Systematic review of guideline recommendations for older and frail adults with type 2 diabetes mellitus

IF 6 2区 医学 Q1 GERIATRICS & GERONTOLOGY
Jennifer Bolt, Valeria Carvalho, Kristine Lin, Sung Ju Lee, Colleen Inglis
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Abstract

Background The application of clinical practice guidelines (CPGs) across the spectrum of individuals living with diabetes can be challenging, particularly in older adults, where factors such as frailty and multimorbidity exacerbate the complexity of management. Objective This systematic review aimed to explore the guidance provided within diabetes CPGs for management of individuals who are older and/or frail, including recommendations for haemoglobin A1C (HbA1c) target and pharmacotherapeutic management. Methods A systematic search was completed in Medline and Embase to identify national or international type 2 diabetes CPGs published in the last 10 years. Data extracted included recommendations for HbA1c targets and pharmacotherapy in older and frail adults, frailty screening and deprescribing. Quality of included CPGs was appraised with the AGREE II tool. Results Twenty-three CPGs were included, within which older adults and frailty were discussed in 21 and 14 CPGs, respectively. Specific HbA1c targets for older and/or frail adults were provided by 15 CPGs, the majority of which suggested a strict target (<7.0%–7.5%) in healthier older adults and a more relaxed target (<8.0%–8.5%) in those who are frail or medically complex. Ten CPGs provided recommendations for insulin therapy and 16 provided recommendations for non-insulin antihyperglycaemic agents that were specific to older and/or frail populations, which primarily focused on minimising risk of hypoglycaemia. Conclusion Most diabetes CPGs recommend strict HbA1c targets in healthier older adults, with more relaxed targets in those living with frailty or medical complexity. However, significant variability exists in pharmacotherapy recommendations and there were proportionately less recommendations for individuals who are frail.
针对患有 2 型糖尿病的年老体弱成人的指南建议的系统性审查
背景 临床实践指南(CPG)在糖尿病患者中的应用具有挑战性,尤其是在老年人中,虚弱和多病等因素加剧了管理的复杂性。目的 本系统性综述旨在探讨糖尿病 CPG 为老年和/或体弱患者的管理提供的指导,包括对血红蛋白 A1C (HbA1c) 目标值和药物治疗管理的建议。方法 在 Medline 和 Embase 中进行系统检索,以确定过去 10 年中发表的国内或国际 2 型糖尿病 CPG。提取的数据包括针对老年和体弱成人的 HbA1c 目标和药物治疗、体弱筛查和去处方化的建议。采用 AGREE II 工具对纳入的 CPGs 进行质量评估。结果 共纳入 23 份 CPG,其中分别有 21 份和 14 份 CPG 讨论了老年人和体弱问题。15 份 CPG 为老年人和/或体弱者提供了具体的 HbA1c 目标,其中大多数建议为健康的老年人设定严格的目标(<7.0%-7.5%),为体弱者或病情复杂者设定较为宽松的目标(<8.0%-8.5%)。10 份 CPG 提供了胰岛素治疗建议,16 份 CPG 提供了非胰岛素降糖药物建议,这些建议专门针对老年人和/或体弱人群,主要侧重于最大限度地降低低血糖风险。结论 大多数糖尿病 CPG 建议为健康的老年人设定严格的 HbA1c 目标,而为体弱或病情复杂的老年人设定较为宽松的目标。然而,药物治疗建议存在很大差异,针对体弱者的建议比例较低。
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来源期刊
Age and ageing
Age and ageing 医学-老年医学
CiteScore
9.20
自引率
6.00%
发文量
796
审稿时长
4-8 weeks
期刊介绍: Age and Ageing is an international journal publishing refereed original articles and commissioned reviews on geriatric medicine and gerontology. Its range includes research on ageing and clinical, epidemiological, and psychological aspects of later life.
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