Diabetes in older people: position statement of The Hong Kong Geriatrics Society and the Hong Kong Society of Endocrinology, Metabolism and Reproduction

Cw, Wong; Lee, Jenny Sw; Tam, KF; Hung, HF; So, Winnie K.W.; Shum, Chun Keung; Lam, CY; Cheng, JN; Man, SP; Auyeung, TW

doi:10.12809/hkmj166140

Cited by 7 publications

(9 citation statements)

References 43 publications

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“…In this vulnerable group of older people, this level of glycemic control may be considered optimal because of the risk of hypoglycemia. 20,21 The incidence of self-reported hypoglycemia was low in the trial participants and no significant group difference was found. However, regular glucose monitoring would have been required to detect hypoglycemia more reliably.…”

Section: Discussionmentioning

confidence: 87%

Randomized trial of a patient empowerment and cognitive training program for older people with diabetes mellitus and cognitive impairment

Wong

Wong³

et al. 2020

Geriatrics Gerontology Int

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Aim To evaluate the effectiveness of a combined patient empowerment program (PEP) and cognitive training (CT) program on improving glycemic control among older subjects with diabetes and cognitive impairment. Methods A prospective single blinded, randomized controlled study was carried out in 139 older patients with diabetes aged ≥65 years with memory complaints and recent glycosylated hemoglobin level of 7–9%. They were randomly assigned to either undergo once‐weekly PEP combined with CT for 10 weeks (intervention group, N = 73) or receive no intervention (control group, N = 66). All participants were followed up at months 4 and 12 to examine the immediate and long‐term effects on glycemic control, cognition, mood and compliance to drug and diabetes self‐management. Results The intervention did not significantly reduce glycosylated hemoglobin. The intervention group showed significant progressive improvement in memory over 1 year and executive function improved significantly at month 12. There was no significant change in diabetes self‐management activities with the intervention. Conclusions Combination of PEP and CT did not improve glycemic control or self‐care activities in older patients with diabetes and memory complaints but was effective in improving cognitive function in the longer term. Geriatr Gerontol Int 2020; 20: 1164–1170.

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Section: Discussionmentioning

confidence: 87%

Randomized trial of a patient empowerment and cognitive training program for older people with diabetes mellitus and cognitive impairment

Wong

Wong³

et al. 2020

Geriatrics Gerontology Int

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“…On the contrary, a randomized trial found no association between intensive glycemic control and fall, and another large cohort study found that tight glycemic control (HbA1c 6.5-6.9%) was associated with lower risk of fracture in the elderly [22,23]. Local and foreign consensus generally agreed that glycemic control should be less aggressive for the elderly, but the suggested target goal for HbA1c ranged widely, from 6.5% to 9% [24][25][26][27][28]. For example, a positional statement of Hong Kong suggested that the HbA1c goal can be similar to general adults in the robust elderly as long as there is no excessive hypoglycemia [28].…”

Section: Diabetes and Fallmentioning

confidence: 99%

The association of glycemic control and fall risk in diabetic elderly: a cross-sectional study in Hong Kong

Cheng

Leung

2022

BMC Prim. Care

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Background Many foreign studies investigated glycemic control and fall risk. However, there was insufficient study on this topic in Hong Kong. This study aims to find out the association of glycemic control and fall risk in the diabetic elderly in a general outpatient clinic in the North District of Hong Kong. Their frequency of falls and other associated risk factors of fall were also studied. Methods A cross-sectional questionnaire survey was conducted on 442 diabetic patients aged 65 years-old or above with regular follow-up in a general outpatient clinic. Main outcome measure was the number of falls in the past one year from the interview date. Recurrent falls was defined as two or more falls in the past one year from the interview date. Subjects were asked about experience of hypoglycemic symptoms. HbA1c level, chronic illness, retinopathy etc. were obtained through computerized medical record review. Chi square test and logistic regression were used to assess the association between outcomes and the explanatory variables. Results In the past one year, 23.3% participants experienced at least one fall and 8.6% had recurrent falls. Hypoglycemic symptoms, and lower visual acuity < 0.6 were significantly associated with fall (OR 2.42, p = 0.007 and OR 1.75, p = 0.038 respectively). Age 75–79 years-old had a higher likelihood of fall than the 65–69 age group (OR 2.23, p = 0.044). Patients with HbA1c 7.0–7.4% had a lower risk of recurrent falls when compared to those with intensive control (OR 0.32, p = 0.044). Other risk factors that increased risk of recurrent falls were hypoglycemic symptoms (OR 6.64, p < 0.001) and history of cerebral vascular accident (OR 4.24, p = 0.003). Conclusions Hypoglycemic symptoms had a very strong association with falls. Less stringent HbA1c control reduced the risk of recurrent falls. Healthcare professionals need to take a more proactive approach in enquiring about hypoglycemia. There should be individualized diabetic treatment target for the diabetic elderly.

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“…17,18 In a Hong Kong consensus statement about glycaemic control, the target Hba1c can vary from as stringent as a common adult Hba1c level of 8.5% for a very frail older adult, and even as liberal as with no specified target when close to end of life. 19 (2) Advance care planning at end of life: Individualised care planning is recognised in hospice for cancer patients whose needs are diversified owing to physical, functional, cultural, religious, and spiritual belief differences. Terminal cancer stage is not equivalent to advanced frailty.…”

Section: Clinical Application Of Frailty Assessmentmentioning

confidence: 99%

Life-course trajectory of frailty and its clinical applications: a narrative review

Auyeung

Lee

2021

Asian Journal of Gerontology and Geriatrics

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Frailty is a condition indicating a reduced reserve in multiple systems and their disconnections. The whole body system cannot repair or recover by itself and may go into irreversible decline should interventions not be carried out early. This review discusses frailty in terms of the conceptual framework, pathophysiology, measurement and identification, lifecourse trajectory, and clinical application of assessment. It is anticipated that clinical application of the electronic frailty index expands to various specialties beyond geriatric medicine.

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Diabetes in older people: position statement of The Hong Kong Geriatrics Society and the Hong Kong Society of Endocrinology, Metabolism and Reproduction

Cited by 7 publications

References 43 publications

Randomized trial of a patient empowerment and cognitive training program for older people with diabetes mellitus and cognitive impairment

Randomized trial of a patient empowerment and cognitive training program for older people with diabetes mellitus and cognitive impairment

The association of glycemic control and fall risk in diabetic elderly: a cross-sectional study in Hong Kong

Life-course trajectory of frailty and its clinical applications: a narrative review

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