European Diabetes Working Party for Older People 2011 Clinical Guidelines for Type 2 Diabetes Mellitus. Executive Summary

Sinclair, Alan J.; Paolisso, Giuseppe; Castro, Marta; Bourdel-Marchasson, I.; Gadsby, Roger; Mañas, Leocadio Rodríguez

doi:10.1016/s1262-3636(11)70962-4

Cited by 281 publications

(210 citation statements)

References 70 publications

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“…There is compelling evidence that older onset‐diabetes has differential characteristics compared with onset in middle‐aged or earlier populations 4. On the one hand, the disease starts insidiously in people 65 years and over, and remains frequently undiagnosed until a routine analysis is performed or after the subject is admitted to a hospital for any other reason.…”

Section: Introductionmentioning

confidence: 99%

“…Although recommendations in clinical guidelines may vary per country, decision‐making should not be in general based on the age of the patient but on a combination of factors including general health status and functional and cognitive ability, among others 4, 5, 7, 8. Thus, in elderly individuals with preserved cognitive and functional abilities and a good life expectancy, the recommendation is a glycated haemoglobin goal similar to that recommended for younger adults.…”

Section: Introductionmentioning

confidence: 99%

“…Thus, in elderly individuals with preserved cognitive and functional abilities and a good life expectancy, the recommendation is a glycated haemoglobin goal similar to that recommended for younger adults. Conversely, the goal for glycaemic control in frail elderly subjects not meeting the above criteria or with greater hypoglycaemia vulnerability should be more relaxed, as the short life expectancy precludes the medium‐ and long‐term benefits resulting from very tight control goals 4, 9. Indeed, the benefits associated with glycaemic control require 5–10 years to reduce the incidence of microvascular complications 4, 10, and it is not yet certain whether it has an actual impact in the incidence of cardiovascular disease (CVD) in these patients.…”

Section: Introductionmentioning

confidence: 99%

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Older type 2 diabetic patients are more likely to achieve glycaemic and cardiovascular risk factors targets than younger patients: analysis of a primary care database

et al. 2015

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SummaryBackgroundOlder subjects with type 2 diabetes mellitus (T2DM) have differential characteristics compared with middle‐aged or younger populations, and require tailored management of the disease.AimsTo evaluate how clinical characteristics, degree of control of glycaemia and cardiovascular risk factors, presence of chronic complications and treatments differ between older T2DM patients and younger adults.MethodsCross‐sectional study using data from a population‐based electronic database. We retrieved data from 318,020 patients ≥ 30 years diagnosed with T2DM, attended during 2011 in primary care centres in Catalonia, Spain. We performed descriptive and comparative analyses stratified by gender and age subgroups: ≤ 65, 66–75, 76–85 and >85 years.ResultsBoth men and women across older age subgroups (> 65 years) had longer diabetes duration than younger adults (8.0 vs. 5.6 in men and 8.4 vs. 6.9 years in women; p < 0.001), but better glycaemic control (mean glycated haemoglobin 7.1 vs. 7.7 in men and 7.1 vs. 7.4 in women; p < 0.001), and better combined control of different cardiovascular risk factors (p < 0.001). Moreover, older patients were more likely to achieve glycaemic targets irrespective of having cardiovascular disease. The use of oral antidiabetics decreased with increasing age, and insulin in monotherapy was more frequently prescribed among patients in the older age subgroups. Diabetes‐related complications were more frequent in men of all group ages. In the older age subgroups, patients of both sexes had a longer duration of T2DM but better glycaemic control. In this context, the prevalence of diabetic retinopathy decreased unexpectedly with increasing age.ConclusionControl of glycaemia and cardiovascular risk factors was better among older T2DM patients. There is a need for prospective studies to quantify the weight of risk factors in each complication to adapt the therapeutic and care approaches in elderly people.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Older type 2 diabetic patients are more likely to achieve glycaemic and cardiovascular risk factors targets than younger patients: analysis of a primary care database

et al. 2015

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“…The European Diabetes Working Party for Older People (EDWPOP) identified frailty as a key priority area for action (2) and published a glucose-lowering algorithm for frail patients with type 2 diabetes. More recently, the international Diabetes Federation (IDF) launched global guidance on the management of diabetes in older adults and made specific recommendations on treatment in those adults who are dependent and frail who depend on others for their diabetes care (3).…”

Section: Introductionmentioning

confidence: 99%

“…The use of fasting glucose levels to guide treatment decisions is also questionable in older patients. Attempts to lower HbA1c towards 7·0% (53 mmol/mol) or less in an older cohort of patients with diabetes might seem unnecessary or even dangerous since higher target levels are now recommended (2,4,6) and more liberal targets in those who are frail are now recommended (3). Such practical issues in management are important to a clinician and those in primary care and community care settings need to be convinced of their importance, otherwise they will not be acted upon.…”

Section: Introductionmentioning

confidence: 99%

Frailty – An emerging high impact complication of diabetes requiring specific management approaches

Sinclair¹,

Vellas

2017

The Journal of nutrition, health and aging

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Polypharmacy in the Aging Patient

Bénétos

Rossignol

Cherubini

et al. 2015

JAMA

123

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IMPORTANCE Hypertension treatment is beneficial for most hypertensive patients. The benefits for patients who are very old and frail, especially those taking numerous medications, are less certain.OBJECTIVE To provide recommendations for the evaluation and treatment of hypertension among patients aged 80 years and older.EVIDENCE ACQUISITION MEDLINE, PubMed Central, and the Cochrane Database of Systematic Reviews were searched from inception through April 2015, with an emphasis on 2010-2015. Manual cross-referencing of review articles and meta-analyses was also performed to identify randomized controlled trials (RCTs) examining antihypertensive use in octogenarians. The search strategy included the following Medical Subject Headings: hypertension or high blood pressure and trials and oldest old or very old or very elderly.FINDINGS Six post hoc analyses of the previously published Hypertension in the Very Elderly Trial (HYVET) met the inclusion criteria. In the only placebo-controlled RCT on hypertension management in patients older than 80 years (HYVET; N = 3845), the treatment was associated with lower total mortality and key cardiovascular end points but the effect on stroke (fatal and nonfatal), which was the primary outcome, failed to reach the significance level (P = .06). Post hoc analyses of HYVET suggested that active hypertension treatment in very elderly patients was beneficial by reducing blood pressure in individuals with white coat hypertension, showed moderate benefits of the active treatment for cognition, a possible effect for fractures prevention, and sustained differences in reductions of total mortality and cardiovascular mortality in those receiving active treatment. However, patients were community dwelling and less disabled than individuals of the same age in general. CONCLUSIONS AND RELEVANCEHypertensive patients who are healthy, functionally independent, and aged 80 years and older should be treated according to current recommendations for people older than 65 years. There is insufficient evidence regarding the benefits of hypertension treatment for frail polymedicated octogenarians, for whom treatment should be individualized.

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European Diabetes Working Party for Older People 2011 Clinical Guidelines for Type 2 Diabetes Mellitus. Executive Summary

Cited by 281 publications

References 70 publications

Older type 2 diabetic patients are more likely to achieve glycaemic and cardiovascular risk factors targets than younger patients: analysis of a primary care database

Older type 2 diabetic patients are more likely to achieve glycaemic and cardiovascular risk factors targets than younger patients: analysis of a primary care database

Frailty – An emerging high impact complication of diabetes requiring specific management approaches

Polypharmacy in the Aging Patient

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