Factors influencing safe glucose-lowering in older adults with type 2 diabetes: A PeRsOn-centred ApproaCh To IndiVidualisEd (PROACTIVE) Glycemic Goals for older people: A position statement of Primary Care Diabetes Europe.

Diabetes in later life is associated with a range of factors increasing the complexity of glycaemic management. This position statement, developed from an extensive literature review of the subject area, represents a consensus opinion of primary care clinicians and diabetes specialists. It highlights many challenges facing older people living with type 2 diabetes and aims to support primary care clinicians in advocating a comprehensive, holistic approach. It emphasises the importance of the wishes of the individual and their carers when determining glycaemic goals, as well as the need to balance intended benefits of treatment against the risk of adverse treatment effects. Its ultimate aim is to promote consistent high-quality care for older people with diabetes.

Older people with Type 2 diabetes, including those with chronic kidney disease or dementia, are commonly overtreated with sulfonylurea or insulin therapies.

AIM: To evaluate potential overtreatment with sulfonylurea and insulin therapies amongst older people with Type 2 diabetes, including those with chronic kidney disease or dementia. METHODS: Using the ECLIPSE Live software tool, we developed a search to examine data on older people (age ≥ 70 years) with Type 2 diabetes, who were prescribed sulfonylurea or insulin therapies over the previous 90 days. Sixteen Norfolk general practices participated, representing a population of 24 661 older people, including 3862 (15.7%) with Type 2 diabetes. Of these, 1379 (35.7%) people were prescribed sulfonylurea or insulin therapies. Data extracted included age, sex, last recorded HbA1c value, renal function and dementia codes. RESULTS: The median age of the study cohort was 78 years. A total of 644 people (47.8%) had chronic kidney disease (estimated GFR < 60 mL/min/1.73m2 ) and 60 people (4.35%) had dementia. The median (interquartile range) HbA1c concentration for the entire cohort was 58 (51-69) mmol/mol [7.5 (6.8-8.5)%], with no difference in median HbA1c between those with or without either chronic kidney disease or dementia. In total, 400 older people (29.9%) had an HbA1c concentration < 53 mmol/mol (7%), of whom 162 (12.1%) had HbA1c < 48 mmol/mol (6.5%). Stratified by prescription for sulfonylurea, insulin or combined insulin and sulfonylurea therapies, 282 (35.2%), 93 (24.2%) and 25 people (16.3%), respectively, had HbA1c < 53 mmol/mol (7.0%). Treatment to an HbA1c target of < 53 mmol/mol (7.0%) was as prevalent in those with chronic kidney disease or dementia as in those without. CONCLUSION: In the present cohort of older people with Type 2 diabetes prescribed sulfonylurea or insulin therapies, overtreatment was common, even in the presence of comorbidities known to increase hypoglycaemia risk.

The nutritional status of patients receiving home enteral feeding.

19 patients receiving home enteral nutrition (HEN) were nutritionally assessed, using anthropometry and blood analysis. Blood was taken for measurement of serum albumin, magnesium, zinc, copper, selenium and vitamins A and E. 8 patients had anthropometric evidence of protein and energy depletion, of whom 6 were severely depleted. 15 patients had biochemical evidence of trace element or vitamin depletion of whom 6 had multiple (>/= 3) depletion. Depletion occurred in all diagnostic categories, even in patients with normal anthropometric measurements, and was independent of duration, volume or method of feeding. We conclude that patients receiving HEN may be at risk of protein energy malnutrition and of developing vitamin or trace element deficiency states regardless of diagnosis, anthropometric measurements or duration of feeding. Therefore close nutritional monitoring of such patients is essential, and it is recommended that patients on HEN are supervised by clinicians with an appropriate interest.