Interior Health Authority-Pharmacy Services, Kelowna Community Health & Services Centre, 505 Doyle Ave, Kelowna, British Columbia V1Y 6V8, Canada.
Faculty of Pharmaceutical Sciences, The University of British Columbia-Vancouver Campus, Vancouver, British Columbia V6T 1Z4, Canada.
Age Ageing. 2024 Nov 1;53(11). doi: 10.1093/ageing/afae259.
The application of clinical practice guidelines (CPGs) across the spectrum of individuals living with diabetes can be challenging, particularly in older adults, where factors such as frailty and multimorbidity exacerbate the complexity of management.
This systematic review aimed to explore the guidance provided within diabetes CPGs for management of individuals who are older and/or frail, including recommendations for haemoglobin A1C (HbA1c) target and pharmacotherapeutic management.
A systematic search was completed in Medline and Embase to identify national or international type 2 diabetes CPGs published in the last 10 years. Data extracted included recommendations for HbA1c targets and pharmacotherapy in older and frail adults, frailty screening and deprescribing. Quality of included CPGs was appraised with the AGREE II tool.
Twenty-three CPGs were included, within which older adults and frailty were discussed in 21 and 14 CPGs, respectively. Specific HbA1c targets for older and/or frail adults were provided by 15 CPGs, the majority of which suggested a strict target (<7.0%-7.5%) in healthier older adults and a more relaxed target (<8.0%-8.5%) in those who are frail or medically complex. Ten CPGs provided recommendations for insulin therapy and 16 provided recommendations for non-insulin antihyperglycaemic agents that were specific to older and/or frail populations, which primarily focused on minimising risk of hypoglycaemia.
Most diabetes CPGs recommend strict HbA1c targets in healthier older adults, with more relaxed targets in those living with frailty or medical complexity. However, significant variability exists in pharmacotherapy recommendations and there were proportionately less recommendations for individuals who are frail.
临床实践指南（CPGs）在糖尿病患者中的应用可能具有挑战性，尤其是在老年人中，衰弱和多种合并症等因素使管理更加复杂。
本系统评价旨在探讨糖尿病 CPG 中针对年龄较大和/或衰弱的个体的管理指南，包括血红蛋白 A1C（HbA1c）目标和药物治疗管理的建议。
在 Medline 和 Embase 中进行了系统搜索，以确定过去 10 年发布的针对 2 型糖尿病的国家或国际 CPG。提取的数据包括针对老年和衰弱成年人的 HbA1c 目标和药物治疗、衰弱筛查和停药的建议。使用 AGREE II 工具评估纳入 CPG 的质量。
纳入了 23 项 CPG，其中 21 项 CPG 讨论了老年患者，14 项 CPG 讨论了衰弱问题。15 项 CPG 为老年和/或衰弱成年人提供了特定的 HbA1c 目标，其中大多数建议健康状况较好的老年人采用严格的目标（<7.0%-7.5%），而身体虚弱或病情复杂的患者采用更宽松的目标（<8.0%-8.5%）。10 项 CPG 提供了针对胰岛素治疗的建议，16 项 CPG 提供了针对特定于老年和/或衰弱人群的非胰岛素抗高血糖药物的建议，这些建议主要侧重于降低低血糖风险。
大多数糖尿病 CPG 建议健康状况较好的老年人采用严格的 HbA1c 目标，而身体虚弱或有合并症的患者采用更宽松的目标。然而，药物治疗建议存在很大的差异，而且针对身体虚弱患者的建议相对较少。
