Impact of frailty metabolic phenotypes on the management of older people with type 2 diabetes mellitus.

Aims: To provide a pathophysiological basis for distinguishing metabolic variants of the frailty phenotype in older adults with type 2 diabetes.

Methods: We have made an in-depth review of the possible mechanisms in diabetes, ageing and frailty that will alter allow us to describe phenotypic changes which might assist in predicting responses to particular glucose-lowering therapy.

Results: Our review has enable us to describe with some confidence a sarcopenic obese phenotype and an anorexic malnourished phenotype.

Newer anti-diabetic therapies with low hypoglycemic risk-potential advantages for frail older people.

The prevalence of diabetes is increasing due to increasing aging of the population. Hypoglycemia is a common diabetes-related complication in old age especially in patients with multiple comorbidities and frailty. Hypoglycemia and frailty appear to have a bidirectional relationship reenforcing each other in a negative downhill spiral that leads to an increased risk of adverse events including disability and mortality.

Diabetes in COVID-19 pandemic-prevalence, patient characteristics and adverse outcomes.

Background: Current literature on COVID-19 pandemic has identified diabetes as a common comorbidity in patients affected. However, the evidence that diabetes increases the risk of infection, effect of diabetes on outcomes and characteristics of patients at risk is not clear.

Objectives: To explore the prevalence of diabetes in COVID-19 pandemic, effect of diabetes on clinical outcomes and to characterise the patients with diabetes affected by COVID-19.

Care for Older People with Dementia During COVID-19 Pandemic.

Older people living with dementia, who are likely frail with multiple comorbidities, appear particularly vulnerable to COVID-19. Care for older people with comorbid dementia and COVID-19 is a challenge to health care professionals due to their complex needs. COVID-19 is a respiratory disease which typically presents with respiratory symptoms; however, in older people with dementia, it may present atypically with delirium.

New hypoglycaemic therapy in frail older people with diabetes mellitus-phenotypic status likely to be more important than functional status.

Frail older people are largely excluded from clinical trials and therefore glycaemic targets and optimum hypoglycaemic therapy in this group has not been fully investigated. Guidelines generally recommend tight glycaemic control in functionally fit individuals and relaxed targets in frail ones mainly due to the fear of hypoglycaemia. The newly introduced sodium glucose cotransporter-2 inhibitors and the glucagon like peptide-1 receptor agonists have shown benefit that is independent of glycaemic control and a minimal risk of hypoglycaemia.

Delirium in Older People with COVID-19: Clinical Scenario and Literature Review.

Delirium is a potentially fatal acute brain dysfunction that is characterised by inattention and fluctuating mental changes. It is indicative of an acute serious organ failure or acute infection. Delirium is also associated with undesirable health outcomes that include prolonged hospital stay, long-term cognitive decline and increased mortality.

Chinese and British Hospitalised Patients with COVID-19-a Comparative Case Series Analysis.

The COVID-19 pandemic initially started in China then spread to Europe. It is not known whether COVID-19 affects patients differently across the two continents. We aimed to describe our cohort of patients admitted to a single British centre with COVID-19 in comparison to a Chinese cohort of similar size and admitted over a similar time period to Chinese centres.