Care of Older People with Diabetes
portes grátis
Care of Older People with Diabetes
A Manual for Healthcare Practice
Abdelhafiz, Ahmed H.; Sinclair, Alan J.
John Wiley & Sons Inc
03/2025
528
Mole
9781394205035
Pré-lançamento - envio 15 a 20 dias após a sua edição
Descrição não disponível.
Contributors xxvii
Foreword xxxiii
Preface xxxv
About the Companion Website xxxvii
Characteristics and Care Needs xxxix
Ahmed H Abdelhafiz, Ann Middleton and Alan J Sinclair
Introduction xxxix
Characteristics xli
Care Needs xliii
Physical Function xliii
Mental Function xliii
Care Delivery xlvi
Family Support xlvi
Care Organisation xlvii
Continuity of Care xlvii
Care Homes xlviii
Conclusion xlix
Clinical Practice Question xlix
References xlix
1 Epidemiology and Pathophysiology 1
Sarah L Sy
Introduction 1
Epidemiology 2
Pathophysiology of Diabetes in Older Adults 3
Age- related Alterations in Glucose Metabolism 3
Genetics 5
Lifestyle and Environmental Factors 5
Other Factors 6
What Are the Key Issues? 6
Prevention of Diabetes in Older Adults 6
Hypoglycaemia 7
Management 7
Summary 7
Clinical Practice Question 9
References 9
2 Screening and Diagnosis 11
Isabelle Bourdel- Marchasson
Introduction 11
Background 12
Key Issues 14
Screening 14
Diagnosis 16
Clinical Practice Questions 17
References 18
3 Lifestyle Interventions 21
Abdiazizi Yusuf and Ahmed H Abdelhafiz
Introduction 21
Impact of Lifestyle Changes 22
Lifestyle Intervention 23
Nutrition 24
Exercise 25
Synergy Between Nutrition and Exercise 27
Care Homes 27
Summary 28
Clinical Practice Question 28
References 29
4 Oral Hypoglycaemic Therapy 31
Nahian Kazi and Ahmed H Abdelhafiz
Introduction 31
Hypoglycaemic Agents 32
Low Hypoglycaemia- Risk Agents 32
Metformin 32
Dipeptidyl Peptidase- 4 Inhibitors 34
Sodium Glucose Transporter- 2 Inhibitors 34
Glucagon- like Peptide- 1 Receptor Agonists 35
Thiazolidinediones 35
Alpha- glucosidase Inhibitors 36
High Hypoglycaemia Risk Agents 36
Sulfonylureas 36
Meglitinides 37
Therapeutic Approach 37
Summary 38
Future Perspectives 39
Clinical Practice Question 39
References 40
5 Insulin Therapy 41
Giuseppe Maltese
Introduction 41
Basal Insulin Analogues 42
Rapid- acting Analogues 44
Treatment Regimens 45
Summary 47
Clinical Practice Question 47
References 47
6 Use of Continuous Glucose Monitoring in Older People with Diabetes 49
Giuseppe Maltese
Introduction 50
Continuous Glucose Monitoring 50
Patient Assessment 52
Challenges 54
Clinical Practice Question 54
References 55
7 Education: Key Features for Achieving Success 57
Kirsty Winkley and Angus Forbes
Introduction 57
Key Issues 58
Diabetes Complications 59
Other Comorbidities Not Specific to Diabetes 60
Polypharmacy 60
Anti- diabetes Oral and Injectable Agents 60
Hypoglycaemia 62
Risk of Falls and Fractures 63
Cognitive Impairment 63
Nutrition 64
Management 64
Determine Frailty Risk 64
Deprescribing and Optimisation 65
Glucose Monitoring and Insulin Delivery Technologies 66
Physical Exercise 66
Healthy Diet 67
Diabetes Self- management Education for Older People 67
Clinical Practice Question 68
References 68
8 Carers and Care Needs 71
Puja Merwaha and Ahmed H Abdelhafiz
Introduction 71
Care Needs 72
Carer Groups 73
Role of Carers 73
Benefit of Care on Outcomes 74
Caring for Carers 74
Carers' Burden 75
Supporting Carers 75
Summary 76
Clinical Practice Question 78
References 78
9a Macrovascular Complications: Peripheral Arterial Disease 81
Leocadio Rodriguez- Manas, Rubi E Sandoval- Santoyo and Marta Castro-Rodriguez
Epidemiology 81
Risk Factors 81
Prevalence 82
Pathogenesis 82
Consequences of Peripheral Arterial Disease 83
