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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

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Aston University develops novel bone cancer therapy which has 99% success rate

Bioactive glasses, doped with gallium developed to create a potential treatment for bone cancer Lab tests have a 99 percent success rate of killing cancerous cells Method could also regenerate diseased bones. Bioactive glasses, a filling material which can bond to tissue and improve the strength of bones and teeth, has been combined with gallium to create a potential treatment for bone cancer. Tests in labs have found that bioactive glasses doped with the metal have a 99 percent success rate of eliminating cancerous cells and can even regenerate diseased bones. The research was conducted by a team of Aston University scientists led by Professor Richard Martin who is based in its College of Engineering and Physical Sciences. In laboratory tests 99% of osteosarcoma (bone cancer) cells were killed off without destroying non-cancerous normal human bone cells. 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The glasses were then ground and sieved into tiny particles which can then be used for treatment. In previous research the team achieved a 50 percent success rate but although impressive this was not enough to be a potential treatment. The team are now hoping to attract more research funding to conduct trials using gallium. Dr Lucas Souza, research laboratory manager for the Dubrowsky Regenerative Medicine Laboratory at the Royal Orthopaedic Hospital, Birmingham worked on the research with Professor Martin. He added: “The safety and effectiveness of these biomaterials will need to be tested further, but the initial results are really promising. “Treatments for a bone cancer diagnosis remain very limited and there’s still much we don’t understand. Research like this is vital to support in the development of new drugs and new methodologies for treatment options.” Notes to Editors Multifunctional Gallium doped bioactive glasses: a targeted delivery for antineoplastic agents and tissue repair against osteosarcoma Shirin B. Hanaei1, Raghavan C. Murugesan1, Lucas Souza1, Juan I.C. Miranda1, Lee Jeys2,3, Ivan B. Wall3, and Richard A. Martin1 1. College of Engineering and Physical Sciences. Aston University, Aston Triangle, Birmingham, B4 7ET, UK 2. Oncology Department, The Royal Orthopaedic Hospital, Birmingham, B31 2AP, UK 3. College of Health and Life Sciences. Aston University, Aston Triangle, Birmingham, B4 7ET, UK DOI 10.1088/1748-605X/ad76f1 About Aston University For over a century, Aston University’s enduring purpose has been to make our world a better place through education, research and innovation, by enabling our students to succeed in work and life, and by supporting our communities to thrive economically, socially and culturally. Aston University’s history has been intertwined with the history of Birmingham, a remarkable city that once was the heartland of the Industrial Revolution and the manufacturing powerhouse of the world. Born out of the First Industrial Revolution, Aston University has a proud and distinct heritage dating back to our formation as the School of Metallurgy in 1875, the first UK College of Technology in 1951, gaining university status by Royal Charter in 1966, and becoming The Guardian University of the Year in 2020. Building on our outstanding past, we are now defining our place and role in the Fourth Industrial Revolution (and beyond) within a rapidly changing world. For media inquiries in relation to this release, contact Nicola Jones, Press and Communications Manager, on (+44) 7825 342091 or email: n.jones6@aston.ac.uk

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Industry and researchers call for action to tackle climate impact of organic, carbon-based chemicals

