Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Guidelines for Geriatric Diabetes Care

J Am Board Fam Med; 2018 Mar-Apr; McCreedy, et al

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.

Citation:

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.

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