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Applying evidence to improve diabetes care for older people

Care of Older People – April 2019 Digest

Evidence-based review and new algorithm for the tailored care of older people with type 2 diabetes.

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.

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