Association between anticholinergic burden and geriatric outcomes in older adults with type 2 diabetes mellitus

BACKGROUND: Older adults with type 2 diabetes mellitus (T2DM) frequently require multiple medications with anticholinergic and sedative properties for the management of diabetes-related complications and comorbidities, and diabetes itself predisposes patients to geriatric syndromes - making this population particularly vulnerable to the cumulative effects of anticholinergic burden. AIMS: This study aimed to determine the association between anticholinergic burden and geriatric syndromes in T2DM. METHODS: This retrospective study analysed comprehensive geriatric assessments of 715 T2DM outpatients from November 2018 to August 2024. Anticholinergic and sedative drug burden was evaluated using the Drug Burden Index, Anticholinergic Cognitive Burden Scale and Anticholinergic Risk Scale. RESULTS: Among the patients with T2DM (80.63 ± 7.3; 70.3% female), 309 had no anticholinergic burden, 320 had low burden and 86 had high burden. After adjustment for dementia, Parkinson disease and HbA1c, high anticholinergic burden was significantly associated with lower scores on the Barthel Index (P = 0.003; adjusted β = -10.22), Mini Nutritional Assessment (P = 0.005; adjusted β = -1.84), Mini-Mental State Examination (P = 0.001; adjusted β = -2.59) and the Tinetti test (P = 0.006; adjusted β = -2.11), as well as higher Timed Up and Go scores (P = 0.001; adjusted β = 5.13) and an increased risk of sarcopenia (P = 0.031; adjusted odds ratios = 1.83). CONCLUSION: Anticholinergic medication exposure is observed in more than half of older adults with T2DM. Increased anticholinergic burden is an independent risk factor for sarcopenia, malnutrition and gait, and cognitive and functional decline in older T2DM patients. The use of anticholinergic drugs in older patients with T2DM should be carefully evaluated and strategies to minimise exposure implemented.