- Reduce incidence of complications (Polypharmacy Guidance8);
- symptomatic hyperglycaemia control (avoidance of polyuria, dehydration, fatigue and renal insufficiency); and
- avoidance of osmotic symptoms and reduced symptomatic hyperglycaemia.
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The benefits of intensive treatment of T2DM should be balanced against the risk of potential hypoglycaemia and the consequence of falls, fractures and hospitalisation.
A frailty assessment should be a routine component of a diabetes review for all older adults, considering comorbidities, dementia or limited life expectancy.
A number of international guidelines on the management of diabetes in the older and/or frailer adult have been published with recommendations based on consensus opinion. The following recommendations, shown in the table below, are informed by the National Collaborative Stakeholder Initiative50 and supported by the expert working groups, for this guidance and the Polypharmacy guidance, and include the Rockwood Clinical Frailty Scale (CFS).51 The glycaemic target ranges below are consensus based, recommending therapeutic targets and treatment de-escalation thresholds, with a focus on patient safety and enhancing clinical outcomes.
See case study 5
There should be a low percentage of those aged 75 years or over prescribed sulfonylureas (SU).
This indicator continues to show that there are high levels of SU prescribing in those aged 75 years or over. Although this has reduced, current data shows that across Scotland a significant proportion of those aged 75 years or over are still being prescribed an SU, increasing their risks of hypoglycaemia and subsequent falls and hospitalization.
Other therapies are available with long term outcome data and lower risk of hypoglycaemia that may be more appropriate.