Featured Post from Aston University

Type 2 diabetes: why treatment plans may need to be different for older adults

Sep 8, 2021

4 min



Around 6% of the world’s population suffer from type 2 diabetes. People of any age can develop the condition, but the number of older adults with type 2 diabetes is rapidly increasing worldwide. In fact, adults over the age of 65 now account for almost half of all adult cases.


There are many ways type 2 diabetes can be managed – including controlling weight through diet and exercise, or taking a drug to manage blood sugar levels. But many people may not realise that type 2 diabetes in older adults can be more complicated to manage. This means people over 65 may need to be managed differently when it comes to type 2 diabetes.


There are a number of reasons why type 2 diabetes may be more difficult to manage in older adults. First, ageing can affect blood sugar control, as the body’s organs (such as the pancreas, which controls insulin and blood sugar levels) lose their ability to work as well as they used to.


On top of this, some research has shown that diabetes may cause people to age faster. It’s thought that this is due to high levels of sugar in the blood stream prematurely ageing the body’s cells. This premature ageing could lead to diseases associated with age-related decline (such as arthritis or dementia) happening sooner.


Frailty – a state of health that is associated with reduced physical and mental resilience in older adults – also affects more people with type 2 diabetes than the rest of the population. In fact, an estimated 25% of older adults with type 2 diabetes are also frail. People who are frail and have type 2 diabetes have poorer health and increased risk of death from all causes compared to those who are not frail. Frailty is associated with reduced physical and cognitive functions and increased risk of low blood sugar. Both of these factors can make treating type 2 diabetes more complicated.


Dementia, which is more common in older adults, may also make it more difficult to manage type 2 diabetes. This is because the memory problems this condition causes may make it harder for patients to remember to take their medication, or take the proper medication dosage. What’s more, type 2 diabetes in older adults is actually a risk factor for developing dementia – including Alzheimer’s disease. While the link between the two isn’t fully understood, elevated blood sugar levels and insulin not working properly have been suggested as causes.


Having other health conditions can also make it more difficult to treat diabetes. Up to 40% of older adults with type 2 diabetes have four or more co-existing diseases – such as heart disease or dementia. These conditions can make it impossible to achieve normal treatment targets and the drugs used to treat them can interact with those used to treat diabetes – which could lead to harm if not managed carefully. Alongside this, poor access to proper medical care, and being more susceptible to low blood sugar in older age are also reasons why treating diabetes can be so difficult in this age group.


Managing type 2 diabetes


Most medical treatments for type 2 diabetes work to keep blood sugar levels low, and prevent them from spiking. But older adults with type 2 diabetes may actually have an increased risk of developing dangerously low blood sugar levels. This usually happens if the medication is not used at the correct dose, or in people who have had diabetes for a long time.


Older adults can also be susceptible to low blood sugar levels. Syda Productions/ Shutterstock


Having very low blood sugar levels is dangerous as it can increase the risk of falls – a serious and sometimes life-threatening problem in older adults. Very low blood sugar levels also increase the risk of heart problems. This means that healthcare professionals need to be careful they aren’t being too aggressive in treatment plans for older adults to avoid causing other health problems.


Ageing may also alter the body’s response to low blood sugar. This is significant, as when blood sugar falls too low it is extremely dangerous and can even be fatal.


Older adults may also be less able to recognise the symptoms of low blood sugar compared to young adults. This is because symptoms such as dizziness and confusion are often less specific in older adults, and can be confused with dementia. Older adults may also take longer to recover from low blood sugar.


Given that repeated bouts of low blood sugar can mean that older people are less able to sense when it’s happened in the future, it’s important that drugs prescribed to older adults for type 2 diabetes are given at the correct doses. Care especially needs to be taken prescribing insulin, the body’s blood sugar control hormone, to very old adults as this significantly increases the risk of low blood sugar.


Given our ageing population, it is projected that more older adults will have type 2 diabetes in the future. This makes it especially important to improve how we treat diabetes in this age group. Though specific treatment guidelines have been developed, some evidence suggests that care approaches need to be more cautious and personalised to each patient, taking into account their other health conditions, and that treatments consider quality of life for each patient.


This article was co-written by Dr James Brown and Dr Srikanth Bellary

You might also like...

