[ad_1]
NEW ORLEANS – The new guidelines of the Society of Endocrinology address the many complex issues related to managing the growing population of older people with diabetes.
The document, Treatment of Diabetes in the Elderly: Clinical Practice Guideline of the Society of Endocrinology, was presented on March 23rd at ENDO 2019: annual meeting of the Endocrine Society and was published simultaneously in the Journal of Clinical Endocrinology and Metabolism with other online resources.
The guidelines are co-sponsored by the European Society of Endocrinology, the Society of Gerontology of America and the Society of Obesity.
"For decades and years, we did not really pay much attention to the older person with diabetes because it was considered to have a limited life span. But now we know that people between the ages of 65 and 70 live to age 85 to 90. It is therefore very important to prevent long-term complications, as well as the short-term problems they suffer, "he said. Committee Chair, Derek LeRoith, MD, PhD, of the Icahn School of Medicine at Mount Sinai, New York, during a press conference.
The document specifically addresses diabetic adults aged 65 and over. It covers the screening, prevention and management of blood glucose, blood pressure and lipids, as well as comorbidities, complications and special situations such as diabetes care in hospitals and long-term care facilities and the management of diabetes. management of type 1 diabetes in the elderly. .
"We think there should be regular screening, so if you are screening for prediabetes and diabetes in the elderly, this may allow you to intervene," LeRoith said.
And most importantly, because of the heterogeneous health status of older people with diabetes, the paper focuses on shared decision-making and provides a framework to help caregivers to individualize the treatment objectives. "We believe that all decisions in terms of managing these patients should be a team approach," he said.
Avoiding hypoglycemia is a key issue, said journalist Mark E. Molitch, MD, of the Feinberg School of Medicine at Northwestern University, in Chicago, Illinois, at the University of Michigan. A point of press.
"A 70-year-old man who suffers from hypoglycemia and falls to the ground can fracture his hip, so we must be very careful to avoid hypoglycaemia, and we do not want blood pressure to be high. too aggressive, as it can lead to falls, all of which play a role in how to adjust the medications for these patients. "
Sarcopenia, frailty, cognitive dysfunction, decreased adherence to treatment, and loss of autonomy in activities of daily living are other comorbidities badociated with aging.
In addition, "Kidney and heart diseases are both very important and we discuss them in these guidelines," said LeRoith.
Comparison with other directives
The new guidelines cover roughly the same basics as the 2012 guidelines of the American Diabetes Association / American Geriatrics Society (ADA / AGS), said Medha Munshi, MD, director of Diabetes Diabetes Josni Geriatrics of Beth Israel Deaconess Medical Center, Boston, in an interview with Medscape Medical News.
Munshi co-authored the ADA / AGS guidelines, which have since been revised in the ADA 2019 Standards for Medical Care of Diabetes.
"I think the guidelines complement each other, and most older people with diabetes will be better cared for if these basic concepts are understood."
Munshi particularly praised the Endocrine Society's new document, which focuses on hypertension and lipid management in addition to blood glucose and its involvement of patients as consultants.
She also noted that the two sets of guidelines similarly clbadify elderly adult patients into categories of good health (ie, absence or low comorbidities, and no or few functional impairments), intermediate health ( three or more comorbidities, mild cognitive impairment and / or functional impairment or more) and poor health[s]moderate to severe dementia, two or more functional limitations, and / or long-term care facility residence).
But Munshi congratulated the Endocrine Society for adding an extra category to this framework: the use of drugs that can cause hypoglycemia, such as insulin, sulfonylureas or glinides.
However, in this setting, she questioned the evidence base for some of the recommended HbA levels.1 C Target values, for example, range from ≥ 7.0% to <7.5% for healthy patients taking medications prone to hypoglycaemia.
Some patients in this category may need a higher target, she noted.
"There is no real data for this recommendation.This is only the opinion of experts.But instead of liberalizing the higher level, they place it in a narrower range . "
She also criticized the document for not providing specific instructions for the simplification of treatment regimens, as recommended for patients with limited life expectancy, cognitive impairment and / or multiple comorbidities.
These guidelines, which appeared for the first time in the 2016 ADA guidelines on diabetes care in specialized nursing and long-term care facilities, were added to the recommendations of the 2016 Ontario Diabetes Care Guidelines. ADA in current standards of care.
"Simplification is a good philosophy, but it is difficult for practitioners to put it into practice," said Munshi.
She was the lead author of these 2016 guidelines on long-term care, stressing that it was important to provide different guidance for different environments.
"Hospitals and long-term care facilities are very different environments, with very different management goals," she said. Medscape Medical News. "In the ADA statement, I explained why they do not belong together, but the endocrine society has regrouped them again."
Does type 1 diabetes in older adults deserve separate guidelines?
And, although the Endocrine Society's document includes a paragraph on the management of type 1 diabetes in the elderly, Munshi said that population growth really deserves separate guidelines.
"With regard to type 1 diabetes, the opinion of experts is largely based on the fact that there is not a lot of data," she said, adding that long-term care is a major concern for this population.
"The lack of understanding about the functioning of different insulins and the management of diabetes in general in type 2 population is difficult enough, and then you put a patient type 1 … We need to write something about diabetes type 1 long-term care. "
But in general, Munshi said that the new guidelines of the Endocrine Society would improve care for the elderly and that the differences between documents in general are minor.
"The main concepts are the same … As long as the recommendations reach a wider audience, they will allow them to better understand the complexity of managing older people with diabetes."
LeRoith is a consultant for AstraZeneca and MannKind and sits on advisory boards for MSD. Molitch is a consultant and / or sits on the Data Security Supervisory Boards for Merck, Pfizer, Janssen, Chiasma and Novartis. Munshi is a consultant for Sanofi and Lilly.
ENDO 2019. Presented on March 23, 2019.
For more information on diabetes and endocrinology, follow us on Twitter and on Facebook.
[ad_2]
Source link
