American Geriatrics Society Releases Updated Guidelines for Improving the Care of Older Adults with Diabetes

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NEW YORK, Nov. 12, 2013 (GLOBE NEWSWIRE) -- Adults 65 and older have the highest rate of diabetes, and many have complications that can make their care more complex. The American Geriatrics Society Guidelines for Improving the Care of the Older Adult with Diabetes Mellitus: 2013 Update, published in the November issue of the Journal of the American Geriatrics Society, are based on new, high-quality research that supports an individualized approach to managing diabetes in older adults.

This individualized approach to diabetes care takes into account the patient's goals and preferences, their functional status, and co-existing conditions common in older diabetics, such as cardiovascular disease and kidney problems. Many older adults with diabetes also have a higher incidence of cognitive impairment, urinary incontinence, injurious falls, persistent pain, depression, and polypharmacy (taking multiple medications). If untreated, these conditions can make it more difficult for the older person to manage their diabetes and can diminish their quality of life.

The 2013 guidelines include new recommendations based on the importance of individualizing and prioritizing treatment. They are an update of the 2003 Guidelines for Improving the Care of the Older Person with Diabetes Mellitus, developed by the American Geriatrics Society (AGS) and the California Health Care Foundation.

The 2013 updated guidelines:

  • Recommend blood sugar control tailored to each person's functional status, co-existing conditions, and life expectancy. If control is too aggressive it may lead to hypoglycemia (low blood sugar), and complications such as falls or loss of consciousness.
  • No longer recommend the use of aspirin for primary prevention of cardiovascular disease because recent well designed studies show that the increased risk of bleeding outweighs the reduction in cardiovascular events.
  • Renew the emphasis on treating elevated cholesterol with statins, but not necessarily treating to specific target levels.
  • Encourage lifestyle modification for healthy older adults with diabetes, based on increased evidence supporting the importance of exercise and weight loss.

"This update was necessitated by new, high-quality research in the care of older adults with diabetes," said Carol M. Mangione, MD, MSPH, and Gerardo Moreno, MD, MSHS, co-chairs of the interdisciplinary panel of experts who developed the recommendations. "This research provides strong evidence that 'one size fits all' treatment goals for blood sugar and blood pressure for older adults are not appropriate. Because of this, the AGS guidelines strongly emphasize the importance of using shared decision making to tailor treatments to the individual patients' health status, goals and personal expectations."

Life expectancy is a particularly important part of individualized treatment decisions for older patients, because their life expectancy may be shorter than the time needed to benefit from a given treatment designed to control blood sugar, blood pressure, or cholesterol levels. In general, the time needed to benefit from blood pressure and cholesterol control is shorter than the blood sugar control. In light of this research, the new guidelines continue to emphasize the importance of blood pressure and blood cholesterol management.

The guidelines also emphasize the importance of diabetes self-management education and support for older adults and their caregivers. For many patients, particularly those who are clinically complex, referral to a diabetes educator for one-on-one counseling or group classes may improve diabetes control. Initial and annual diabetes education is a covered benefit under Medicare Part B.

About the American Geriatrics Society

Founded in 1942, the American Geriatrics Society (AGS) is a non-profit organization of over 6,300 healthcare professionals whose shared mission is to improve the health, independence and quality of life of older people. Our vision for the future is that all older adults will have access to quality health care that meets their unique needs. To achieve this, the Society focuses on: educating all healthcare professionals about the special healthcare needs of older adults; advancing aging research; enhancing clinical care for older people; raising public awareness of seniors' healthcare needs; and advocating for public policy that ensures older adults have access to high quality, appropriate, cost-effective care. The Society is a pivotal force in shaping practices, policies and perspectives in the field of older adult health and wellness.

CONTACT: Jillian Lubarsky Communications Manager American Geriatrics Society jlubarsky@americangeriatrics.org 212-308-1414

Source:American Geriatrics Society