Caring
for Elderly Diabetics: New Guidelines
New Guidelines stress the need to aggressively
manage elevated blood pressure, cholesterol, even
if that means being more flexible with blood glucose
levels.
That
from the American Geriatrics Society (AGS) on
caring for elderly diabetics
The
new AGS guidelines by the American Geriatrics
Society (AGS) and the University of California
at Los Angeles (UCLA) were announced on May 15th
at the Society's 2003 Annual Scientific Meeting.
The
treatment of older adults should be based on a
patient's functional status, together with age
and blood-sugar numbers rather than on blood-sugar
numbers alone, the guidelines state. The functional
status of older diabetics can vary greatly, from
the patient who barely maneuvers around the house
to the one who is still employed and exercises
daily. Providers need to focus on maintaining
quality of life.
"Care
for older persons with diabetes goes beyond the
issue of chronological age," said Arleen
Brown, MD, PhD, assistant professor of medicine
at UCLA, and a co-chair of the guideline panel.
"[Some] are frailer, and they need to be
treated differently."
Another
particular emphasis of the guidelines is the benefit
of treating hypertension and abnormal concentrations
of lipids or lipoproteins in the blood, since
the main causes of mortality in older diabetics
are heart disease and stroke. Carol Mangione,
MD, MFPH, associate professor of medicine at UCLA
and a co-chair of the guideline panel, noted that
glucose control can be a bit looser if it allows
an older person to more aggressively manage elevated
blood pressure or cholesterol. She added that,
by contrast, an older diabetic with early kidney
or eye damage would require tight control over
glucose levels.
"Make
some room for the patient [to add medications
for control of serious conditions]," she
said. "We know from the literature, every
time you add another medication, you decrease
the chance of taking the drugs correctly."
On average, elderly diabetics take seven medications,
which means half of them are taking more.
Most
older adults with diabetes in the U.S. are treated
by generalists, who may not be as familiar with
checking for co-existing depression, memory problems,
falls, urinary incontinence and pain, as well
as juggling polypharmacy. The new guidelines include
care recommendations to screen for these common
geriatric syndromes.
The
guidelines were funded by a grant from the California
Healthcare Foundation's Program for Elders in
Managed Care and an unrestricted educational grant
from Aventis Pharmaceuticals.
The
were published in a supplement to the May issue
of the Journal of the American Geriatrics Society
(May 2003; 51[5 suppl]). An executive summary
of the guidelines is available at the AGS web
site: www.americangeriatrics.org.
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DO YOU KNOW:
Women with pregestational type 1 diabetes who
experience stillbirths are more likely to have
suboptimal glycemic control during pregnancy.
They are also more likely to have diabetic nephropathy,
to smoke and to have low educational and social
attainment. That's according to an audit of 25
stillbirths experienced by 22 type 1 diabetic
women, the results of which appear in the May
issue of Diabetes Care. Three of the women had
a history of two stillbirths.
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