology

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Review Article Published: 25 June 2021
Type 2 diabetes mellitus in older adults: clinical considerations

and management
Srikanth Bellary , Ioannis Kyrou, James E. Brown & Clifford J. Bailey
Nature Reviews Endocrinology

17, 534–548 (2021)
6953 Accesses 6 Citations 307 Altmetric Metrics
Abstract
The past 50 years have seen a growing ageing population with an increasing
prevalence of type 2 diabetes mellitus (T2DM); now, nearly half of all individuals with
diabetes mellitus are older adults (aged ≥65 years). Older adults with T2DM present
particularly difficult challenges. For example, the accentuated heterogeneity of these
patients, the potential presence of multiple comorbidities, the increased
susceptibility to hypoglycaemia, the increased dependence on care and the effect of
frailty all add to the complexity of managing diabetes mellitus in this age group. In this
Review, we offer an update on the key pathophysiological mechanisms associated with
T2DM in older people. We then evaluate new evidence relating particularly to the
effects of frailty and sarcopenia, the clinical difficulties of age-associated
comorbidities, and the implications for existing guidelines and therapeutic options.
Our conclusions will focus on the effect of T2DM on an ageing society.
https://www.nature.com/articles/s41574-021-00512-2#Abs1 1/31
Key points
Older adults (≥65 years of age) with type 2 diabetes mellitus (T2DM) account for
nearly half of all individuals with diabetes mellitus.
T2DM in older adults is highly heterogeneous but is generally associated with

various degrees of underlying insulin resistance, excess adiposity, β-cell
dysfunction and sarcopenia.
The management of T2DM in older adults is complicated by the frequent

occurrence of multimorbidity, necessitating highly individualized approaches.
The presence of frailty, cognitive decline and functional impairments in older

adults with T2DM highlights the importance of liaison with carers and social
support.
Targets for glycaemic control in older adults with T2DM are often less stringent
than in younger adults to avoid hypoglycaemia and minimize unbeneficial
interventions.
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Author information
Affiliations
School of Life and Health Sciences, Aston University, Birmingham, UK
Srikanth Bellary, James E. Brown & Clifford J. Bailey
University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK

Srikanth Bellary
Aston Research Centre for Healthy Ageing (ARCHA), Aston University, Birmingham, UK
Srikanth Bellary, James E. Brown & Clifford J. Bailey
Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and
Warwickshire NHS Trust, Coventry, UK
Ioannis Kyrou
Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, UK
Ioannis Kyrou
Warwick Medical School, University of Warwick, Coventry, UK

Ioannis Kyrou
Centre for Sport, Exercise and Life Sciences, Research Institute for Health & Wellbeing, Coventry University, Coventry, UK
Ioannis Kyrou
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The authors contributed equally to all aspects of the article.
Corresponding author
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Srikanth Bellary.
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Competing interests
S.B. has received research grants from The Binding Site Ltd. and Novo Nordisk, UK,
Ltd. as well as speaker fees and honoraria from AstraZeneca, Boehringer Ingelheim,
MSD, Novo Nordisk, Janssen, Eli Lilly, and Sanofi-Aventis outside of the submitted
work. C.J.B. has received personal fees from AstraZeneca, Boehringer Ingelheim,
Elcelyx, Lexicon, Poxel, Eli Lilly, Janssen, Merck, Sharpe & Dohme, Novo Nordisk, and
Sanofi-Aventis. J.E.B. has received speaker fees from Gilead Biosciences Inc. I.K. has no
competing interests to declare.
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Literature searches were conducted using Google Scholar, MEDLINE and Embase with
the following terms: ‘elderly’, ‘frail’, ‘older people’ and ‘aged’ combined with ‘diabetes’,
‘type 2 diabetes’, ‘prediabetes’ and ‘glucose control’. The selection was made by at least
two of the present authors and was limited to English language articles from 2000 to
2020 and relevant references cited in the publications selected. Priority was given to
prospective randomized studies and meta-analyses, though these were scarce, and
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Bellary, S., Kyrou, I., Brown, J.E. et al. Type 2 diabetes mellitus in older adults: clinical considerations
and management.
Nat Rev Endocrinol 17, 534–548 (2021). https://doi.org/10.1038/s41574-021-
00512-2
Accepted Published Issue Date

13 May 2021 25 June 2021 September 2021
DOI
https://doi.org/10.1038/s41574-021-00512-2
Subjects
Endocrine system and metabolic diseases • Type 2 diabetes
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Type 2 diabetes mellitus in older adults: clinical considerations

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T2DM in older adults is highly heterogeneous but is generally associated with

The management of T2DM in older adults is complicated by the frequent

The presence of frailty, cognitive decline and functional impairments in older

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