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New Guidelines Urge Individualized Care for Elderly Diabetics: Presented at AGS

By Roberta Friedman, PhD

BALTIMORE, MD -- May 16, 2002 -- New guidelines from the American Geriatrics Society (AGS) on caring for elderly diabetics stress the need to aggressively manage their elevated blood pressure or cholesterol, even if that means being more flexible with blood glucose levels.

The new AGS guidelines by the American Geriatrics Society (AGS) and the University of California at Los Angeles (UCLA) were announced here on May 15^th at the Society's 2003 Annual Scientific Meeting.

The treatment of older adults should be based on a patient's functional status, together with age and blood-sugar numbers rather than on blood-sugar numbers alone, the guidelines state. The functional status of older diabetics can vary greatly, from the patient who barely maneuvers around the house to the one who is still employed and exercises daily. Providers need to focus on maintaining quality of life.

"Care for older persons with diabetes goes beyond the issue of chronological age," said Arleen Brown, MD, PhD, assistant professor of medicine at UCLA, and a co-chair of the guideline panel. "[Some] are frailer, and they need to be treated differently."

Another particular emphasis of the guidelines is the benefit of treating hypertension and abnormal concentrations of lipids or lipoproteins in the blood, since the main causes of mortality in older diabetics are heart disease and stroke. Carol Mangione, MD, MFPH, associate professor of medicine at UCLA and a co-chair of the guideline panel, noted that glucose control can be a bit looser if it allows an older person to more aggressively manage elevated blood pressure or cholesterol. She added that, by contrast, an older diabetic with early kidney or eye damage would require tight control over glucose levels.

"Make some room for the patient [to add medications for control of serious conditions]," she said. "We know from the literature, every time you add another medication, you decrease the chance of taking the drugs correctly." On average, elderly diabetics take seven medications, which means half of them are taking more.

Most older adults with diabetes in the U.S. are treated by generalists, who may not be as familiar with checking for co-existing depression, memory problems, falls, urinary incontinence and pain, as well as juggling polypharmacy. The new guidelines include care recommendations to screen for these common geriatric syndromes.

The guidelines were funded by a grant from the California Healthcare Foundation's Program for Elders in Managed Care and an unrestricted educational grant from Aventis Pharmaceuticals.

The were published in a supplement to the May issue of the Journal of the American Geriatrics Society (May 2003; 51[5 suppl]). An executive summary of the guidelines is available at the AGS web site: www.americangeriatrics.org.

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