An Update to Diabetes Guidelines

Diabetes is a condition that continues to plague modern society. Recent estimates indicate that as many as 100 million people have diabetes and roughly 84 million adults in the US (~1 in 3 U.S. adults) have prediabetes. ^[1]

The Endocrine Society recently held its annual meeting in New Orleans, LA. As part of the proceedings, the organization set forth a new set of guidelines to address the diverse array of issues commensurate with managing such as massive population with the chronic disease. ^[2]

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The new set of guidelines were cosponsored by the Obesity Society, the European Society of Endocrinology, and the Gerontological Society of America.

Inside the New Diabetes Guidelines

The document, titled “Treatment of Diabetes in Older Adults Guideline Resources” specifically addresses adults 65 years or older with diabetes and covers a myriad of issues involved in the diagnosis, monitoring, treatment, and care for those with the disease, including:

• Prevention
• Screening
• Blood pressure
• Lipid profile
• Blood sugar management
• Comorbidities (e.g. obesity, sarcopenia, cognitive dysfunction, renal disease)
• Complications
• Special situations (type 1 diabetes, long-term care facilities, hospitalization)

The new set of guidelines put forth by the Endocrine Society includes much of the same information as the 2012 American Diabetes Association/American Geriatrics Society (ADA/AGS) guidelines. ^[3]

However, one area that received increased attention was the use of drugs that may lead to low blood sugar (hypoglycemia). Commonly prescribed medications that can induce a state of hypoglycemia include sulfonylureas, glinides, and insulin.

The reason for the renewed focus on hypoglycemic drugs was explained by coauthor of the guidelines Mark E. Molitch, MD, who said:

“A 70 year old who has hypoglycemia and falls on the floor can fracture a hip, so we have to be very careful about avoiding hypoglycemia. Similarly, for blood pressure we don't want to be too aggressive because that can lead to falls. All of these things play a role in how to adjust medications for these patients."

The new guidelines were not without its detractors though.

Medha Munshi, MD, director of the Joslin Geriatric Diabetes Programs and coauthor of the 2012 ADS/AGS guidelines expressed concern of the document’s combining of both type 1 and type 2 diabetics as well as the overview of long-term care facilities.

In an interview with Medscape Medical News, Dr. Munshi remarked:

“Hospitals and long-term care facilities are very different environments, with very different management goals. In the ADA statement, I explained why they don't belong together, but the Endocrine Society has again lumped them together..."

"With type 1 diabetes, much is expert opinion as there is not a lot of data. The lack of understanding about how different insulins work and how to manage diabetes generally in the type 2 population is difficult enough, and then you put in a type 1 patient...We need to write something about type 1 diabetes in long-term care." ^[4]

Overall, Dr. Munshi felt that the core concepts of both the 2012 guidelines and new recommendations from the Endocrine Society are more similar than different and help expand the understanding of the complexity involved in treating elderly diabetics.

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