Prevalence of geriatric syndromes and polypharmacy in elderly patients with type 2 diabetes mellitus: Cross-sectional study data

Introduction. Type 2 diabetes mellitus (T2DM) in the elderly is characterized by a high prevalence of geriatric syndromes (GS) and polypharmacy, which increases patient vulnerability. Therapy with sulfonylureas (SU) is associated with an increased risk of hypoglycemia, especially in older adults. Finding approaches to comprehensive outpatient support for these patients is relevant. Aim. To analyze the initial geriatric and clinical-metabolic status of a cohort of elderly patients with T2DM to substantiate an outpatient monitoring program aimed at correcting GS and optimizing therapy.

Materials and methods. A cross-sectional study was conducted involving 40 T2DM patients (30 women, 10 men) aged ≥ 65 years receiving SU. All underwent comprehensive geriatric assessment (SPPB, dynamometry, Barthel and Lawton scales, MMSE, MoCA, GDS-15, Insomnia Severity Index), evaluation of clinical-metabolic parameters, fall risk, polypharmacy, and social activity.

Results. The mean age was 72.3 ± 4.6 years, T2DM duration was 12 [8.0; 17.5] years, and HbA1c was 7.4 ± 1.1%. Polypharmacy was detected in 90% of patients, with a median number of drugs of 7 [5; 8]. Hypoglycemia history was reported by 45%, and 50% were unaware of its management. Prefrailty/frailty by SPPB was found in 40%, low muscle strength in 30%, falls in 30%, and home fall risk factors in 95%. Mild cognitive impairment by MoCA was detected in 42.5% (by MMSE – in 25%). Social activity was preserved in most (80%). Conclusions. A high prevalence of GS, polypharmacy, and poor awareness of hypoglycemia was revealed in elderly T2DM patients on SU therapy. The results justify the need to develop a comprehensive outpatient support program focused on deprescribing, fall prevention, and cognitive impairment management.

1. Shabunova AA, Barsukov VN. Trends in demographic aging of population of the Russian Federation and ways of overcoming them. Problems of Territory’s Development. 2015;(1):76–87. (In Russ.) Available at: http://pdt.isert-ran.ru/article/1228?_lang=en.

2. Older Adults: Standards of Medical Care in Diabetes-2022. Diabetes Care. 2022;45(Suppl. 1):S195–S207. https://doi.org/10.2337/dc22-S013.

3. Ткачева ОН, Котовская ЮВ, Рунихина НК, Фролова ЕВ, Наумов АВ, Воробьева НМ и др. Старческая астения: клинические рекомендации. 2024. 106 с. Режим доступа: https://kurskveteran.gosuslugi.ru/netcat_files/35/68/KR_starcheskaya_asteniya.pdf.

4. Morley JE. Diabetes and aging: epidemiologic overview. Clin Geriatr Med. 2008;24(3):395–405. https://doi.org/10.1016/j.cger.2008.03.005.

5. Monickaraj F, Aravind S, Gokulakrishnan K, Sathishkumar C, Prabu P, Prabu D et al. Accelerated aging as evidenced by increased telomere shortening and mitochondrial DNA depletion in patients with type 2 diabetes. Mol Cell Biochem. 2012;365(1-2):343–350. https://doi.org/10.1007/s11010-012-1276-0.

6. Park SW, Goodpaster BH, Strotmeyer ES, Kuller LH, Broudeau R, Kammerer C et al. Accelerated loss of skeletal muscle strength in older adults with type 2 diabetes: the health, aging, and body composition study. Diabetes Care. 2007;30(6):1507–1512. https://doi.org/10.2337/dc06-2537.

7. Elmotia K, Abouyaala O, Bougrine S, Ouahidi ML. Geriatric Syndromes in Older Adults With and Without Diabetes: A Systematic Review and Meta-Analysis. Res Gerontol Nurs. 2025;18(2):99–108. https://doi.org/10.3928/19404921-20250115-01.

8. Pasquetti P, Apicella L, Mangone G. Pathogenesis and treatment of falls in elderly. Clin Cases Miner Bone Metab. 2014;11(3):222–225. Available at: https://pubmed.ncbi.nlm.nih.gov/25568657.

9. Сычев ДА (ред.). Полипрагмазия в клинической практике: проблема и решения. 2-е изд., испр. и доп. СПб.: ЦОП «Профессия»; 2018. 272 с.

10. Dedov II, Shestakova MV, Vikulova OK, Zheleznyakova AV, Isakov MA, Sazonova DV, Mokrysheva NG. Diabetes mellitus in the Russian Federation: dynamics of epidemiological indicators according to the Federal Diabetes Register of Diabetes Mellitus for the period 2010–2022. Diabetes Mellitus. 2023;26(2):104–123. (In Russ.) https://doi.org/10.14341/DM13035.

11. Edridge CL, Dunkley AJ, Bodicoat DH, Gray LJ, Davies MJ, Khunti K. Prevalence and Incidence of Hypoglycaemia in 532,542 People with Type 2 Diabetes on Oral Therapies and Insulin: A Systematic Review and MetaAnalysis of Population Based Studies. PLoS ONE. 2015;10(6):e0126427. https://doi.org/10.1371/journal.pone.0126427.

