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Insights Into the Current Management of Older Adults With Type 2 Diabetes in the Ontario Primary Care Setting.

Abstract：

OBJECTIVE:The Goal Oriented controL of Diabetes in the Elderly populatioN (GOLDEN) Program assessed the management of older persons with type 2 diabetes in Canadian primary care. METHODS:Data were extracted from the records of 833 consecutively identified persons 65 years of age or older who had type 2 diabetes and were taking 1 antihyperglycemic agent or more; they were managed by 64 physicians from 36 Ontario clinics. RESULTS:More than half (53%) had glycated hemoglobin (A1C) levels of 7.0% or lower, 41% had blood pressure levels below 130/80 mm Hg, and 73% had low-density lipoprotein levels of 2.0 mmol/L or lower; 19% met all 3 criteria. Over the past year, 11% had been assessed for frailty, 16% for cognitive dysfunction and 19% for depression; 88% were referred for eye checkups, and 83% had undergone foot examinations. One-tenth were taking 4 or more antihyperglycemic agents, 87% statins and 52% an angiotensin-converting enzyme inhibitor. More than half of those with high clinical complexity had A1C levels of 7.0% or lower; of these, one-third were taking a sulfonylurea, and one-fifth were taking insulin. In the patients with A1C levels of 7.0% or above and low clinical complexity, there was often no up-titration or initiation of additional antihyperglycemic agents. CONCLUSIONS:Older persons with type 2 diabetes often have multiple comorbidities. Unlike eye and foot examinations, there was less emphasis on evaluating for frailty, cognitive dysfunction and depression. The GOLDEN patients had generally well-controlled glycemic, blood pressure and cholesterol profiles, but whether these would be reflected in a "sicker" population is not known. Personalized strategies are necessary to avoid undertreatment of "healthy" older patients and overtreatment of the frail elderly.

journal_name

Can J Diabetes

journal_title

Canadian journal of diabetes

authors

Meneilly GS,Berard LD,Cheng AYY,Lin PJ,MacCallum L,Tsuyuki RT,Yale JF,Nasseri N,Richard JF,Goldin L,Langer A,Tan MK,Leiter LA

doi

10.1016/j.jcjd.2017.03.003

subject

Has Abstract

pub_date

2018-02-01 00:00:00

pages

23-30

issue

eissn

1499-2671

issn

2352-3840

pii

S1499-2671(16)30814-0

journal_volume

pub_type

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Insights Into the Current Management of Older Adults With Type 2 Diabetes in the Ontario Primary Care Setting.