Sinclair AJ, Abdelhafiz AH, Forbes A, Munshi M (2018) Evidence-based diabetes care for older people with Type 2 diabetes: a critical review. Diabet Med Nov 8 [Epub ahead of print]
- Although diabetes confers a considerable burden on older people, who often present clinicians with complex management challenges, there is currently a relatively small evidence base on which to guide treatment, and this may have a negative impact on outcomes.
- In this review, the authors review the small but growing evidence base and advise on a comprehensive treatment scheme for: glucose lowering; blood pressure, lipid and frailty management; and lifestyle interventions in older people.
- A flow diagram outlining the development of complex illness scenarios that can occur in older people with diabetes is provided. It moves through normal glucose handling, subclinical and clinical type 2 diabetes (including delayed diagnosis) and high-risk health state, as well as providing dynamic modulation of goals by decade.
- The first detailed algorithm for developing individualised care plans for this patient group is provided, with assessment and treatment phases.
- The authors advise that efforts be made to provide older people who have diabetes with individualised care, taking into consideration different functional and comorbid categories and duration of diabetes. A safer, risk-stratification approach with proactive monitoring is advocated for those who are frail or have a high comorbidity burden.
- A call is made for more high-quality trials to further knowledge about the best way in which to manage this vulnerable patient group.
Amid accumulating evidence of benefits with new diabetes drugs, Vinod Patel asks whether the costs can be justified.
9 Nov 2023