Sinclair A J, Abdelhafiz A, Dunning T, Izquierdo M, Rodriguez Manas L, Bourdel-Marchasson I, Morley J E, Munshi M, Woo J, Vellas B
Professor Alan Sinclair, Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, Medici Medical Practice, 3 Windsor Street, Luton, Bedfordshire, UK. Email:
J Frailty Aging. 2018;7(1):10-20. doi: 10.14283/jfa.2017.39.
The International Position Statement provides the opportunity to summarise all existing clinical trial and best practice evidence for older people with frailty and diabetes. It is the first document of its kind and is intended to support clinical decisions that will enhance safety in management and promote high quality care.
The Review Group sought evidence from a wide range of studies that provide sufficient confidence (in the absence of grading) for the basis of each recommendation. This was supported by a given rationale and key references for our recommendations in each section, all of which have been reviewed by leading international experts. Searches for any relevant clinical evidence were generally limited to English language citations over the previous 15 years. The following databases were examined: Embase, Medline/PubMed, Cochrane Trials Register, Cinahl, and Science Citation. Hand searching of 16 key major peer-reviewed journals was undertaken by two reviewers (AJS and AA) and these included Lancet, Diabetes, Diabetologia, Diabetes Care, British Medical Journal, New England Journal of Medicine, Journal of the American Medical Association, Journal of Frailty and Aging, Journal of the American Medical Directors Association, and Journals of Gerontology - Series A Biological Sciences and Medical Sciences.
Two scientific supporting statements have been provided that relate to the area of frailty and diabetes; this is accompanied by evidence-based decisions in 9 clinical domains. The Summary has been supported by diagrammatic figures and a table relating to the inter-relations between frailty and diabetes, a frailty assessment pathway, an exercise-based programme of intervention, a glucose-lowering algorithm with a description of available therapies.
We have provided an up to date evidence-based approach to practical decision-making for older adults with frailty and diabetes. This Summary document includes a user-friendly set of recommendations that should be considered for implementation in primary, community-based and secondary care settings.
《国际立场声明》提供了一个机会，可总结针对体弱老年人和糖尿病患者的所有现有临床试验及最佳实践证据。这是同类文件中的首份文件，旨在支持有助于提高管理安全性并促进高质量护理的临床决策。
审查小组从广泛的研究中寻找证据，这些研究为每项建议提供了足够的可信度（无分级）。各部分建议均有既定的理论依据和关键参考文献作为支撑，所有这些都经过了国际顶尖专家的审阅。对任何相关临床证据的检索一般限于过去15年的英文文献引用。审查了以下数据库：Embase、Medline/PubMed、Cochrane试验注册库、护理学与健康领域数据库（Cinahl）和科学引文索引。两名评审人员（AJS和AA）对16种主要的同行评审关键期刊进行了手工检索，这些期刊包括《柳叶刀》《糖尿病》《糖尿病学》《糖尿病护理》《英国医学杂志》《新英格兰医学杂志》《美国医学会杂志》《衰弱与衰老杂志》《美国医学主任协会杂志》以及《老年学杂志》系列A：生物科学与医学科学。
提供了两份与衰弱和糖尿病领域相关的科学支持声明；同时还伴有9个临床领域基于证据的决策。该总结有示意图以及与衰弱和糖尿病之间的相互关系、衰弱评估途径、基于运动的干预计划、降糖算法及可用疗法描述相关的表格作为支撑。
我们为体弱的老年糖尿病患者提供了一种最新的基于证据的实际决策方法。这份总结文件包含了一套便于用户使用的建议，应考虑在初级、社区和二级护理环境中实施。
