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Applying evidence to improve diabetes care for older people

Glargine 300 units/mL reduces nocturnal hypoglycaemia in over 65s

Preventing misdiagnosis of diabetes in the elderly

Investigators examining increased HbA_1c levels in older people without diabetes have found a positive association between HbA_1c concentration and age in two independent population-based cohorts. This increase was observed equally in lean, overweight and obese individuals. Investigators used their findings to propose age-dependent reference values for HbA_1c and suggested that clinicians be made aware of this age-related increase in HbA_1c that is independent of diabetes. They propose that age-dependent reference intervals be used to improve patient care and the diagnosis of diabetes.

High blood glucose associated with excess mortality in older people

In this study investigators wanted to examine the relationship between HbA_1c, cardiovascular morbidity and all-cause mortality in older patients using insulin to treat type 2 diabetes, after adjusting for other factors. They examined a large GP database to gather information on patients aged over 65 treated with insulin. Both low and high HbA_1cwere found to be associated with increased all-cause mortality, with the greatest increase in risk seen at HbA_1c>96 mmol/mol (>11%). The lowest risk, in this U-shaped relationship, was seen in the 47.5–57.4 mmol/mol (6.5–7.4%) HbA_1crange.

Severe hypoglycaemia doubles dementia risk

Investigators wanted to discover whether there was an association between treatment choices for diabetes and dementia. They performed a systematic review and meta-analysis of pharmacological treatment of diabetes and incident or progressive cognitive impairment. Antidiabetic drug treatment was not generally associated with incident dementia. Differential effects were, however, found across drug classes, with insulin therapy being associated with a signal of harm and thiazolidinediones having potentially protective effects on cognition. There was nearly a twofold increase in the likelihood of incident dementia in those who experienced severe hypoglycaemic episodes.

How tight is too tight? Glycaemic control and mortality in older people

Tight glycaemic control associated with mortality in older people

Recognition and forward planning of end-of-life care

Severe hypoglycaemia associated with cognitive damage

Diabetes in care homes: greater investment in time and expertise required

A look at what needs to be done to improve the outcomes of adults with diabetes in care homes.

Old but not very old adults with diabetes benefit from statins

In this study investigators assessed whether statin treatment is associated with a reduction in atherosclerotic cardiovascular disease (ASCVD) and mortality in old and very old adults with and without diabetes. Participants were stratified by the presence of type 2 diabetes and whether they were new statin users or non-users. Statins had no effect on mortality in people aged over 74 who did not have diabetes. In people with diabetes, however, statin use was statistically associated with reductions in ASCVD incidence and in all-cause mortality. This effect decreased after 85 years and disappeared in nonagenarians.

Hypertriglyceridaemic waist in older adults: Comparison of diagnostic criteria

The hypertriglyceridaemic waist (HW) phenotype is defined as the combination of high waist circumference and high fasting blood triglyceride concentrations. The results of this study suggest that cut-off points derived from younger adults may overestimate the prevalence of HW, and the associated cardiometabolic risk, in older people.

Keeping abreast of the latest diabetes research: Overprescribing, protein intake and service use in older people

Trisha Dunning, Chair in Nursing at Deakin University and Barwon Health, Australia, selects the latest papers of interest to diabetes nurses.

A framework for modern-day management and assessment of frailty

Diabetes in care homes: Residents’ needs not being met

Efficacy and safety of insulin glargine 300 units/mL in older people

Do new high-concentration insulins paradoxically bring improved safety in older people with diabetes?

GPs urged to assess frailty in older people with diabetes

GPs should prioritise the assessment of frailty in older patients with type 2 diabetes and tailor their care plans accordingly, new guidelines urge.

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