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

3 min

Aston University optometrist develops app with the best easy blinking exercises to improve dry eye symptoms

Dry eye disease is a common condition affecting one-third of the adult population and one-in-five children Professor James Wolffsohn researched the most effective blinking exercises to reduce discomfort, involving a close-squeeze-blink cycle He developed the MyDryEye app in collaboration with Alec Kingsnorth and Mark Nattriss to help sufferers An Aston University optometrist, Professor James Wolffsohn, has determined an optimum blinking exercise routine for people suffering with dry eye disease, and has developed a new app, MyDryEye, to help them complete the routine to ease their symptoms. Dry eye disease is a common condition which affects one-third of the adult population and one-in-five children, in which the eyes either do not make enough tears, or produce only poor-quality tears. It causes the eyes to become uncomfortable, with gritty- or itchy-feeling eyes, watery eyes and short-term blurred vision. It is more common in older adults and can be exacerbated by factors including dry air caused by air conditioning, dust, windy conditions, screen use and incomplete blinks, where the eye does not fully close. Professor Wolffsohn is head of Aston University’s School of Optometry and a specialist in dry eye disease. While it has long been known that blinking exercises can ease the symptoms of dry eye disease, the optimum technique, number of repetitions and necessary repeats per day are unclear. Professor Wolffsohn set out to determine the best exercises. His team found that the best technique for a dry eye blinking exercise is a close-squeeze-blink cycle, repeated 15 times, three times per day. Participants found that while they were doing their exercises symptom severity and frequency decreased, and the number of incomplete blinks decreased. Within two weeks of stopping the exercises, their symptoms returned to normal levels, showing the efficacy of the exercises. To carry out the work, Professor Wolffsohn’s team ran two studies. For the first, they recruited 98 participants, who were assessed for dry eye symptoms before and after the two weeks of blinking exercises. Participants were randomly allocated different blinking exercises to determine the most effective. A second study with 28 people measured the efficacy of the blinking exercise. Once the optimum blinking routine had been developed, Professor Wolffsohn worked withAlec Kingsnorth, an engineer and former Aston undergraduate and PhD student, and Mark Nattriss, business manager of his spin-out company, Wolffsohn Research Ltd, to develop the app, MyDryEye, which is freely available on Android and iOS operating systems. The app allows users to monitor their dry eye symptoms, assess their risk factors, add treatment reminders and monitor their compliance, complete the science-based blink exercises and find a specialist near them. Professor Wolffsohn says that the blinking exercises should be carried out as part of a treatment programme which could also include the use of lipid-based artificial tears, omega-3 supplements and warm compresses. Professor Wolffsohn said: “This research confirmed that blink exercises can be a way of overcoming the bad habit of only partially closing our eyes during a blink, that we develop when using digital devices. The research demonstrated that the most effective way to do the exercises is three times a day, 15 repeats of close, squeeze shut and reopen – just three minutes in total out of your busy lifestyle. To make it easier, we have made our MyDryEye app freely available on iOS and Android so you can choose when you want to be reminded to do the exercises and for this to map your progress and how it affects your symptoms.” Read the full paper, ‘Optimisation of Blinking Exercises for Dry Eye Disease’, in Contact Lens and Anterior Eye at https://doi.org/10.1016/j.clae.2025.102453.

2 min

Aston University researchers to take the first steps to find out if AI can help policymakers make urban mobility more sustainable

Researchers to explore how AI can help urban mobility planners They are to investigate AI-driven policy tools’ potential to create greener cities Project to benefit from expertise of five European universities. A European group of researchers led by Aston University is taking the first steps to explore how AI can help urban mobility planners. As city populations grow causing strain on resources, the experts are to investigate AI-driven policy tools’ potential to create greener cities. The team have received £10,000 in funding from the British Academy which they hope will set them on the road to further research. Taking part in the project will be experts from University College London, Ruralis University in Norway, the University of Turin, Italy and Lisbon University Institute, Portugal. Dr Dalila Ribaudo from the Centre for Business Prosperity at Aston Business School and Dr Alina Patelli from the Aston Centre for Artificial Intelligence Research and Application will co-lead a UK-EU consortium consolidation project. The interdisciplinary project will benefit from expertise in applied business and specialist insight into global economics, policymaking and urban transport planning. Dr Patelli said “Policymakers and society could all benefit from our research into innovative ways of managing the strain on urban infrastructures and resources. "The AI-powered policy tools we are developing are meant to support decision managers at all levels of urban governance with reducing emissions, optimising transportation as well as predicting and preventing environmental hazards. Such changes would improve the quality of life for the millions of people living in towns and cities across the UK, Europe and, in the long term, the entire world.” Following the successful bid for the British Academy pump priming grant the team will apply for Horizon Europe funding to continue developing impactful AI-driven policy tools for greener cities.