Check out some other posts from Aston University

2 min

Aston University’s Ian Maidment helps develop training for pharmacy staff supporting those with long COVID

The e-learning resource, Supporting people living with long COVID, was developed by the Centre for Pharmacy Postgraduate Education (CPPE) It is designed to help community pharmacy teams build their skills, knowledge and confidence The programme offers video and audio resources, practical consultation examples and strategies for supporting individuals. Professor Ian Maidment at Aston Pharmacy School has been involved in a project with the Centre for Pharmacy Postgraduate Education (CPPE) to develop a new e-learning programme for community pharmacists, called Supporting people living with long COVID. The programme is designed to help community pharmacy teams build their skills, knowledge and confidence to support people managing the long-term effects of COVID-19. It was developed with researchers undertaking the National Institute for Health and Care Research (NIHR)-funded PHARM-LC research study: What role can community PHARMacy play in the support of people with long COVID? During the development of the e-learning resource, as well as with Professor Maidment, CPPE worked in collaboration with researchers from Keele University, the University of Kent, Midlands Partnership University NHS Foundation Trust and lechyd Cyhoeddus Cymru (Public Health Wales). The research draws on lived experience of long COVID, as well as the views of community pharmacy teams on what learning they need to better support people living with the condition. This new programme offers video and audio resources, practical consultation examples and strategies for supporting individuals through lifestyle advice, person-centred care and access to wider services. Professor Maidment said: “As an ex-community pharmacist, community pharmacy can have a key role in helping people living with long COVID. The approach is in line with the NHS 10 Year Health Plan, which aims to develop the role of community pharmacy in supporting people with long-term conditions.” Professor Carolyn Chew-Graham, professor of general practice research at Keele University, said: “Two million people in the UK are living with long COVID, a condition people are still developing, which may not be readily recognised, because routine testing for acute infection has largely stopped. For many, the pharmacy is the first place they seek advice about persisting symptoms following viral infection. The pharmacy team, therefore, has the potential to play a really important role in supporting people with long COVID. This learning programme provides evidence-based information to develop the confidence of pharmacy staff in talking to people with long COVID. Developed with people living with long COVID, the programme’s key message is to believe and empathise with people about their symptoms.” Visit www.cppe.ac.uk/programmes/l/covid-e-01 to access the e-learning programme. This project is funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number NIHR205384).

5 min

Building organisational 'sustainability fitness': Dr Breno Nunes on preparing businesses for a net zero future

