Each week we will aim to bring out a concise email that provides 4-5 key pieces of information addressing a specific issue in clinical therapeutics. This week:
The International Diabetes Foundation have produced Global Guidelines for Managing Older People with Type 2 Diabetes. This information is a valuable resource to assist with the management of diabetes in the aged care setting.
- The target levels for HbA1c are different to those of the younger population.
- For functionally independent1 elderly people, aim for a HbA1c target <7.0-7.5% (53-59 mmol/l).
- For the functionally dependent2 elderly, aim for target 7.0-8.0% (53-64 mmol/mol), and for those who are either frail3 and/or who have dementia the approach should be re-adjusted with a target HbA1c of up to 8.5% (70 mmol/mol).
- Hyperglycaemia can cause loss of weight, feelings of weakness/tiredness and problems with vison that may not necessarily be attributed to diabetes.
- Hypoglycaemia can cause weakness, hunger, blurred vision, confusion and increases risk of falls.
- Minimising extremes of blood glucose (high or low) should be to be the focus of treatment plans and should address social, emotional and physical issues to maximize safety and QOL.
- In the context of end of life care, the aim is to manage symptoms; to avoid hyperglycaemia and hypoglycaemia, and to promote comfort and quality of life.
- Oral medication choices should be based on achieving BG goals without the risk of hypoglycaemia. Medications regimens should be kept as simple as possible.
- Finger-prick BGL testing should be kept to a minimum, and for those treated with insulin, basal insulin may be enough.
1 – people who are living independently and have no impairments of AOL and minimal caregiver support.
2 – individuals who, due to loss of function, have impairments of ADL such as bathing, dressing, or personal care and are at risk of placement in a nursing home.
3 – frail: these individuals are characterized by a combination of significant fatigue, recent weight loss, severe restriction in mobility and strength, increased propensity to falls, and increased risk of institutionalization.
Please consider these issues when preparing or interpreting RMMR reports or education sessions. Contributions of content or suggested topics are welcome and should be sent directly to firstname.lastname@example.org