Investigations 83
Anamnesis 83
Physical Examination 84
Non- invasive Tests 84
Invasive Tests 85
Management 85
Risk Factor Modification 85
Exercise Rehabilitation 85
Foot Care 86
Pharmacological Therapy 86
Antiplatelet Therapy 86
Cilostazol 86
Revascularisation 86
Clinical Practice Question 86
References 87
9b Macrovascular Complications: Coronary Arterial Disease 89
Leocadio Rodriguez-Manas, Rubi E., Sandoval-Santoyo and Marta Castro Rodriguez
Epidemiology 89
Pathogenesis 90
Medical Treatment 90
Indications for Revascularisation 91
Management of Cardiovascular Risk Factors According to Baseline Functional and Cognitive Status 92
Effect of Glycaemic Control on Cardiovascular Events 92
Effect of Blood Pressure Control 92
Lipid Monitoring 93
Physical Exercise and Diet 93
Frailty Management 93
Management 93
Summary 95
Clinical Practice Question 95
References 96
9c Macrovascular Complications: Cerebrovascular Disease 97
Abubakhr Subkhan, Arshad Majid and Ali Ali
Introduction 97
Epidemiology 98
Risk Factors 98
Aetiology and Pathophysiology 99
Presentation 99
Stroke and Transient Ischaemic Attack 101
Cerebral Small Vessel Disease and Dementia 101
Management of Cerebrovascular Disease 102
Acute Stroke 102
Management of Risk Factors 104
Prognosis 105
Summary 106
Clinical Practice Question 106
References 107
10a Microvascular Complications: Diabetic Eye Disease 109
Archith Kamath and Nachiketa Acharya
Introduction 110
Epidemiology 110
Presentation 110
Pathophysiology 111
Management 113
Primary Care 113
Secondary Care 115
Summary 117
Clinical Practice Questions 117
References 118
10b Microvascular Complications: Diabetic Kidney Disease 119
Mohsen El Kossi
Introduction 119
Diabetic Kidney Disease 120
Definitions and Diagnoses 120
Management 121
Lifestyle 121
Glycaemic Control 122
Blood Pressure Control 122
Lipid Control 123
Diabetic Kidney Disease- related Complications 124
Anaemia 124
Mineral Bone Disorder 124
Metabolic Acidosis and Fluid Retention 125
Nephrology Referral 125
Summary 126
Clinical Practice Question 127
References 127
10c Microvascular Complications: Peripheral Neuropathy 129
Mitra Tavakoli
Introduction 130
Prevalence and Risk Factors 130
Clinical Manifestations and Complications 131
Diagnosis and Assessment 132
Management of Diabetic Neuropathy 135
Diabetes Foot Care in Care Homes 136
Summary 138
Clinical Practice Question 138
References 139
11a Vascular Risk Factors: Hypertension 141
Pann Ei Hnynn Si and Ahmed H Abdelhafiz
Introduction 141
Age- related Blood Pressure Changes 142
Definition 142
Diagnosis 144
Types 144
Management 145
Recommended Targets 145
Medications 146
Considerations in Older People 147
Orthostatic Hypotension 147
Falls 148
Systolic Hypertension 148
Frailty 148
Dementia 149
Comorbidity 149
Polypharmacy 149
Summary 149
Clinical Practice Question 151
References 151
11b Vascular Risk Factors: Dyslipidaemia 153
Pann Ei Hnynn, Si and Ahmed H Abdelhafiz
Introduction 153
Ageing and Lipid Profile 154
Diabetes and Lipid Profile 154
Diabetes and Risk of Atherosclerotic Cardiovascular Disease 155
Atherosclerotic Cardiovascular Disease Risk Reduction 156
Lipid- lowering Agents 157
Goals of Therapy in Old Age 160
Recommendations from Guidelines 160
Goals in Frailty 162
Summary 162
Clinical Practice Question 162
References 164
12a Metabolic Decompensation: Hyperglycaemic Crisis 165
Puja Merwaha and Ahmed H Abdelhafiz
Introduction 165
Epidemiology 166
Precipitating Factors 166
Pathogenesis 168
Clinical Presentation 168
Diagnosis 169
Management 171
Correction of Hypovolaemia 172
Correction of Hyperglycaemia 173
Correction of Acidosis 174