Aston University’s approach to a global challenge Across industries, companies face mounting pressure to cut carbon, improve resource efficiency, and contribute to the UN Sustainable Development Goals (SDGs). Yet many firms still struggle to move from vision statements to measurable action. At Aston Business School, Dr Breno Nunes, reader in sustainable operations management, is developing practical frameworks that help organisations embed sustainability at their core. His concept of 'sustainability fitness' captures how firms can build the capabilities they need to adapt, compete, and thrive in the transition to a net zero economy. “Many organisations want to be sustainable but struggle to operationalise what that means. My work is about bridging that gap — helping businesses translate strategies into practice.” — Dr Breno Nunes The sustainability fitness concept involves both meeting human needs and respecting environmental limits. While it can also be applied at the societal and individual level, Dr Nunes focuses on organisations, where capability building delivers the fastest, measurable change. Corporate sustainability fitness examines how a firm is able to survive and meet its own needs, while aligning itself to wider essential needs of society and operating within limits imposed by its surrounding natural environment. From research to real-world action Dr Nunes’ research examines how organisations design, implement, and monitor sustainability strategies across operations, supply chains, facilities, and product development. He is the main author of the book Sustainable Operations Management: Key practices and cases, which applies the issues of sustainability to all strategic decisions of operations. His work is already making a tangible difference, including international partnerships in Brazil, Canada, and the US, bringing cross-cultural insights into organisational transformation, as well as for various companies and organisations. In an Innovate UK Knowledge Transfer Partnership (KTP) with automotive supplier Metal Assemblies, Dr Nunes and Professor Alexeis Garcia Perez, professor of digital business and society at Aston University, are working to calculate and report the carbon cost of metal components used in car production, tackling one of the industry’s biggest sustainability challenges. The digitalisation of processes will allow Metal Assemblies to meet customers' requirements and position itself as a trusted and transparent supplier of low-carbon components. In another KTP with Brockhouse Group, a forging manufacturer in the West Midlands, Dr Nunes worked with Aston colleague Dr Muhammad Imran, reader in mechanical, biomedical and design engineering. Together they developed a sustainable manufacturing strategy centred on carbon reduction and process improvement. The work involved the development of an energy dashboard, allowing analysis of data on gas and electricity consumption. The project also included analysis of alternatives for energy recovery systems, and development of routines and procedures to improve the manufacturing process. As a result, Brockhouse group is more competitive to supply in non-captive markets. Dr Nunes has also been involved with a collaboration with Birmingham Botanical Gardens to integrate sustainability into policy and practice, expanding the use of business sustainability theories to nonprofit sectors. Sustainability can be embedded across different areas of organisations while seeking financial stability. As an environmental education charity, it is important to for Birmingham Botanical Gardens to 'practise what it preaches'. It was recently awarded almost £20m from various grants (including Heritage Lottery) in a capital project, thanks to having sustainability at the core of renovation plans. These projects highlight Aston University’s role in bridging academia, industry, and policy — ensuring research findings reach the boardroom as well as the factory floor. Key insights from the research Dr Nunes’ studies highlight several critical factors for turning sustainability from intention into measurable results: • Organisational capabilities are central to embedding sustainability. These include empowering sustainability “champions” (institutional entrepreneurs), supportive structures, superior technologies, and the ability to learn and balance economic, environmental, and social performance. • The tensions in implementing sustainability vary not just by function (supply chains, governance, innovation) but also by an organisation’s maturity level. • Start with the low-hanging fruit: tools like self-assessments, capability diagnostics, and learning games allow firms to act at lower cost before committing to full environmental impact assessments or formal reporting. • Collaboration between academia, industry, and policymakers accelerates real-world impact. Why this matters The stakes are high. Businesses worldwide are expected to reduce carbon emissions, demonstrate social responsibility, and remain competitive in a rapidly changing global economy. Aston University’s research shows that strengthening sustainability capabilities not only improves environmental outcomes but also boosts resilience and cost savings. In pilot projects, teams working with Dr Nunes have achieved up to 30% reductions in both cost and carbon emissions — proof that sustainability can drive operational performance as well as compliance. Looking ahead: expanding the Sustainable Growth Hub The next phase of Dr Nunes’ work centres on Aston’s Sustainable Growth Hub, which is being developed as a reference point for SMEs seeking sustainability solutions. In 2025, the Hub will: • Launch its first industry club cohort and expand its team. • Roll out new self-assessment tools to size sustainability needs and decarbonisation goals. • Introduce new learning formats and follow-up courses to Aston’s Green Advantage programme, alongside sessions to play a new corporate sustainability game. • Host events to bring together businesses, policymakers, and the wider sustainability management community. • Attract new research grants and publish results to share knowledge across both academic and practitioner circles. These initiatives aim to equip organisations not only to meet today’s challenges, but to anticipate tomorrow’s. Get involved Follow Dr Nunes via his profile below, and soon through the Sustainability Fitness website. Businesses can also attend Aston Business School events to explore workshops, tools, and courses first-hand. About Dr Breno Nunes Dr Breno Nunes is reader in sustainable operations management at Aston Business School and president of the International Association for Management of Technology (IAMOT). He serves as associate editor of the IEEE Engineering Management Review and has published widely on sustainability strategy execution and innovation. Aston University’s work in sustainable operations — shaped by researchers like Dr Nunes — is helping organisations worldwide move from ambition to action, building the 'sustainability fitness' needed for a net zero future.

