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New Endocrine Society Guidelines Address Diabetes in Older Adults

Discussion in 'Endocrinology' started by Dr.Scorpiowoman, Mar 31, 2019.

  1. Dr.Scorpiowoman

    Dr.Scorpiowoman Golden Member

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    New guidelines from the Endocrine Society address the numerous complex issues involved in managing the growing population of older adults with diabetes.

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    The document, Treatment of Diabetes in Older Adults: An Endocrine Society Clinical Practice Guideline, was presented March 23 here at ENDO 2019: The Endocrine Society Annual Meeting and was simultaneously published in the Journal of Clinical Endocrinology and Metabolism along with other online resources.

    The guidelines are cosponsored by the European Society of Endocrinology, the Gerontological Society of America, and the Obesity Society.

    "For many decades and many years, we have not really paid a lot of attention to the older individual with diabetes because they were considered to have a limited lifespan. But we now know that 65 to 70 year olds live until 85 to 90 years, and so preventing the long-term complications is very important, much as the short-term issues they suffer from," said committee chair Derek LeRoith, MD, PhD, of the Icahn School of Medicine at Mount Sinai, New York City, during a press briefing.

    The document specifically pertains to adults with diabetes aged 65 years and older. It covers screening, prevention, and management of glycemia, blood pressure, and lipids, as well as comorbidities, complications, and special situations such as diabetes care in the hospital and long-term care facilities, and management of type 1 diabetes in older adults.

    "We believe there should be regular screening. If you screen for prediabetes and diabetes in the older population, it can allow you to intervene," LeRoith said.

    And, importantly, because of the heterogeneity of health status in older people with diabetes, the document emphasizes shared decision-making and provides a framework to assist healthcare providers to individualize treatment goals. "We believe that all the decisions in terms of management of these patients should be a team approach," he stressed.

    Avoidance of hypoglycemia is a key issue, coauthor Mark E. Molitch, MD, of the Northwestern University Feinberg School of Medicine, Chicago, Illinois, told journalists during the briefing.

    "A 70 year old who has hypoglycemia and falls on the floor can fracture a hip, so we have to be very careful about avoiding hypoglycemia. Similarly, for blood pressure we don't want to be too aggressive because that can lead to falls. All of these things play a role in how to adjust medications for these patients."

    Other specific aging-related comorbidities and issues addressed in the guidelines include sarcopenia, frailty, cognitive dysfunction, diminished medication adherence, and loss of independence in daily living activities.

    In addition, "Both renal disease and cardiac disease are very important, and we discuss that in these guidelines," LeRoith said.

    Comparison to Other Guidelines

    The new guidelines cover much the same ground as the 2012 American Diabetes Association/American Geriatrics Society (ADA/AGS) guidelines, noted Medha Munshi, MD, director of the Joslin Geriatric Diabetes Programs at Beth Israel Deaconess Medical Center, Boston, in an interview with Medscape Medical News.

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