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 research: Parents should encourage structure and independence around food to support children’s healthy eating

Dr Katie Edwards studied the feeding practices of parents of children with ‘avid’ eating traits, which can lead to obesity Focusing on health or deciding when it is time for a meal or snack helps parents to use supportive feeding practices. Supportive feeding practices could include involving children in decisions about food, or sitting together for mealtimes New research from Aston University has shone a light on the best ways for parents to encourage healthy eating in their children. The team of academics from Aston University’s School of Psychology, led by Professor Jacqueline Blissett, with Dr Katie Edwards as the lead researcher, looked at the meal- and snack-time practices of parents of children with ‘avid’ eating behaviours. ‘Avid’ eaters, who make up around 20% of children, particularly love food, are often hungry and will eat in response to food cues in the environment and their emotions, not just when they are hungry. They are the most susceptible to obesity and therefore encouraging a healthy, balanced diet is vital. Feeding children with avid eating behaviours can be challenging and the researchers wanted to understand how factors in everyday life, such as parent mood or eating situations, influence the feeding practices that parents use. Understanding this can help to create better support for families around meal and snack times and reduce the risk of children developing obesity. Dr Edwards says that the research shows that when parents prioritise children’s health or decide when it is time for a meal or snack, parents are more likely to use supportive feeding practices which create structure around meal or snack times or encourage children to be independent with their food choices. For example, parents could sit and eat with their children, choose what food is available for their children, or involve children in decisions about what food to eat. She adds that there are three main things that parents can do to help encourage healthy eating behaviour. The first is to focus on health, by providing nutritious and balanced meals. The second is to ensure a calm and positive atmosphere during eating occasions. The final recommendation is that parents should take the lead on setting meal- and snack-times, with a good structure being three meals and two snacks a day. These recommendations are linked to parents’ use of supportive feeding practices which are known to encourage children’s healthy eating. To carry out the research, the team recruited parents of children aged 3-5 with avid eating behaviour and asked them to download an app to their smartphones. The app sent four semi-random reminders per day for a 10-day period, asking them to complete a survey with information about mood and stress levels. Every time a child had a meal or a snack, or asked for food, parents completed another survey to give information about feeding practices (including those which give children structure, or independence, around food), mealtime goals (such as prioritising healthy eating), and information about the mealtime setting (such as the atmosphere). Previous research from this team at Aston University identified four main eating traits in children. As well as ‘avid’, the other traits, not studied here, are ‘typical’ eaters, who have no extreme behaviours, ‘avoidant’ eaters, who are extremely fussy, and ‘emotional’ eaters, who eat in response to emotions but do not necessarily enjoy food in the way that avid eaters do. Dr Edwards was also involved in the team’s research at Aston University that showed that parents’ eating behaviour influences that of their children. Dr Edwards said: “Given the challenges that parents may face and the risk of childhood obesity, we will use these findings to develop feeding support for families. Encouraging parents to use feeding practices which provide structure around meal and snack times, or promote children’s independence with food, could be helpful for supporting children’s healthy eating. Read the full paper in the International Journal of Behavioral Nutrition and Physical Activity at https://doi.org/10.1186/s12966-025-01768-x.

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.

View all posts