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Caring for an Older Person with Diabetes Mellitus

Care Recommendations

Another distinctive feature of the guidelines is the inclusion of care recommendations to screen for a number of geriatric syndromes that are more common in older adults who have diabetes. These include depression, injurious falls, urinary incontinence, persistent pain and inappropriate medication use. Evidence suggests that these syndromes may go unrecognized and untreated or undertreated in many clinical settings.

In sum, these guidelines are meant to direct providers not simply to new target numbers or timelines, but instead to an approach to the care of older adults with diabetes that focuses on individualized assessment, planning and decision-making, based on the characteristics of each patient, with the goal of improving both clinical status and quality of life.

The recommendations are divided into diabetes-related topic areas: aspirin use for cardiovascular benefit; smoking cessation; hypertension; glycemic control; lipid management; eye care; foot care; renal disease; diabetes education and lifestyle modification; and the geriatric syndromes, like depression, cognitive impairment, polypharmacy, urinary incontinence, injurious falls and persistent pain. For each section, general recommendations are made, and in some cases, these are followed by specific recommendations on such issues as medication use and monitoring.

The guidelines were developed and written under the auspices of the California Healthcare Foundation American Geriatrics Society (AGS) Panel on Improving Care of Elders with Diabetes and approved by the AGS Board of Directors on February 25, 2003, and published in the May 2003 supplement issue of the Journal of the American Geriatrics Society under the title "Guidelines for Improving the Care of the Older Person with Diabetes Mellitus."

The following organizations with special interest and expertise in the management of diabetes provided peer review of a preliminary draft of the guidelines: the American Academy of Family Physicians; the American College of Physicians; the American College of Consultant Pharmacists; the American College of Clinical Pharmacy; the Society of General Internal Medicine; the American Association of Clinical Endocrinologists; and the American Diabetes Association.