Correction of Electrolytes 175
Complications 175
Prevention 176
Clinical Practice Question 176
References 177
12b Metabolic Decompensation: Hypoglycaemia 178
Srikanth Bellary, Ahmed H Abdelhafiz and Alan J Sinclair
Introduction 179
Definition 179
Recognition 179
Epidemiology 180
Pathophysiology 180
Clinical Consequences 181
Impact on Cognition 182
Impact on Frailty 182
Management 183
Summary 185
Clinical Practice Question 185
References 186
13a Management of Diabetes in Hospital 189
Julie Lewis and Chris Cottrell
Introduction 189
Fundamentals of Care 190
Key Considerations for Effective Inpatient Care for Older People with Diabetes 192
The Inpatient Setting 192
Pressure Damage and Footcare Assessment 193
Planning Care 193
Key Considerations to Reduce Unscheduled Admission to Hospital 193
Monitoring Requirements 196
Education and Training 196
Summary 197
Clinical Practice Questions 198
References 199
13b Management of Diabetes in Care Homes 201
Lynne Reedman and Alan J Sinclair
Introduction 201
Important Considerations for Diabetes Care 203
Importance of Monitoring Glucose Levels 207
Other Management Issues 207
Hypoglycaemia 208
Diabetes Foot Disease 209
Nutritional Deficiency and Weight Loss 209
Frailty 210
Education 210
Communication and Collaboration 211
Use of Audit 211
Measuring Outcomes 212
Summary 212
Clinical Practice Question 213
References 214
14 Nutrition 215
Rihan Said and Grace Zaman
Introduction 215
Nutritional Deficiencies 216
Causes of Malnutrition in the Elderly 216
Recommendations 217
Specific Recommendations for Older People with Diabetes 218
Practical Steps for Nutritional Care in the Elderly 218
Screening 218
Assessment 219
Intervention 219
Enteral Nutrition 221
Types of Enteral Tubes 221
Types of Feeds 221
Enteral Feed Delivery Options 221
Management of Blood Glucose 221
Parenteral Nutrition 222
Management of Blood Glucose 223
General Considerations for Patients on Nutritional Support 224
Summary 224
Clinical Practice Questions 225
References 226
15 Sexual Health 229
Pann Ei Hnynn Si and Ahmed H Abdelhafiz
Introduction 229
Ageing and Sexual Function 230
Diabetes and Sexual Dysfunction 230
Sexual Dysfunction in Men 231
Aetiology and Pathogenesis 231
Diagnosis 232
Treatment 233
Sexual Dysfunction in Women 236
Aetiology and Pathogenesis 236
Diagnosis 237
Treatment 237
Summary 238
Clinical Practice Questions 238
References 239
16a Special Issues in Old Age: Frailty 241
Alan J Sinclair and Ahmed H Abdelhafiz
Introduction 241
Frailty-diabetes Inter- relationship 242
Effect of Diabetes on Frailty 244
Effects of Frailty on Diabetes 245
Outcome Effects 249
Metabolic Effects 249
Sarcopenic Obese Phenotype 254
Anorexic Malnourished Phenotype 254
Prevention and Management 255
Screening 255
Non- pharmacological Therapy 256
Pharmacological Therapy 257
Special Considerations 259
Glycaemic Control 259
Choice of Hypoglycaemic Agent 260
Sarcopenic Obese Phenotype 260
Anorexic Malnourished Phenotype 260
Goals of Therapy 261
Summary 262
Future Perspectives 262
Clinical Practice Question 263
References 264
16b Special Issues in Old Age: Multimorbidity 266
Alan J Sinclair and Ahmed H Abdelhafiz
Introduction 266
Multimorbidity 267
Multimorbidity-Frailty Interaction 268
Multimorbidity Effects on Diabetes 268
Clusters of Multimorbidity 269
Clinical Implications 270
Summary 272
Future Perspectives 272
Clinical Practice Question 273
References 273
16c Special Issues in Old Age: Type 1 Diabetes Mellitus 275
Alex M Summerbell and Ahmed H Abdelhafiz
Introduction 275
Epidemiology and Diagnosis 276
Management 276
Insulin Therapy 278
Monitoring 279
