Clinical Practice GuidelinesDiabetes in the Elderly
Introduction
The definition of “elderly” varies, with some studies defining the elderly population as ≥60 years of age. Administrative guidelines frequently classify people >65 years of age as elderly. Although there is no uniformly agreed-upon definition of elderly, it is generally accepted that this is a concept that reflects an age continuum starting sometime after age 65 and is characterized by a slow, progressive impairment in function that continues until the end of life (1).
Section snippets
Diagnosis
As noted in the Definition, Classification and Diagnosis of Diabetes, Prediabetes and Metabolic Syndrome chapter (p. S8), glycated hemoglobin (A1C) can be used as 1 of the diagnostic tests for type 2 diabetes in adults. Unfortunately, normal aging is associated with a progressive increase in A1C, and there is a significant discordance between fasting plasma glucose–based and A1C-based diagnosis of diabetes in this age group, a difference that is accentuated by race and gender (2). Pending
Reducing the Risk of Developing Diabetes
Lifestyle interventions are effective in reducing the risk of developing diabetes in elderly people at high risk for the development of the disease (3). Acarbose (4), rosiglitazone (5) and pioglitazone (6) also are effective in preventing diabetes in elderly people at high risk. Metformin may not be effective (3).
Glycemic control
As interdisciplinary interventions, especially those that have been specifically designed for this age group, have been shown to improve glycemic control in elderly individuals with diabetes, these people should be referred to a diabetes healthcare team 7, 8, 9. Pay-for-performance programs improve a number of quality indicators in this age group 10, 11. Telemedicine case management and web-based interventions can improve glycemic control, lipids, blood pressure (BP), psychosocial well-being
Hypertension
Treatment of isolated systolic hypertension or combined systolic and diastolic hypertension in elderly people with diabetes is associated with a significant reduction in CV morbidity and mortality and microvascular events. Also, the number needed to treat (NNT) reduces with increasing age 116, 117, 118, 119, 120. Treatment of isolated systolic hypertension may also preserve renal function in elderly people with diabetes (121). Several different classes of antihypertensive agents have been shown
Diabetes in Nursing Homes
Diabetes is often undiagnosed in nursing home patients 147, 148, 149, 150. The prevalence of diabetes is high in institutions, and individuals frequently have established macro- and microvascular complications, as well as substantial comorbidity 150, 151, 152, 153. Antipsychotic drug use is a risk factor for the development of diabetes in patients in institutions (154). In observational studies, the degree of glycemic control varies widely between different centres 147, 152, adherence to
Other Relevant Guidelines
Screening for Type 1 and Type 2 Diabetes, p. S12
Reducing the Risk of Developing Diabetes, p. S16
Organization of Diabetes Care, p. S20
Self-Management Education, p. S26
Targets for Glycemic Control, p. S31
Pharmacotherapy in Type 1 Diabetes, p. S56
Pharmacologic Management of Type 2 Diabetes, p. S61
Hypoglycemia, p. S69
Screening for the Presence of Coronary Artery Disease, p. S105
Dyslipidemia, p. S110
Treatment of Hypertension, p. S117
Erectile Dysfunction, p. S150
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2021, Journal of Cardiothoracic and Vascular AnesthesiaDiabetes in ageing: pathways for developing the evidence base for clinical guidance
2020, The Lancet Diabetes and EndocrinologyCitation Excerpt :All the crucial research gaps in current evidence and the important new research questions that should be investigated are summarised in panel 7. In the absence of an adequate evidence base, guidelines are almost exclusively based on expert opinion and extrapolated from trials in younger or healthier populations.1–11 Thus, additional studies are urgently needed to: (1) identify which older adults with diabetes would benefit from which diabetes interventions and (2) establish which outcomes are most important for subpopulations of older adults with diabetes.
Type 2 Diabetes in Older Adults in Long-Term Care Homes: An Educational Intervention to Improve Diabetes Care
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