Nagoba BS, Bhavthankar SS, Gavkare AM. Decoding the glycemic paradox: The imperative for frailty-centered inpatient diabetes care. World J Clin Cases 2026; 14(21): 123085 [DOI: 10.12998/wjcc.123085]
Corresponding Author of This Article
Basavraj S Nagoba, Professor, Department of Microbiology, Maharashtra Institute of Medical Sciences and Research (Medical College), Vishwanathpuram, Ambajogai Road, Latur 413531, Maharashtra, India. basavraj.nagoba@mimsr.edu.in
Research Domain of This Article
Geriatrics & Gerontology
Article-Type of This Article
editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jul 26, 2026; 14(21): 123085 Published online Jul 26, 2026. doi: 10.12998/wjcc.123085
Decoding the glycemic paradox: The imperative for frailty-centered inpatient diabetes care
Basavraj S Nagoba, Sachin S Bhavthankar, Ajay M Gavkare
Basavraj S Nagoba, Department of Microbiology, Maharashtra Institute of Medical Sciences and Research (Medical College), Latur 413531, Maharashtra, India
Sachin S Bhavthankar, Department of Biochemistry, Maharashtra Institute of Medical Sciences and Research, Latur 413512, India
Ajay M Gavkare, Department of Physiology, Government Medical College, Buldhana 443001, Maharashtra, India
Author contributions: Nagoba BS designed the overall concept and outline of the manuscript; Bhavthankar SS and Gavkare AM contributed to the discussion and design of the manuscript; Nagoba BS, Bhavthankar SS, and Gavkare AM contributed to the writing, editing the manuscript, and review of literature; all authors contributed to finalising the manuscript.
AI contribution statement: We have used Gemini as an AI tool for grammatical and typographical corrections only.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Basavraj S Nagoba, Professor, Department of Microbiology, Maharashtra Institute of Medical Sciences and Research (Medical College), Vishwanathpuram, Ambajogai Road, Latur 413531, Maharashtra, India. basavraj.nagoba@mimsr.edu.in
Received: May 8, 2026 Revised: June 8, 2026 Accepted: July 1, 2026 Published online: July 26, 2026 Processing time: 75 Days and 2 Hours
Abstract
The management of type 2 diabetes mellitus in older adults involves the “glycemic paradox”, where lower glycated haemoglobin levels paradoxically link to increased mortality. This editorial for the article which study by Papakitsou et al recently published in World Journal of Clinical Cases, argues that the current “one-size-fits-all” approach in inpatient settings is inadequate. We advocate for the systematic integration of the Clinical Frailty Scale to replace rigid glycemic targets with individualized, safety-focused care. Future clinical protocols must prioritize real-time monitoring and “deprescribing” to prevent iatrogenic hypoglycemia, thereby improving survival and quality of life in this vulnerable cohort. By utilizing the Clinical Frailty Scale - a validated, rapid assessment tool ideal for acute care - clinicians can objectively stratify risk and tailor glycemic targets. Future research should utilize continuous glucose monitoring to determine if these mortality rates are directly tied to iatrogenic hypoglycemia. It is recommended that hospitals incorporate frailty scores as a mandatory component of the diabetes management plan. This would facilitate an automated “alert” for clinicians to consider de-intensifying therapy when a patient crosses a specific frailty threshold.
Core Tip: In frail older adults with type 2 diabetes, lower glycated haemoglobin levels may paradoxically be associated with increased mortality, reflecting overtreatment, hypoglycemia, and underlying physiological decline. Frailty is a key modifier of risk and should guide glycemic targets, particularly in the inpatient setting. Routine frailty assessment, individualized treatment goals, and deprescribing of high-risk therapies are essential. A shift from rigid glycemic control to a safety-focused, patient-centered approach is crucial to improve outcomes in this vulnerable population.
