Improving Care in Older Patients with Diabetes: A Focus on Glycemic Control

Lee, Eric A; Gibbs, Nancy E; Martin, John P.; Ziel, F H; Polzin, Jennifer K.; Palmer-Toy, Darryl E.

doi:10.7812/tpp/15-080

Cited by 6 publications

(3 citation statements)

References 27 publications

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“…[20] HbA1c, or the glycosylated glycated hemoglobin is a reflection of the blood glucose levels over the past 6 to 8 weeks, whereas higher HbA1c levels might indicate the poor glycemic control which usually accompanied with type 1 or type 2 diabetes. [212223] In the current study, HbA1C% were measured at the time of HHC visit with mean value of 8.31 ± 1.75, we found that for the patients over 60 years, 69 (44%) could reach the treatment goal of HbA1C <7.5% in addition to 23 (15%) could reach the goal of 7.5--8% and only 51 (32%) of the cases did not reach the glycemic target with HbA1C >8%. HbA1C values were statistically tested against the diabetes duration and time of diagnosis to result in overall 101 (64%) of study population reached the glycemic goals versus 51 (32%) of HbA1C >8%.…”

Section: Discussionmentioning

confidence: 48%

Prevalence of type 2 diabetes and their complications among home health care patients at Al-Kharj military industries corporation hospital

Albarakat¹,

Guzu²

2019

J Family Med Prim Care

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Introduction:The diabetes mellitus type 2 is a result of hyperglycemia due to insulin resistance caused by insufficient secretion of insulin from the beta cells of pancreas. The detection and controlling of diabetes mellitus type 2 (DMT2) at primary health-care centers in Saudi Arabia is well justified and widely practiced. The knowledge and awareness of DMT2 patients should be increased through the determination of its prevalence which may decrease the rates of comorbidities.Methods:A questionnaire of 159 patients registered at Home Care Center at Family and Community Medicine Department, Al-Kharj Military Industries Corporation Hospital, Saudi Arabia was used. Hemoglobin A1C (HbA1C) percentage and blood pressure were measured for all participants. Statistical analysis was performed for all data.Results:A total of 36.5% of cases were males and 63.5% were females with a mean age of 77.6 years. 94.3% of participants had DMT2 where 3.8% had type 1. 74.2% of cases experienced only one to two complications other than diabetes where 20.8% had more than three diseases. 47.2% of cases had HbA1C% <7.5% where 29 cases had HbA1C% ranged from 7.5% to 8% and about 32.8% of patients had poor glycemic control with HbA1C >8%. 81.1% of cases had hypertension, while 25.8% suffered from Stroke complication, 8.8% of patients had a congestive cardiac failure, 7.5% had ischemic heart disease, and 6.3% suffered from chronic kidney disease. The treatment goals, HbA1C 7.5--8%, have been achieved for about 64% of DMT2 patients where 51 patients still had uncontrolled DMT2 with HbA1C >8%.Conclusion:Despite the majority of cases had good glycemic control, more attention should be paid to those over 65 years as they commonly had more morbidities that definitely affect their treatment regimes. Patients should be involved in different home health care programs to increase their awareness and knowledge of the possible risk factors and diabetes comorbidities.

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Section: Discussionmentioning

confidence: 48%

Prevalence of type 2 diabetes and their complications among home health care patients at Al-Kharj military industries corporation hospital

Albarakat¹,

Guzu²

2019

J Family Med Prim Care

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“…In January of 2016, the laboratory system implemented a change in the range of HbA1c values that were flagged as high. Starting in 2016, HbA1c therapeutic targets were relaxed to <7.5 percent for patients age 65 to 75, and to <8.0 percent for patients age 76 and above [24]. This change was based on the hypothesis that more stringent therapeutic targets may result in overly intensive management of glucose in older diabetic patients.…”

Section: Introductionmentioning

confidence: 99%

Age-Dependent Hemoglobin A1c Therapeutic Targets Reduce Diabetic Medication Changes in the Elderly

McCormick

Adams

Lee³

et al. 2019

eGEMs

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Objective: To assess whether implementation of age-dependent therapeutic targets for high hemoglobin A1c (HbA1c) changed clinicians’ ordering of diabetes medications for older adults. Background: In 2016, Kaiser Permanente Southern California (KPSC) changed the therapeutic targets for alerting clinicians about high HbA1c results in the electronic health record, KP HealthConnect (KPHC). Previously, all HbA1c results ≥7.0 percent were flagged as high in adult patients with diabetes. Starting in 2016, HbA1c therapeutic targets were relaxed to <7.5 percent for patients age 65 to 75, and to <8.0 percent for patients over age 75 to reduce treatment intensity and adverse events. Methods: This retrospective analysis used logistic regression models to calculate the change in odds of a medication change following an HbA1c result after age-dependent HbA1c flags were introduced. Results: The odds of medication change decreased among patients whose HbA1c targets were relaxed: Odds Ratio (OR) 0.72 (95 percent CI 0.67–0.76) for patients age 65–75 and HbA1c 7.0 percent–7.5 percent; OR 0.72 (95 percent CI 0.65–0.80) for patients over age 75 and HbA1c 7.0 percent–7.5 percent; and OR 0.67 (95 percent CI 0.61–0.75) for patients over age 75 and HbA1c 7.5 percent–8.0 percent. In the age and HbA1c ranges for which the alerts did not change, the odds of medication change generally increased or stayed the same. There was little evidence of medication de-intensification in any group. Conclusions: These findings suggest that the change in therapeutic targets was associated with a reduction in medication intensification among older adults with diabetes.

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“…In the literature, it is observed that the geriatric population is more susceptible to micro and macrovascular complications due to a decrease in physiological reserve capacity, which leads to functional decline 4 . In addition, older adults aged 75 years or over are at an increased risk for death due to hyperglycemic events, as well as hospital readmissions due to hypoglycemic episodes, compared to younger age groups 5 .…”

Section: Introductionmentioning

confidence: 99%

Self-care competence in the administration of insulin in older people aged 70 or over

Silva¹,

Nascimento

Soares

2017

Rev. Latino-Am. Enfermagem

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Objective:to analyze the self-care competence in the administration of insulin performed by older people aged 70 or over. Method:cross-sectional study carried out with 148 older people aged 70 or over, who performed self-administration of insulin. Data collection was carried out using a structured questionnaire and an adapted guide for the application of the Scale to Identify Self-Care Competence of Patients with Diabetes, at the participants’ home. Data analysis included descriptive and inferential statistical tests, with forward logistic regression. Results:the prevalence of self-care competence in the administration of insulin was 35.1%. Handwashing error was the most frequent in self-administration of insulin. Self-care competence was negatively associated with retirees and positively associated with senior patients who performed capillary blood glucose monitoring and skin pinching during insulin application. Conclusion:there was low self-care competence and it was associated with both the sociodemographic and the clinical characteristics with regard to self-application of insulin by the older people.

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Improving Care in Older Patients with Diabetes: A Focus on Glycemic Control

Cited by 6 publications

References 27 publications

Prevalence of type 2 diabetes and their complications among home health care patients at Al-Kharj military industries corporation hospital

Prevalence of type 2 diabetes and their complications among home health care patients at Al-Kharj military industries corporation hospital

Age-Dependent Hemoglobin A1c Therapeutic Targets Reduce Diabetic Medication Changes in the Elderly

Self-care competence in the administration of insulin in older people aged 70 or over

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