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Learning Objective 1: The learner will be able to identify current guidelines for diabetes management in the elderly.
Learning Objective 2: The learner will be able to list qualities unique to the elderly that impact the ability to adhere to current guidelines.
- To explore existing literature and current practice regarding treatment of diabetes in the population over age 75.
- To propose individualized clinical guideline recommendations for care of the elderly with diabetes.
Methods: A review of literature was collected via search of online databases. A questionnaire was administered to local providers responsible for the care of elderly diabetics to explore how decisions are made regarding diabetes care.
Results: Three themes identified; frailty, glycemic recommendations, and guidelines.
General consensus: Healthy elderly should strive for glycemic goals established for younger diabetics. The frail elderly were recommended an A1C <8%. A single study explored outcomes of elderly diabetics with various A1C levels. Results suggested that A1C levels between 8% and 8.9% were optimal.
Guidelines agreed that maintaining glycemic targets leads to decreased morbidity and mortality. All recommended optimizing lifestyle, avoiding obesity, tobacco cessation, and exercise for diabetics. A major limitation of the literature was lack of scientific data to support recommendations for the elderly.
Questionnaire responses:
- 20.5% of offices have a written protocol elderly patients with diabetes
- 92.7% found guidelines helpful.
- 78.5% reported that preventing hypoglycemia was a primary concern.
- 52.5% do not treat elderly diabetics the same as younger diabetics.
- 18.1 percent reported an A1C <7.0% was optimal in the elderly
- 7.6%, stated 7.0% to 7.9%.
- 23.4 percent state 8.0%.
Conclusion: Individualize treatment of diabetes in the elderly. Providers should consider quality of life. Aggressive pursuit of an A1C of < 7% not recommended. Patient centered care and patient goals should guide management.
Recommendations
- Individual assessment.
- Assess comorbid conditions.
- Assess risk of hypoglycemia.
- Avoidance of “diabetic diet”
- Exercise
- Reassessment of medications
- Evaluation of limitations.
- Simplification.
- Relaxed A1C guidelines