12. Prokhorova YaD, Demidova TYu, Gritskevich EYu. Deprescribing of antidiabetic drugs in middle-aged and elderly people with type 2 diabetes mellitus. Endocrinology: News, Opinions, Training. 2021;10(3):108–110. (In Russ.) https://doi.org/10.33029/2304-9529-2021-10-3-108-110.

13. Ткачева ОН, Фролова ЕВ, Яхно НН (ред.). Гериатрия. М.: ГЭОТАР-Медиа; 2023. 784 с.

14. Maduro PA, Carvalho LPDC, Maduro LAR, da Silva TBL, da Silva LSL, Yassuda MS et al. Accuracy of the Mini-Mental State Examination and Montreal Cognitive Assessment in Detecting Cognitive Impairment in Older Adults: A Comparative Study Adjusted for Educational Level. NeuroSci. 2025;6(3):86. https://doi.org/10.3390/neurosci6030086.

15. Remelli F, Ceresini MG, Trevisan C, Noale M, Volpato S. Prevalence and impact of polypharmacy in older patients with type 2 diabetes. Aging Clin Exp Res. 2022;34(9):1969–1983. https://doi.org/10.1007/s40520-022-02165-1.

16. Yu X, Qian Y, Zhang Y, Chen Y, Wang M. Association between polypharmacy and cognitive impairment in older adults: A systematic review and metaanalysis. Geriatr Nurs. 2024;59:330–337. https://doi.org/10.1016/j.gerinurse.2024.07.005.

17. Sharma R, Gill JK, Chhabra M, Carter C, Alkabbani W, Vidyasagar K et al. Prevalence of Potentially Inappropriate Medications in Older Adults with Cognitive Impairment or Dementia Attending Memory Clinics: A Systematic Review and Meta-Analysis. J Alzheimers Dis. 2024;101(4):1107–1120. https://doi.org/10.3233/JAD-240575.

18. Buse JB, Bigger JT, Byington RP, Cooper LS, Cushman WC, Friedewald WT et al. Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial: design and methods. Am J Cardiol. 2007;99(12 Suppl.):S21–S33. https://doi.org/10.1016/j.amjcard.2007.03.003.

19. Glinkina IV, Balashova AV, Shyman AS, Oderij AV, Khan SA, Runova GE et al. Factors determining the clinical significance of dipeptidyl peptidase-4 inhibitors in the treatment of elderly patients with type 2 diabetes mellitus. Meditsinskiy Sovet. 2021;(7):56–67. (In Russ.) https://doi.org/10.21518/2079-701X-2021-7-56-67.

20. Collard RM, Boter H, Schoevers RA, Oude Voshaar RC. Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc. 2012;60(8):1487–1492. https://doi.org/10.1111/j.1532-5415.2012.04054.x.

21. Romadlon DS, Hasan F, Wiratama BS, Chiu HY. Prevalence and risk factors of fatigue in type 1 and type 2 diabetes: A systematic review and metaanalysis. J Nurs Scholarsh. 2022;54(5):546–553. https://doi.org/10.1111/jnu.12763.

22. Laosa O, Topinkova E, Bourdel-Marchasson I, et al. Long-term frailty and physical performance transitions in older people with type-2 diabetes. The MIDFRAIL randomized clinical study. J Nutr Health Aging. 2025;29(4):100512. https://doi.org/10.1016/j.jnha.2025.100512.

23. Izzo A, Massimino E, Riccardi G, Della Pepa G. A Narrative Review on Sarcopenia in Type 2 Diabetes Mellitus: Prevalence and Associated Factors. Nutrients. 2021;13(1):183. https://doi.org/10.3390/nu13010183.

24. Pasquetti P, Apicella L, Mangone G. Pathogenesis and treatment of falls in elderly. Clin Cases Miner Bone Metab. 2014;11(3):222–225. Available at: https://pubmed.ncbi.nlm.nih.gov/25568657.

25. Galkina AP, Glinkina IV, Surkova EV, Kolokolova EV, Fadeev VV. Falls syndrome in elderly patients with diabetes mellitus: Risk factors, clinical significance, prevention. Meditsinskiy Sovet. 2025;(16):148–160. (In Russ.) https://doi.org/10.21518/ms2025-388..

26. Rockwood K, Wolfson C, McDowell I. The Canadian Study of Health and Aging: organizational lessons from a national, multicenter, epidemiologic study. Int Psychogeriatr. 2001;13(Suppl. 1):233–237. https://doi.org/10.1017/s1041610202008177.

27. Surkova EV, Glinkina IV, Gurova OY, Mamleeva DV, Galstyan GR. History of patient education for chronic diseases (with diabetes mellitus as an example): from an idea to the branch of modern medicine. Terapevticheskii Arkhiv. 2025;97(1):86–93. (In Russ.) https://doi.org/10.26442/00403660.2025.01.203139.

28. Balashova AV, Glinkina IV, Pavlova MG, Oderiy AV, Fadeev VV. Special considerations in the therapeutic education of elderly with diabetes mellitus type 2. Meditsinskiy Sovet. 2022;16(10):22–32. (In Russ.) https://doi.org/ 10.21518/2079-701X-2022-16-10-22-32.