be MOR FEXIBLE WITH OLDER PATIENTS

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Diabetes Health Staff

Jun 4, 2011

This press release is an announcement submitted by , and was not written by

Diabetes Health.

Diabetes <http://www.diabeteshealth.com/> treatment standards for frail

older adults should be more flexible than those for younger adults, focusing

more on day-to-day quality of life and less on long-term results, according

to a geriatrician at the San Francisco VA Medical Center.

In a commentary in the April 6, 2011, issue of Journal of the American

Medical Association, Sei J. Lee, MD, said treatment plans for frail elders

should be based on degree of frailty, life expectancy, and the health

outcomes that are most important for each patient.

The long-term goal of diabetes treatment for younger patients is the

avoidance of vascular complications, including heart attack, stroke, and

kidney disease, brought about by chronically high blood glucose. High blood

glucose levels damage circulation in small blood vessels. To accomplish

this, patients are trained to monitor their blood glucose frequently during

the day and keep their level relatively low through diet, medications, and

insulin <http://www.diabeteshealth.com/browse/medications/insulin/>

injections-a regimen known as tight control.

" Although tight control makes sense for most patients, for frail older

patients it may come at too high a price, namely hypoglycemia

<http://www.diabeteshealth.com/browse/complications-and-care/low-blood-sugar

/> -dangerously low blood

<http://www.diabeteshealth.com/browse/monitoring/blood-sugar/> sugar-and

even hypoglycemic coma, " said Lee. " We should keep in mind that the

long-term vascular benefits of tight control are usually not seen in

patients for approximately eight years. Since frail older patients face

other, more immediate risks to their mortality and are unlikely to survive

this long, they are exposed to all of the risks with none of the

advantages. "

Lee, who is also an assistant adjunct professor of medicine at the

University of California, San Francisco, said that for frail elders, other

goals should take precedence, such as decreasing the immediate risks of

incontinence, deteriorating cognition, or symptomatic hyperglycemia (high

blood sugar). " Since these outcomes can be avoided with less aggressive

treatment, these are what we should focus on, with the goal of increasing

each elder's quality of life, " he said. " More research is needed to

determine the correct, evidence-based standards for glycemic control among

these patients, " said Lee.

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