Hypoglycemia, frailty and dementia in older people with diabetes: Reciprocal relations and clinical implications

The relationships between hypoglycemia, frailty and dementia appear to be reciprocal and can lead to a vicious circle. Frailty appears to be a crucial factor increasing the risk for both hypoglycemia and dementia, initiating the reciprocal relationships. Weight loss is likely to be the underlying risk factor for frailty. Many frail older people with diabetes seem to have unnecessarily tight glycemic control, being treated with hypoglycemic medications that likely increase the risk of hypoglycemia. As patients get older with significant weight loss their glycemic targets should be reviewed, and reduction or even withdrawal of their hypoglycemic medications should be considered.