Reducing Hypoglycaemia 280
Goals of Therapy 282
Summary 282
Clinical Practice Question 282
References 283
16d Special Issues in Old Age: Cognitive Health Agility, Cognitive Dysfunction, Dementia and Diabetes 285
Tali Cukierman- Yaffe
Introduction 286
Population Studies Demonstrating the Relationship Between Cognitive Dysfunction, Dementia and Diabetes 286
Implications of the Relationship Between Diabetes and Cognitive Dysfunction 287
The Effect of Cognitive Dysfunction on Self- care Capacity in Older People with Diabetes 288
Assessment of Cognitive Health Agility in Older People with Diabetes 290
Prevention and Treatment of Cognitive Dysfunction in Older People with Diabetes 291
The Effect of Current Diabetes Pharmacological Agents on Cognitive Dysfunction 291
Glucose Control 292
Insulin 293
Dipeptidyl Peptidase- 4 Inhibitors 294
Glucagon- like Peptide- 1 Receptor Analysts 294
The Multidomain Approach 295
Summary, Knowledge Gaps and Future Research 296
Clinical Practice Question 296
References 298
16e Special Issues in Old Age: Depression 299
Sara- Louise Wylie
Introduction 299
Depression and Diabetes 300
Presentation 300
Evaluation 302
Screening 302
Diagnosis 303
Assessment 304
Management 307
Lifestyle 307
Pharmacological Therapy 308
Psychotherapy 309
Collaborative Care 310
Summary 310
Clinical Practice Question 310
References 311
16f Special Issues in Old Age: Foot Care 313
Solomon Muzulu
Introduction 313
Epidemiology 314
Pathogenesis 314
Ageing and Diabetic Foot Ulcer Disease 315
Assessment of a Diabetic Foot 316
Testing for Peripheral Sensory Neuropathy 316
10- g Monofilament Test 317
128- Hz Tuning Fork 318
Ipswich Touch Test 318
Checking for Peripheral Vascular Disease 318
Management 318
Offloading 320
Debridement 320
Dressings 320
Infection Control 320
Ischaemia Relief 321
Glycaemic Control 322
Prevention 322
Summary 323
Clinical Practice Question 323
References 324
16g Special Issues in Old Age: Skin Care 326
Grace Keegan and Sarah Mahmoud
Introduction 326
Age- related Skin Changes 327
Diabetes Mellitus- related Skin Conditions 327
Primary Skin Conditions 328
Acanthosis Nigricans 328
Necrobiosis Lipoidica 328
Diabetic Dermopathy 329
Bullous Eruption of Diabetes Mellitus 329
Diabetes- related Skin Infections 330
Bacterial Infections 330
Fungal Infections 331
Diabetes Medications- related Skin Adverse Effects 334
Insulin 334
Sodium Glucose Transporter- 2 Inhibitors 334
Summary 334
Clinical Practice Question 335
References 335
16h Special Issues in Old Age: Falls and Bone Health 336
Nandkishor V Athavale
Introduction 336
Epidemiology 337
Pathophysiology of Fracture Risk in Diabetes 337
Pathophysiology and Risk Factors for Falls in Diabetes 338
Assessment of the Risk of Falls in the Community 339
Assessment of Bone Health in Community 340
Management and Prevention 344
Falls 344
Fractures 345
Summary 345
Clinical Practice Question 345
References 346
16i Special Issues in Old Age: Avoiding Hospitalisation 347
Demelza Emmerton and Ahmed H Abdelhafiz
Introduction 347
Risk Factors for Hospitalisation 348
Avoiding Hospitalisation 349
Patient- Related Interventions 349
Physical Function 349
Mental Function 351
Polypharmacy 351
Healthcare System- related Interventions 352
Community Setting 352
Care- home Setting 353
Emergency Setting 353
Summary 355
Clinical Practice Question 355
References 356
16j Special Issues in Old Age: Use of Technology 357
Anna Kahkoska, Aastha Dubal, Josh Weinstein and Ruth S Weinstock
Introduction 358
What Is Diabetes Technology? 358
What Is Remote Patient Monitoring? 359
Diabetes Technology and Remote Patient Monitoring in Older Adults 360
