Challenges, current innovations, and opportunities for managing type 2 diabetes in frail older adults: a position paper of the European Geriatric Medicine Society (EuGMS)-Special Interest Group in Diabetes

Purpose: This position paper aims to address the challenges of managing type 2 diabetes mellitus (T2DM) in frail older adults, a diverse and growing demographic with significant variability in health status. The primary research questions are: How can frailty assessment be effectively integrated into diabetes care? What strategies can optimize glycaemic control and outcomes for frail older adults? How can innovative tools and technologies, including artificial intelligence (AI), improve the management of this population? Methods: The paper uses the 5 I’s framework (Identification, Innovation, Individualization, Integration, Intelligence) to integrate frailty into diabetes care, proposing strategies such as frailty tools, novel therapies, digital technologies, and AI systems. It also examines metabolic heterogeneity, highlighting anorexic-malnourished and sarcopenic-obese phenotypes. Results: The proposed framework highlights the importance of tailoring glycaemic targets to frailty levels, prioritizing quality of life, and minimizing treatment burden. Strategies such as leveraging AI tools are emphasized for their potential to enhance personalized care. The distinct management needs of the two metabolic phenotypes are outlined, with specific recommendations for each group. Conclusion: This paper calls for a holistic, patient-centered approach to diabetes care for frail older adults, ensuring equity in access to innovations and prioritizing quality of life. It highlights the need for research to fill evidence gaps, refine therapies, and improve healthcare integration for better outcomes in this vulnerable group.