What are the consequences of over and undertreatment of type 2 diabetes mellitus in a frail population? A systematic review.

AIMS: This review aims to identify the evidence base for the consequences of over and undertreatment of type 2 diabetes mellitus in a frail population. METHOD: In this systematic review, we searched MEDLINE, Embase, PubMed, CINAHL and the Cochrane Library for studies from January 2001 to 15th August 2022. We included a variety of study types that assessed and reported frailty including patients ≥18 years old. Studies included those that reported the prevalence of over or undertreatment of diabetes mellitus in a frail population and those examining outcomes related to glucose control in frail older people living with diabetes. Data were extracted using a bespoke extraction table using a narrative synthesis approach. RESULTS: A total of 4114 articles were identified with 112 meeting inclusion criteria. These included 15,130 participants across the 11 studies with sample sizes ranging from 101 to 11,140. Several areas were identified in the included studies where under or overtreatment of diabetes impacted outcomes for patients. These included hospital admissions, readmissions, length of stay, falls, mortality, cognitive impairment and cardiovascular disease outcomes. CONCLUSION: The results showed that there was a high heterogeneity of outcomes between the studies and that many examined small numbers of participants. In this review, both over and undertreatment were shown to increase adverse outcomes in frail older people. Further research around optimal glycaemic control for frail older people living with diabetes is required with the aim to identify ideal target ranges and produce practical clinical guidelines to promote attainment of these.

Ultra-low Ultraviolet Radiation in Office Lighting Can Moderate Seasonal Vitamin D Cycle: A Pilot Study.

BACKGROUND/AIM: Ultraviolet-B (UV-B) radiation initiates vitamin D synthesis in the skin, making sun exposure a major source of vitamin D. We aimed to determine whether office lighting containing ultra-low levels of UV-B radiation could modify the winter decline in vitamin D status in the UK, while being safe and well tolerated. PATIENTS AND METHODS: Twenty commercial office desk lamps were modified with the addition of UV-B LEDs. Ten hospital office administrative staff received UV-modified lamps with UV-on, and 10 staff received identical placebo lamps with UV switched off, in a double-blind, cross-over pilot study during the winter of 2021/22. Circulating 25-hydroxyvitamin D [25(OH)D] was measured every 4 weeks for 20 weeks: at baseline and during an 8-week trial period, 4-week washout, and a cross-over 8-week trial period. RESULTS: The linear regression combining the complete datasets for phase 1 and 2 of the trial showed that an 8-week UV light intervention significantly increased 25OHD by 7.13 nmol/l with a p-Value=0.02, compared to the placebo group. Similar results were confirmed by cross-over analyses using the datasets of those completing both phases of the trial both with and without using the inverse probability weighing method to handle dropouts. CONCLUSION: The UV-B-modified lighting was well-tolerated and safe with weekly doses of UV-B of 0.5 - 0.9 Standard Erythema Dose [SED=100 Jm-2 erythema weighted UV radiation] measured at chest level. This ultra-low dosing was effective in reducing the winter decline in vitamin D status.