Call led by members of Supergen Bioenergy Hub, based at Aston University They highlight that carbon-based chemicals cannot be decarbonised but can be defossilised They want a transition to renewable carbon sources such as biomass, recycled carbon, and carbon dioxide. Director of Supergen Bioenergy Hub, Professor Patricia Thornley Industry experts and university researchers have joined together to ask the government to address the climate impact of organic, carbon-based chemicals. While demand for fossil fuels as energy is expected to fall in the coming decades, the petrochemicals sector is set to grow significantly according to experts and is set out in a 2018 report by the International Energy Agency. Members of the Supergen Bioenergy Hub which is based at Aston University and the Biomass Biorefinery Network believe the issue has yet to receive proper attention and is calling for a strategy that addresses this key component of our greenhouse gas emissions. They want a move to a more circular economy, managing supply and demand levels and transitioning away from fossil feedstocks which are raw materials required for some industrial processes. In their paper Carbon for chemicals How can biomass contribute to the defossilisation of the chemicals sector? they highlight that carbon-based chemicals cannot be decarbonised but can be defossilised through a transition to renewable carbon sources such as biomass, recycled carbon and carbon dioxide. Many products in modern society contain carbon such as pharmaceuticals, plastics, textiles, food additives, cosmetics, and cleaning products. These chemicals are derived from fossil feedstocks, so they are classed as petrochemicals. As a result, they contribute to global greenhouse gas emissions and climate change. Carbon is embedded in organic chemical products and released when they break down at end-of-life, for example through incineration. To address the emissions from carbon in chemicals and accelerate the development of bio-based chemicals, the group want a cross-party consensus to support a sustainable chemical system. Director of Supergen Bioenergy Hub, Professor Patricia Thornley, said: “We need to consider the UK’s future feedstock and chemicals production and use, and how it relates to net zero, agriculture, environment, economy, trade, and just transition policy objectives. There are opportunities here for the UK to lead the way on sustainable chemical production, but we need to carefully plan a roadmap for the transition, that delivers opportunities around jobs and the economy as well as sustainable greenhouse gas reductions. “There is a definite role for biomass here. But it is essential that any future use of biomass in the chemicals sector is underpinned by rigorous, trusted, and enforceable sustainability governance to build confidence, deliver sustainability benefits, and minimise negative impacts. That requires improvements in sustainability governance and regulation. “We think there are real economic and trade opportunities by the UK accelerating sustainable chemicals. At the moment bio-based chemicals, and chemicals derived from other renewable carbon sources, are not being expanded in the UK because there are no explicit incentives that prioritise them over fossil-based production.” The group argues that the UK has significant academic and industrial research expertise to underpin the development of sustainable bio-based products and could be a global leader in bio-based products and sustainability governance. They believe that to date little of this has manifested as UK-based scale-up and manufacturing, whilst there are numerous examples of UK-led research being scaled up elsewhere. The paper was delivered at a webinar on 7 August. Notes to Editors Carbon for chemicals How can biomass contribute to the defossilisation of the chemicals sector? https://www.supergen-bioenergy.net/output/carbon-for-chemicals-how-can-biomass-contribute-to-the-defossilisation-of-the-chemicals-sector-policy-briefing/ Author: Joanna Sparks (formerly Aston University) With contributions from: Cristiane Scaldaferri (formerly Aston University), Andrew Welfle (University of Manchester), Patricia Thornley (Aston University), Ashley Victoria (University of Leeds), Caspar Donnison (Lawrence Livermore National Laboratory), Jason Hallett (Imperial College London), Nilay Shah (Imperial College London), Mirjam Rӧder (Aston University), Paul Mines (Biome Bioplastics), David Bott (Society of Chemical Industry), Adrian Higson (NNFCC), Neil Bruce (University of York) 2018 International Energy Agency report https://www.iea.org/reports/the-future-of-petrochemicals https://www.supergen-bioenergy.net/ The Supergen Bioenergy Hub works with academia, industry, government, and societal stakeholders to develop sustainable bioenergy systems that support the UK’s transition to an affordable, resilient, low-carbon energy future. The Hub is funded jointly by the Engineering and Physical Sciences Research Council (EPSRC) and the Biotechnology and Biological Sciences Research Council (BBSRC) under grant EP/Y016300/1 and is part of the wider Supergen Programme. www.bbnet-nibb.co.uk The Biomass Biorefinery Network (BBNet), a phase II Network in Industrial Biotechnology & Bioenergy funded by the Biotechnology and Biological Sciences Research Council (BBSRC-NIBB) under grant BB/S009779/1. The aim of the Biomass Biorefinery Network is to act as a focal point to build and sustain a dynamic community of industrial and academic practitioners who work together to develop new and improved processes for the conversion of non-food biomass into sustainable fuels, chemicals and materials. About Aston University For over a century, Aston University’s enduring purpose has been to make our world a better place through education, research and innovation, by enabling our students to succeed in work and life, and by supporting our communities to thrive economically, socially and culturally. Aston University’s history has been intertwined with the history of Birmingham, a remarkable city that once was the heartland of the Industrial Revolution and the manufacturing powerhouse of the world. Born out of the First Industrial Revolution, Aston University has a proud and distinct heritage dating back to our formation as the School of Metallurgy in 1875, the first UK College of Technology in 1951, gaining university status by Royal Charter in 1966, and becoming the Guardian University of the Year in 2020. Building on our outstanding past, we are now defining our place and role in the Fourth Industrial Revolution (and beyond) within a rapidly changing world. For media inquiries in relation to this release, contact Nicola Jones, Press and Communications Manager, on (+44) 7825 342091 or email: n.jones6@aston.ac.uk

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