Implications of New Geriatric Diabetes Care Guidelines for the Assessment of Quality of Care in Older Patients

The question motivating this research was to assess whether the same goals for controlling type 2 diabetes in the general population should be used in controlling the disease in older patients. If the answer was no, what criteria should be used to apply different standards in older patients? The authors' concern was that applying general goals to older patients might lead to overly intensive treatments of frail patients, which would then affect quality of life negatively instead of positively. Specifically, the authors examined conclusions regarding adequacy of glucose and blood pressure control in such patients to determine whether "stratified" approaches were justified. During in-person interviews, 554 patients were questioned about their treatment and health status and these patients' physicians were also surveyed.

The authors compared new diabetic treatment guidelines for the general population with stratified guideline goals. Under general-population guidelines, 35 percent of "frail" older patients met their target goals for glucose and blood pressure control; under stratified guidelines, 70 percent did. This increase held true for each clinical marker under consideration: age greater than 85 and various functional impairments.

The question remains, what is the best way to identify frail patients? Currently, there is no agreed-upon way to do this. The authors recommend using physician-assessed life expectancy, based on age and comorbidity scores, and then imposition of less stringent care-goals on patients with lower life expectancy.