Management 362
Continuous Glucose Monitoring 362
What Is Continuous Glucose Monitoring? 362
What Is the Evidence for Continuous Glucose Monitoring as Part of Management for Older Adults with Diabetes? 362
What Are Challenges for Continuous Glucose Monitoring Use in Older Adults? 363
Automated Insulin Delivery Systems 363
What Is Automated Insulin Delivery? 363
Evidence on Automated Insulin Delivery for Older Adults 364
Clinical Guidelines for Automated Insulin Delivery Usage among Older Adults with Type 1 Diabetes 364
What Are Challenges for Automated Insulin Delivery Use in Older Adults? 364
Integration of Diabetes Technologies with Remote Patient Monitoring 365
What Are the Key Issues? 366
Clinical Practice Questions 368
References 369
16k Special Issues in Old Age: Annual Reviews 371
Puja Merwaha and Ahmed H Abdelhafiz
Introduction 371
Diabetes Phenotype in Older People 372
Multimorbidity 372
Geriatric Syndromes 373
Frailty 373
Functional Implications 373
Annual Review Contents 374
Demographics 374
History 374
Physical Examination 374
Vascular Complications 376
Sexual Function 376
Cognition and Mood 376
Physical Function and Frailty 377
Foot Care 377
Diet and Nutrition 377
Medication Review 377
Infection Prevention 378
Summary 378
Clinical Practice Question 378
References 380
16l Special Issues in Old Age: Mouth Care 381
Nali Ahmed and Ahmed H Abdelhafiz
Introduction 381
Age- related Oral Changes 382
Diabetes- related Oral Changes 382
Common Oral Conditions in Older People with Diabetes 384
Periodontal Disease 384
Dental Caries 384
Dry Mouth 385
Candida 386
Oral Cancer 386
Taste Impairment 387
Mouth Care 387
Education 387
Glycaemic Control 388
Preventative Measures 388
Summary 389
Clinical Practice Question 390
References 390
16m Special Issues in Old Age: Pain Management 392
Pann Ei Hnynn Si and Ahmed H Abdelhafiz
Introduction 392
Aetiology 393
Assessment 393
Pain in Care- home Residents 396
Management 397
Non- pharmacological Therapy 397
Pharmacological Therapy 398
Prevention 401
Clinical Practice Question 401
References 402
17 Deintensification of Therapy 405
Antoine Christiaens
Introduction 405
Key Issues 407
Management 407
Identifying Patients Who Might Benefit 407
Deintensifying Glucose- lowering Treatment in Older Patients 409
Implementing Deintensification in Daily Clinical Practice 410
Clinical Practice Questions 411
References 412
18 Diabetes in End- of- Life Care 413
June James
Introduction 413
Background 414
What is End of Life and How is the Need for End- of- life Care Identified? 414
Management of Diabetes in End- of- Life Care 419
Medicines Management and De- escalation of Therapies 419
Steroids and Cancer 422
Nutrition and Enteral Feeding 424
Advanced Care Planning 424
Treatment Withdrawal 424
Workforce Training and Competencies 424
Summary 425
Clinical Practice Questions 425
References 426
Answers to Clinical Practice Questions 429
Index 445
Foreword xxxiii
Preface xxxv
About the Companion Website xxxvii
Characteristics and Care Needs xxxix
Ahmed H Abdelhafiz, Ann Middleton and Alan J Sinclair
Introduction xxxix
Characteristics xli
Care Needs xliii
Physical Function xliii
Mental Function xliii
Care Delivery xlvi
Family Support xlvi
Care Organisation xlvii
Continuity of Care xlvii
Care Homes xlviii
Conclusion xlix
Clinical Practice Question xlix
References xlix
1 Epidemiology and Pathophysiology 1
Sarah L Sy
Introduction 1
Epidemiology 2
Pathophysiology of Diabetes in Older Adults 3
Age- related Alterations in Glucose Metabolism 3
Genetics 5
Lifestyle and Environmental Factors 5
Other Factors 6
What Are the Key Issues? 6
