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New guideline for diabetes in older adults emphasizes simpler diabetes regimens, looser glycemic targets

NEW ORLEANS — A new guideline from the Endocrine Society released at the group’s annual meeting highlights simpler diabetes regimens and looser glycemic targets among patients 65 years of age and older with diabetes.

These patients should be screened regularly for prediabetes and diabetes and cognitive disorders upon entering a care program. Cognitive screening should be repeated every 2 to 3 years following a normal screening test result, according to the guidelines.

In addition, patients diagnosed with diabetes — except for those who have diabetes in addition to impaired kidney function or gastrointestinal intolerance — should be treated with metformin. Other oral treatments and injectable agents should only be considered when glycemic targets cannot be reached. Also, BP targets for most patients aged 65 to 85 years should be 140 mm Hg/90 mm Hg.

The guidelines’ authors also noted that especially among older patients with a history of cognitive impairment, such as dementia, medication regimens be simplified and glycemic targets tailored so they are more lenient. In addition, designing outpatient diabetes regimens to specifically minimize hypoglycemia and personalizing glycemic targets to overall health and management strategies may be beneficial. The goal is to improve compliance and prevent complications related to treatment.

The guideline’s authors said clinicians must recognize a treatment strategy that works for one patient, may not work for all.

“Given the heterogeneity of the health status of older people with diabetes, the guideline emphasizes shared decision-making and provides a framework to assist health care providers to individualize treatment goals,” Derek LeRoith, MD, PhD, professor of medicine at Icahn School of Medicine at Mount Sinai, said during a presentation at ENDO 2019.

For more of Healio’s coverage of this guideline, click here. – by Janel Miller and Katie Kalvaitis

References:

LeRoith D, et al. Treatment of diabetes in older adults: An Endocrine Society Clinical Practice Guideline. Presented at: The Endocrine Society Annual Meeting; March 23-26, 2019; New Orleans.

LeRoith D, et al. J Clin Endocrinol Metab. 2019;doi:10.1210/jc.2019-00198.

Disclosures: LeRoith reports being a consultant for AstraZeneca and MannKind, and is on an advisory board for AstraZeneca.