Several changes to recommended care for diabetes patients over age 65, including less use of aspirin therapy, were made in a guideline update from the American Geriatrics Society (AGS).
“The American Geriatrics Society Guidelines for Improving the Care of Older Adults with Diabetes Mellitus: 2013 Update” were based on high-quality research and developed by an expert panel of clinicians and researchers in the fields of medicine, nursing and pharmacy. An abridged version of the full guidelines was published in the Journal of the American Geriatrics Society on Nov. 12.
The update included several changes from the AGS's 2003 guideline. Aspirin is no longer recommended for the primary prevention of cardiovascular disease (CVD) in older diabetics, due to new evidence on the risk of bleeding. Daily aspirin therapy (81 mg to 325 mg) is still recommended for patients with diabetes and known CVD, however. Recommendations on using statins to treat dyslipidemia were revised to put less focus on targeting specific lipid levels.
The recommendations on glycemic control were also revised to encourage more personalization of blood glucose goals, based on patients' functional status, comorbidities and life expectancy. According to the update, hemoglobin A1c (HbA1c) targets for older adults should generally be 7% to 8%, but a lower target (7% to 7.5%) may be appropriate for healthier, more functional adults, and a higher target (8% to 9%) may be appropriate for less healthy patients with limited life expectancy. Lowering HbA1c to less than 6.5% is associated with potential harm in older adults with diabetes, the guideline update said.
The update also strengthened recommendations about lifestyle modification, calling for regular dietary counseling of all older diabetes patients and at least 150 minutes of moderate-intensity aerobic exercise per week, as well as resistance exercise, for older diabetes patients with normal cognition and functional status.
Other topics covered by the guideline update include smoking cessation, hypertension treatment, glycemic control monitoring and medications, and polypharmacy, as well as screening for foot problems, nephropathy, depression, cognitive impairment, urinary incontinence, fall risk and pain.