Prevention of Diabetes in Older Adults 6
Hypoglycaemia 7
Management 7
Summary 7
Clinical Practice Question 9
References 9
2 Screening and Diagnosis 11
Isabelle Bourdel- Marchasson
Introduction 11
Background 12
Key Issues 14
Screening 14
Diagnosis 16
Clinical Practice Questions 17
References 18
3 Lifestyle Interventions 21
Abdiazizi Yusuf and Ahmed H Abdelhafiz
Introduction 21
Impact of Lifestyle Changes 22
Lifestyle Intervention 23
Nutrition 24
Exercise 25
Synergy Between Nutrition and Exercise 27
Care Homes 27
Summary 28
Clinical Practice Question 28
References 29
4 Oral Hypoglycaemic Therapy 31
Nahian Kazi and Ahmed H Abdelhafiz
Introduction 31
Hypoglycaemic Agents 32
Low Hypoglycaemia- Risk Agents 32
Metformin 32
Dipeptidyl Peptidase- 4 Inhibitors 34
Sodium Glucose Transporter- 2 Inhibitors 34
Glucagon- like Peptide- 1 Receptor Agonists 35
Thiazolidinediones 35
Alpha- glucosidase Inhibitors 36
High Hypoglycaemia Risk Agents 36
Sulfonylureas 36
Meglitinides 37
Therapeutic Approach 37
Summary 38
Future Perspectives 39
Clinical Practice Question 39
References 40
5 Insulin Therapy 41
Giuseppe Maltese
Introduction 41
Basal Insulin Analogues 42
Rapid- acting Analogues 44
Treatment Regimens 45
Summary 47
Clinical Practice Question 47
References 47
6 Use of Continuous Glucose Monitoring in Older People with Diabetes 49
Giuseppe Maltese
Introduction 50
Continuous Glucose Monitoring 50
Patient Assessment 52
Challenges 54
Clinical Practice Question 54
References 55
7 Education: Key Features for Achieving Success 57
Kirsty Winkley and Angus Forbes
Introduction 57
Key Issues 58
Diabetes Complications 59
Other Comorbidities Not Specific to Diabetes 60
Polypharmacy 60
Anti- diabetes Oral and Injectable Agents 60
Hypoglycaemia 62
Risk of Falls and Fractures 63
Cognitive Impairment 63
Nutrition 64
Management 64
Determine Frailty Risk 64
Deprescribing and Optimisation 65
Glucose Monitoring and Insulin Delivery Technologies 66
Physical Exercise 66
Healthy Diet 67
Diabetes Self- management Education for Older People 67
Clinical Practice Question 68
References 68
8 Carers and Care Needs 71
Puja Merwaha and Ahmed H Abdelhafiz
Introduction 71
Care Needs 72
Carer Groups 73
Role of Carers 73
Benefit of Care on Outcomes 74
Caring for Carers 74
Carers' Burden 75
Supporting Carers 75
Summary 76
Clinical Practice Question 78
References 78
9a Macrovascular Complications: Peripheral Arterial Disease 81
Leocadio Rodriguez- Manas, Rubi E Sandoval- Santoyo and Marta Castro-Rodriguez
Epidemiology 81
Risk Factors 81
Prevalence 82
Pathogenesis 82
Consequences of Peripheral Arterial Disease 83
Investigations 83
Anamnesis 83
Physical Examination 84
Non- invasive Tests 84
Invasive Tests 85
Management 85
Risk Factor Modification 85
Exercise Rehabilitation 85
Foot Care 86
Pharmacological Therapy 86
Antiplatelet Therapy 86
Cilostazol 86
Revascularisation 86
Clinical Practice Question 86
References 87
9b Macrovascular Complications: Coronary Arterial Disease 89
Leocadio Rodriguez-Manas, Rubi E., Sandoval-Santoyo and Marta Castro Rodriguez
Epidemiology 89
Pathogenesis 90
Medical Treatment 90
Indications for Revascularisation 91
Management of Cardiovascular Risk Factors According to Baseline Functional and Cognitive Status 92
Effect of Glycaemic Control on Cardiovascular Events 92
Effect of Blood Pressure Control 92
Lipid Monitoring 93
Physical Exercise and Diet 93
Frailty Management 93
Management 93
Summary 95
Clinical Practice Question 95
References 96
9c Macrovascular Complications: Cerebrovascular Disease 97
Abubakhr Subkhan, Arshad Majid and Ali Ali
Introduction 97
