Clinical guidelines for type 1 diabetes mellitus with an emphasis on older adults: an Executive Summary

Abstract

We present a summary of a guideline produced by an international group of experts for managing type 1 diabetes in adults with an emphasis on the special needs of older people with this condition. The rationale for delivering high‐quality diabetes care for adults with type 1 diabetes, why it is important to include older people in our considerations, and the key underpinning principles of the guideline are included. The structure of the recommendations given is described and consists of ‘general’ recommendations followed by ‘specific’ recommendations according to three categories depending on the characteristics of adults addressed, such as functional level or self‐management ability. Recommendations are provided in the areas of: clinical diagnosis, establishing management plans and glucose regulation, diabetes self‐management education, nutritional therapy, physical activity, exercise and lifestyle modification, insulin treatments and regimens, use of technology in diabetes management, hypoglycaemia, managing cardiovascular risk, management of microvascular risk, and inpatient management of type 1 diabetes and ketoacidosis.

Mesa 1: Diabetes mellitus tipo 1 y enfermedad cardiovascular

“…Como se expuso previamente, las guías actuales proponen que el screening y el manejo de DM1 y ECV debería ser similar al de DM2, pero en los adultos mayores habrá que incluir requisitos adicionales y estratificarlos para fijar objetivos de tratamiento según estado de dependencia, cognición, funcionalidad y capacidad de automanejo de la diabetes 11,65,113,114,115 .…”

“…Ensayos no aleatorios sugieren una reducción en la mortalidad CV 118,119,120 . Fuente: Sinclair AJ, et al 114 . FRCV: factores de riesgo cardiovascular; MCG: monitoreo continuo de glucosa; TA: tensión arterial; TG: triglicéridos; ECV: enfermedad cardiovascular.…”

The challenge of diagnosing type 1 diabetes in older adults

“…We thank Prof. Sinclair and colleagues for their helpful position statement, addressing the important clinical problem of managing type 1 diabetes in older adults [1]. We believe that future versions of these guidelines would benefit from further considerations regarding the difficult area of making a diagnosis of type 1 diabetes in older adults.…”

“…We hope that this area receives more attention in future research, allowing future guidelines to give this area more emphasis. The latest Royal College of Obstetricians and Gynaecologists guidance for diagnosis of gestational diabetes mellitus (GDM) recommends avoiding the 'gold standard' 2-h oral glucose tolerance test (OGTT) for the duration of the COVID-19 pandemic [1]. To avoid prolonged waiting in large groups the suggested alternative diagnostic pathway involves four simpler tests, in women at greater risk of developing GDM according to the National Institute for Health and Care Excellence (NICE) checklist.…”

“…A. G. Jones 1,2 , B. M. Shields 1 , J. M. Dennis 1 , A. T. Hattersley 1,2 , T. J. McDonald 1,3 and N. J.…”