May 25, 2015

Medical Care of Older Diabetes Patients

I am glad that someone else is writing about this. And she is right, older patients with diabetes are not receiving adequate medical care. Doctors are so busy spending more time looking at the computer, checking off “something” and not really listening to what the patients are saying. Older patients repeatedly expressed frustration at the lack of time they spend with their doctor and feel they are not being heard.

Now not all doctors are doing this, I know, as some of my doctors are using recording devices and either having someone enter the information later or are doing this themselves later.

Recent standards for treatment of older patients with diabetes include more flexibility in setting goals for this population, including current health status (comorbid conditions) and expected lifespan. Due to the many pathways to help monitor and control diabetes, along with the variable and ever changing goals, more individualized time is required to assess and set a disease management course during the patient’s visit to their health care provider. This one on one time, in reality, is shrinking.

I am fortunate to have doctors and nurse practitioners that are helping me along the way. I have left the Diabetes Clinic that served me well until I reached 70 years of age and then they kept telling me to let my A1c rise to 7.0% to 7.5%. Then in a fortunate move, the local Veterans Clinic added a Clinical Pharmacist specializing in diabetes that encourages me to manage my diabetes to the best of my abilities.

I can say that I do not agree with the author when she writes, “We as diabetes educators have such an important job. We can have a huge impact on the lives of the older person with diabetes and help to achieve the 2020 healthy goals for Americans which includes: “Reduce the disease and economic burden of diabetes mellitus (DM) and improve the quality of life for all persons who have, or are at risk for, DM””. This could true if most certified diabetes educators did not teach to a one-size-fits-all mantra. Plus most CDEs do not and will not work with type 2 diabetes people, especially the elderly.

Then with the lack of clinical evidence from trials that confirm treatment therapies for the elderly, those of us over the age of 65 have nothing to compare to for determining whether we are even being treated properly.

The last AACE conference heard of a trial promoting oral medications over insulin in a very small study of only 18 individuals under the age of 60 when oral medications were effective in lowering A1Cs effectively for people starting at 9.0% or higher. Many had stacked oral medications and lost weight as a result. The presenter emphasized that this was better than insulin which often caused weight gain. This only happens when endocrinologists do not advise patients to reduce the quantity of carbohydrates consumed and to find an exercise regimen they can follow.

Since the study did not include people over 65, we don't know if people with other conditions such as kidney problems and heart disease will be able to tolerate this therapy. Yet many doctors will force this therapy on the elderly because it worked for younger patients. This is just another case of elderly discrimination.

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