Diabetes in ageing: pathways for developing the evidence base for clinical guidance

Medha N Munshi; Graydon S Meneilly; Leocadio Rodríguez-Mañas; Kelly L Close; Paul R Conlin; Tali Cukierman-Yaffe; Angus Forbes; Om P Ganda; C Ronald Kahn; Elbert Huang; Lori M Laffel; Christine G Lee; Sei Lee; David M Nathan; Naushira Pandya; Richard Pratley; Robert Gabbay; Alan J Sinclair

doi:10.1016/S2213-8587(20)30230-8

Diabetes in ageing: pathways for developing the evidence base for clinical guidance

Lancet Diabetes Endocrinol. 2020 Oct;8(10):855-867. doi: 10.1016/S2213-8587(20)30230-8.

Authors

Medha N Munshi¹, Graydon S Meneilly², Leocadio Rodríguez-Mañas³, Kelly L Close⁴, Paul R Conlin⁵, Tali Cukierman-Yaffe⁶, Angus Forbes⁷, Om P Ganda⁸, C Ronald Kahn⁸, Elbert Huang⁹, Lori M Laffel⁸, Christine G Lee¹⁰, Sei Lee¹¹, David M Nathan¹², Naushira Pandya¹³, Richard Pratley¹⁴, Robert Gabbay⁸, Alan J Sinclair¹⁵

Affiliations

¹ Harvard Medical School, Boston, MA, USA; Joslin Diabetes Center, Boston, MA, USA; Beth Israel Deaconess Medical Center, Boston, MA, USA. Electronic address: mmunshi@bidmc.harvard.edu.
² University of British Columbia, Vancouver, BC, Canada.
³ Servicio de Geriatria, Hospital Universitario de Getafe, Getafe, Spain.
⁴ The diaTribe Foundation San Francisco, CA, USA; Close Concerns, San Francisco, CA, USA.
⁵ Harvard Medical School, Boston, MA, USA; Veteran Affairs Boston Healthcare System, Boston, MA, USA.
⁶ Division of Endocrinology, Diabetes and Metabolism, Gertner Institute, Ramat Gan, Israel; Sheba Medical Centre, Ramat Gan, Israel; Epidemiology Department, Sackler School of Medicine, Herczeg Institute on Aging, Tel Aviv University, Tel Aviv, Israel.
⁷ King's College London, London, UK.
⁸ Harvard Medical School, Boston, MA, USA; Joslin Diabetes Center, Boston, MA, USA.
⁹ Center for Chronic Disease Research and Policy, Section of General Internal Medicine, University of Chicago, Chicago, IL, USA.
¹⁰ Division of Diabetes, Endocrinology and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.
¹¹ University of California San Francisco, San Francisco, CA, USA; Geriatrics and Extended Care, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.
¹² Harvard Medical School, Boston, MA, USA; Diabetes Research Center and Clinical Research Center, Massachusetts General Hospital, Boston, MA, USA.
¹³ Department of Geriatrics, Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Aventura Hospital, Aventura, FL, USA.
¹⁴ AdventHealth, AdventHealth Diabetes Institute, AdventHealth Translational Research Institute, Orlando, FL, USA.
¹⁵ King's College London, London, UK; Diabetes Frail, London, UK.

Abstract

Older adults with diabetes are heterogeneous in their medical, functional, and cognitive status, and require careful individualisation of their treatment regimens. However, in the absence of detailed information from clinical trials involving older people with varying characteristics, there is little evidence-based guidance, which is a notable limitation of current approaches to care. It is important to recognise that older people with diabetes might vary in their profiles according to age category, functional health, presence of frailty, and comorbidity profiles. In addition, all older adults with diabetes require an individualised approach to care, ranging from robust individuals to those residing in care homes with a short life expectancy, those requiring palliative care, or those requiring end-of-life management. In this Review, our multidisciplinary team of experts describes the current evidence in several important areas in geriatric diabetes, and outlines key research gaps and research questions in each of these areas with the aim to develop evidence-based recommendations to improve the outcomes of interest in older adults.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Aged
Aged, 80 and over
Aging*
Diabetes Mellitus / therapy*
Humans
Patient-Centered Care / standards*
Practice Guidelines as Topic / standards*

Abstract

Publication types

MeSH terms

Grants and funding