5 min

Aston University: From Metformin to modern obesity therapies

Early beginnings: from herbal medicine to modern drug The origins of a modern diabetes therapy can be traced back to Galega officinalis (goat’s rue), a herb used in European folk medicine for centuries to treat excessive thirst and urination. Its active chemical, guanidine, was found to lower blood sugar in animals in 1918, inspiring the synthesis of a family of drugs known as biguanides. Among these new drugs was metformin, created in 1922 and introduced as a treatment for diabetes in Europe in the late 1950s. However, by the 1970s, metformin was largely disregarded because other biguanide medicines were being withdrawn due to their side-effect of lactic acidosis. Revival in the 1990s: Aston’s role in rediscovery In the early 1990s, research at Aston University provided a decisive turning point. Professor Cliff Bailey and his colleagues revealed that metformin’s primary action occurred in the intestine, where it promoted glucose metabolism and reduced blood sugar without causing weight gain. Their studies clarified that concerns about lactic acid were largely due to misuse, not inherent toxicity. These findings reignited global interest in metformin. Professor Bailey presented his work as an expert witness to the US Food and Drug Administration in 1994, a critical step in securing approval of the drug in the US. He also assisted the European Medicines Agency during periodic reassessments. “My research has always focused on understanding how type 2 diabetes develops and how best to treat it.” Professor Clifford Bailey, Aston University. Establishing global first-line therapy Momentum built through the late 1990s. The UK Prospective Diabetes Study (1998) demonstrated that metformin not only improved blood sugar but also reduced cardiovascular risk, strengthening the case for its wider adoption. By 2012, the American Diabetes Association and the European Association for the Study of Diabetes recommended metformin as the preferred first-line treatment for type 2 diabetes. “We discovered that metformin worked somewhat differently from what was previously thought. By showing how it could be used safely and effectively, we helped pave the way for its wider acceptance.” Today, metformin is the most prescribed diabetes drug worldwide. It is included in the World Health Organization’s Essential Medicines List and has been taken by hundreds of millions of patients, profoundly reshaping global diabetes care. New directions: dapagliflozin and the SGLT-2 inhibitors After the success of metformin, Aston played a central role in the next wave of diabetes medicines. In the 2000s, Professor Bailey was principal investigator in clinical trials for dapagliflozin, the first of the sodium-glucose co-transporter-2 (SGLT-2) inhibitors. Unlike older therapies, SGLT inhibitors lower blood sugar by blocking reabsorption of glucose in the kidneys, causing excess glucose to be excreted in urine. Large international trials demonstrated additional benefits, including weight reduction, lower blood pressure, and improved outcomes for patients with kidney and heart disease. Since its launch in 2012, dapagliflozin has become the most widely prescribed SGLT-2 inhibitor, with more than five million patients treated. It is now embedded in global treatment guidelines, expanding therapeutic options to improve the control of blood glucose and body weight. Foundations for modern obesity therapies The influence of Aston University’s research extends beyond metformin and dapagliflozin. The University’s diabetes research team also studied gut hormones such as GIP (glucose-dependent insulinotropic peptide), which play a central role in regulating insulin secretion and fat metabolism. These early discoveries helped lay the groundwork for today’s incretin-based therapies, including combined GIP/GLP-1 receptor agonists such as tirzepatide. Now widely known as 'anti-obesity injections', these medicines emerged as diabetes treatments and are now transforming care for overweight people with and without type 2 diabetes. Key findings from the research at Aston University Metformin is now being investigated for its anti-ageing and fertility benefits Dapagliflozin shows promise against heart and kidney diseases and gout Gut hormones such as GIP may hold the key to entirely new treatment strategies Why does this matter? The work by Professor Bailey and his colleagues at Aston University has contributed to metformin’s recognition as the primary treatment worldwide for type 2 diabetes. Today, at least half of all patients in Western countries are prescribed metformin — an incredibly cost-effective medicine that continues to save lives. “We identified early on that gut hormones such as GIP were central players in the control of blood glucose and body weight — long before they became the basis for today’s new generation of anti-obesity medicines.” This original research helped lay the scientific foundation for breakthrough treatments like tirzepatide, widely hailed as a game-changer in obesity and diabetes care. Aston University also contributed to the development of dapagliflozin, the first in a new class of drugs that lower blood sugar while also protecting the heart and kidneys. “Millions of people worldwide are living longer and healthier lives because of therapies that have been underpinned by research at Aston University.” Looking ahead Type 2 diabetes remains one of the world’s most pressing health challenges, affecting more than 500 million people globally. Its progressive nature demands a continual search for safer, more effective treatments. From helping rescue a nearly forgotten drug in the 1990s to shaping the next generation of therapies, Aston University’s research has left an enduring mark on clinical practice, regulation, and patient outcomes. The legacy of this work is clear: millions of people worldwide are living longer, healthier lives because of medicines that Aston helped bring to the forefront of modern diabetes and obesity care. About Cliff Bailey is Emeritus Professor of Clinical Science and Anniversary Professor at Aston University in Birmingham, England. He has served on medical and scientific committees of Diabetes UK (formerly the British Diabetic Association), Society for Endocrinology, and European Association for the Study of Diabetes. He has served as a diabetes expert for the approval of new medicines by regulatory agencies including the European Medicines Agency and NICE. His research is mainly directed towards the pathogenesis and treatment of diabetes, especially the development of new agents to improve insulin action and reduce obesity, and the therapeutic application of surrogate beta-cells. Dr Bailey has published over 400 research papers and reviews, and four books, and he is particularly known for research on metformin. References to Case Studies and Key Sources Bailey CJ et al. Metformin: Changing the Treatment Algorithm for Type 2 Diabetes. Aston University REF Impact Case Study, 2014. Bailey CJ. Metformin: Historical Overview. Diabetologia, 2017. Bailey CJ & Day C. Treatment of Type 2 Diabetes: Future Approaches. British Medical Bulletin, 2018.

View all posts
Powered by