Available diabetes guidelines rarely address specific care issues for the elderly, yet diabetes in older people is our most common chronic condition and one of our most challenging health problems.

While therapeutic options such as physical activity, nutrition and medication are available and enable the achievement of optimal glycemic control in the majority, co-morbidities, cognitive and functional disability, depression, frailty and social issues are common in the elderly person with diabetes and may impact adversely on efforts to optimise diabetes care.

Where diabetes is under treated or under managed due to such barriers elderly people are more likely to experience increased morbidity, disability and mortality.

New guidelines

The Guidelines for the Management and Care of Diabetes in the Elderly focus specifically on the ‘healthy’ person with diabetes over the age of 65 years. This includes the elderly person who despite a decline in physical or cognitive function is able to actively participate in their diabetes care. The application of the Guidelines in the frail elderly person with diabetes should be determined on an individual basis with special consideration of the physical and mental health status of the person.

It is anticipated that the Guidelines will assist in decision making by providers and consumers, assure quality of care and offer the opportunity for significant health gain and improvement to quality of life in older people with diabetes.

The Guidelines for the Management and Care of Diabetes in the Elderly provide readily accessible information about diabetes prevention, diagnosis, treatment and long term management options for elderly people at risk of or living with diabetes today.

They provide guidance about what is broadly appropriate rather than a prescriptive set of rules and it is important that their application relies on an individual medical assessment of the elderly person’s health status, attitudes, self care beliefs and physical environment.

Evidence

This information is a summary of the best knowledge and research available at the time of their development.

The Guidelines for the Management and Care of Diabetes in the Elderly were formulated using the NHMRC development process, the recognised standard for evidence based guideline development.

Where there was a lack of evidence of sufficient research rigour to meet NHMRC standards, other types of evidence such as position statements and expert consensus were used to augment the available evidence.

Level of Evidence

1. Evidence obtained from a systematic review of all relevant population-based studies.
2. Evidence obtained from a well-designed population-based study or representative cohort study
3. Evidence obtained from less well-designed population study, non representative cohort study or well-designed case-control study.
4. Evidence obtained from case series.

The search for evidence also identified issues requiring further research – these include the impact of the disease, the special problems faced by elderly people with diabetes in accessing a range of appropriate services and care, choice of treatment, treatment options and cost effectiveness and the consumer view.

Importantly, identifying the gaps in our knowledge offers the opportunity to focus and motivate our research efforts in this special group of people.

Download

Guidelines for the Management and Care of Diabetes in the Elderly are available at the bottom of this page.

Tags: diabetes