In geriatric diabetes care, primary care clinicians often chose to intensify glycemic control despite individual factors that may warrant higher glycemic targets based on existing ADA guidelines. Using a vignette-based survey, 336 primary care clinicians were queried on their intended management of geriatric patients with diabetes and whether they would intensity glycemic control by adding a second-line hypoglycemia medication. Researchers found:
- Despite recommendations for HbA1c targets <8% for more complex patients, a woman aged 80 with an HbA1c of 7.5%, longstanding diabetes, coronary disease, and cognitive impairment and with instrumental activity of daily living dependencies, had a predicted probability of treatment intensification of 35%.
- Internists were 11% and nurse practitioners were 15% more likely to intensify treatment than family physicians.
- Providers in Florida were more likely to intensify treatment.
McCreedy EM, Kane RL, Gollust SE, Shippee ND, Clark KD. Patient-centered guidelines for geriatric diabetes care: Potential missed opportunities to avoid harm. J Am Board Fam Med. 2018;31(2):192-200. doi:10.3122/jabfm.2018.02.170141.
Must Reads in Clinical Guidelines
USPSTF: Interventions to Avert Perinatal Depression, JAMA; 2019 Feb 12; US Preventive Services Task Force
ACIP Updates Adult Immunization Schedule, Ann Intern Med; 2019 Feb 5; Kim, Hunter, et al
USPSTF: Interventions to Prevent Child Maltreatment, JAMA; 2018 Nov 27; US Preventive Services Task Force
Cholesterol Guidelines Stress Lifetime Approach, Circulation; ePub 2018 Nov 10; Grundy, et al
USPSTF: Screen Adults for Unhealthy Alcohol Use, JAMA; 2018 Nov 13; Curry, et al