3 min

New Aston University spin-out company will develop novel ways to treat non-healing wounds

EVolution Therapeutics (EVo) has been founded on the work of Professor Andrew Devitt into the causes of inflammatory disease A failure to control inflammation in the body, usually a natural defence mechanism, can cause chronic inflammation, such as non-healing wounds Non-healing wounds cost the NHS £5.6bn annually, so there is a vital need for new treatments. Aston University’s Professor Andrew Devitt, Dr Ivana Milic and Dr James Gavin have launched a new spin-out company to develop revolutionary treatments to treat chronic inflammation in patients. One of the most common inflammatory conditions is non-healing wounds, such as diabetic foot ulcers, which cost the NHS £5.6bn annually, the same cost as managing obesity. Such wounds are generally just dressed, but clinicians say there is a vital need for active wound treatments, rather than passive management. The spin-out, Evolution Therapeutics (EVo), will aim to create these vital active treatments. Inflammation in the human body helps to fight infection and repair damage following injury and occurs when the immune system floods the area with immune cells. Normally, this inflammation subsides as the damage heals, with the immune system signalling to the immune cells to leave. However, in some cases, the usual healing mechanism is not triggered and the inflammatory response is not turned off, leading to chronic inflammation and so-called inflammatory diseases. EVo is based on Professor Devitt’s work on dying cells in the body, known as apoptotic cells, and how they contribute to health. Dying cells release small, membrane-enclosed fragments called extracellular vesicles (EVs), which alert the immune system to the death of cells, and then trigger the body’s natural repair mechanism and remove the dead cells. It is estimated that 1m cells die every second. Professor Devitt and his team have identified the molecules within the EVs which control the healing process and are engineering new EVs loaded with novel healing enzymes, to drive the body’s repair responses to actively heal wounds. Much of the research has been funded by the Biotechnology and Biological Sciences Research Council (BBSRC) with additional support from the Dunhill Medical Trust. Professor Devitt, Dr Milic and Dr Gavin received Innovation-to-Commercialisation of University Research (ICURe) follow-on funding of £284,000 to develop the vesicle-based therapy with EVo. Most recently, in December 2023, Professor Devitt and Dr Milic were awarded £585,000 from the BBSRC Super Follow-on-Fund to develop engineered cells as a source of membrane vesicles carrying inflammation controlling cargo. The team, together with Professor Paul Topham, also received funding from the National Engineering Biology Programme (£237,000) to support polymer delivery systems for vesicles. EVo is one of the 12 projects being supported by SPARK The Midlands, a network which aims to bridge the gap between medical research discoveries of novel therapeutics, medical devices and diagnostics, and real-world clinical use. SPARK The Midlands is hosted at Aston University, supported by the West Midlands Health Tech Innovation Accelerator (WMHTIA), and was launched at an event on 31 January 2024. Professor Devitt, EVo chief technical officer, said: “Inflammation is the major driver of almost all disease with a huge contribution to those unwelcome consequences of ageing. We are now at a most exciting time in our science where we can harness all the learning from our research to develop targeted and active therapies for these chronic inflammatory conditions.” Dr Gavin, EVo CEO, said: “The chronic inflammation that results in non-healing wounds are a huge health burden to individuals affecting quality of life as we age but also to the economy. Our approach at EVo is to target the burden of non-healing wounds directly to provide completely novel approaches to wound care treatment. By developing a therapy which actively accelerates wound healing, we hope to drastically improve quality of life for patients, whilst reducing the high cost attached to long term treatment for healthcare systems worldwide.”

View all posts
Powered by