July 8, 2012

Position Statement on Diabetes in the Elderly

American Diabetes Association (ADA), pay attention, you just might learn something!  Three international groups have taken the first step in the establishment of guidelines for a global initiative to improve diabetes care for the elderly.  They will address age related problems for their care.

The three groups are the International Association of Gerontology and Geriatrics, the European Diabetes Working Party for Older People, and the International Task Force of Experts in Diabetes.  The group realizes that most international clinical diabetes guidelines fail to address problems common in the elderly, such as frailty, functional limitation, mental health changes, and increasing dependency on others for help.  This is a problem that is ignored in the USA.  Yes, the ADA pays lip service to the individual needs, but has not addressed the needs of the elderly.  It is still a “one-size-fits-all” policy.

The authors write, "the effective management of the older patient with diabetes requires an emphasis on safety, diabetes prevention, early treatment for vascular disease, and functional assessment of disability because of limb problems, eye disease, and stroke. Additionally, in older age, prevention and management of other diabetes-related complications and associated conditions, such as cognitive dysfunction, functional dependence, and depression, become a priority."

The authors list in the purpose of the position statement the following:
  1. Arrive at a consensus on how we approach the management of key issues of diabetes care for older people.
  2. Identify a series of key areas for diabetes-related surveys and/or audits of clinical care within a range of countries. These may take the form of surveys of particular drug usage, mortality and comorbidity rates, models of care, and use of clinical guidelines in clinical decision making.
  3. Recommend up to 3 to 4 research areas that could be considered for further investigation using selected research tools, and that could form the basis of one or more collaborative research proposals.

The authors then identified major research areas that need to be explored, including:
  1. the use of exercise, nutrition, and glucose-lowering therapies in the effective management of type 2 diabetes in older people;
  2. practical community-based interventions to reduce hospitalization;
  3. methods to decrease hypoglycemia rates in various clinical settings;
  4. health economic evaluations of metabolic treatment;
  5. interventions to delay/prevent diabetes-related complications that are important in older age, such as cognitive impairment and functional dependence; and
  6. development of technical devices that help to maintain autonomy and safety for older people with diabetes.

Now we will need to wait and see what is issued in the guidelines and if other areas come to the surface during the formation of the guidelines.  If this was the ADA doing this, I could guess that it would be more platitudes and lip service, and the old ways of doing things would not change.

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