AGS Diabetes Management Toolkit
Gerardo Moreno MD, MSHS and Carol M. Mangione MD, MSPH
University of California Los Angeles
Opening commentary
This year, The American Geriatrics Society (AGS) undertook the important task of launching this Diabetes Online Management Tool to empower healthcare providers with resources to enhance medical decision making to effectively manage diabetes mellitus (DM) in older adults. An important component of this online resource is an incremental update of the evidence base of the care for the older person with DM. It has been almost ten years since the California Health Care Foundation/AGS Panel published one of the first patient-centered clinical guidelines to assist clinicians with the complex care of the older person with DM. The goal of the original guideline was to improve the care of older persons with DM by providing a set of evidence-based recommendations individualized to persons with DM who are aged 65 and older.
Care for older persons with diabetes is complex and heterogeneous because of the risk of geriatric syndromes, variation in health status, and personal choices related health care. Since the publication in 2003 of the Guidelines for Improving the Care of the Older Person with Diabetes Mellitus, there have been important randomized controlled clinical trials that are critical to the management of DM. New evidence indicates that the conventional belief for tighter control of glycemia and blood pressure does not apply well to frail, older persons with DM. This new information makes it critically important for clinicians to tailor management goals. To assist with this effort the updated recommendations will be grouped under the following DM components of care: glucose control, blood pressure, lipids, and aspirin.
An important resource included in this toolkit for healthcare providers are evidence tables used to update the 2003 guidelines. We reviewed the peer-reviewed literature (2002-2012) and guidelines on each DM topic. We searched the medical literature for relevant studies published in the peer reviewed literature and limited this search to the English language literature. We reviewed randomized controlled clinical trials and systematic reviews or meta-analyses for aspirin use, glycemic control, hypertension management, lipid management, lifestyle modifications, and depression. Existing published clinical guidelines from all relevant societies, the Cochrane Collaboration, Canadian Hypertension Education Program, and the Adult Treatment Panel III report from the National Cholesterol Education Program were also carefully reviewed. The new evidence tables in this AGS toolkit were then constructed to summarize recent studies for each DM topic and provide an updated overview of some of the most important aspects of care that either differ significantly or deserve special emphasis in comparison to the care provided to younger persons with diabetes.
The launching of the online toolkit and the incremental update of the Guidelines for Improving the Care of the Older Person with Diabetes Mellitus are important initiatives in geriatrics that virtually impacts all clinicians who care for older adults. Like other AGS clinical decision support tools and the original 2003 guidelines, the updated Guidelines for Improving the Care of the Older Person with Diabetes Mellitus will continue to assist clinicians with tailoring diabetes care to the needs of individual persons with diabetes but not as a substitute for clinical judgment. We expect the updated guideline to be released in early 2013.