Epidemiology 98
Risk Factors 98
Aetiology and Pathophysiology 99
Presentation 99
Stroke and Transient Ischaemic Attack 101
Cerebral Small Vessel Disease and Dementia 101
Management of Cerebrovascular Disease 102
Acute Stroke 102
Management of Risk Factors 104
Prognosis 105
Summary 106
Clinical Practice Question 106
References 107
10a Microvascular Complications: Diabetic Eye Disease 109
Archith Kamath and Nachiketa Acharya
Introduction 110
Epidemiology 110
Presentation 110
Pathophysiology 111
Management 113
Primary Care 113
Secondary Care 115
Summary 117
Clinical Practice Questions 117
References 118
10b Microvascular Complications: Diabetic Kidney Disease 119
Mohsen El Kossi
Introduction 119
Diabetic Kidney Disease 120
Definitions and Diagnoses 120
Management 121
Lifestyle 121
Glycaemic Control 122
Blood Pressure Control 122
Lipid Control 123
Diabetic Kidney Disease- related Complications 124
Anaemia 124
Mineral Bone Disorder 124
Metabolic Acidosis and Fluid Retention 125
Nephrology Referral 125
Summary 126
Clinical Practice Question 127
References 127
10c Microvascular Complications: Peripheral Neuropathy 129
Mitra Tavakoli
Introduction 130
Prevalence and Risk Factors 130
Clinical Manifestations and Complications 131
Diagnosis and Assessment 132
Management of Diabetic Neuropathy 135
Diabetes Foot Care in Care Homes 136
Summary 138
Clinical Practice Question 138
References 139
11a Vascular Risk Factors: Hypertension 141
Pann Ei Hnynn Si and Ahmed H Abdelhafiz
Introduction 141
Age- related Blood Pressure Changes 142
Definition 142
Diagnosis 144
Types 144
Management 145
Recommended Targets 145
Medications 146
Considerations in Older People 147
Orthostatic Hypotension 147
Falls 148
Systolic Hypertension 148
Frailty 148
Dementia 149
Comorbidity 149
Polypharmacy 149
Summary 149
Clinical Practice Question 151
References 151
11b Vascular Risk Factors: Dyslipidaemia 153
Pann Ei Hnynn, Si and Ahmed H Abdelhafiz
Introduction 153
Ageing and Lipid Profile 154
Diabetes and Lipid Profile 154
Diabetes and Risk of Atherosclerotic Cardiovascular Disease 155
Atherosclerotic Cardiovascular Disease Risk Reduction 156
Lipid- lowering Agents 157
Goals of Therapy in Old Age 160
Recommendations from Guidelines 160
Goals in Frailty 162
Summary 162
Clinical Practice Question 162
References 164
12a Metabolic Decompensation: Hyperglycaemic Crisis 165
Puja Merwaha and Ahmed H Abdelhafiz
Introduction 165
Epidemiology 166
Precipitating Factors 166
Pathogenesis 168
Clinical Presentation 168
Diagnosis 169
Management 171
Correction of Hypovolaemia 172
Correction of Hyperglycaemia 173
Correction of Acidosis 174
Correction of Electrolytes 175
Complications 175
Prevention 176
Clinical Practice Question 176
References 177
12b Metabolic Decompensation: Hypoglycaemia 178
Srikanth Bellary, Ahmed H Abdelhafiz and Alan J Sinclair
Introduction 179
Definition 179
Recognition 179
Epidemiology 180
Pathophysiology 180
Clinical Consequences 181
Impact on Cognition 182
Impact on Frailty 182
Management 183
Summary 185
Clinical Practice Question 185
References 186
13a Management of Diabetes in Hospital 189
Julie Lewis and Chris Cottrell
Introduction 189
Fundamentals of Care 190
Key Considerations for Effective Inpatient Care for Older People with Diabetes 192
The Inpatient Setting 192
Pressure Damage and Footcare Assessment 193
Planning Care 193
Key Considerations to Reduce Unscheduled Admission to Hospital 193
Monitoring Requirements 196
Education and Training 196
Summary 197
Clinical Practice Questions 198
References 199
13b Management of Diabetes in Care Homes 201
Lynne Reedman and Alan J Sinclair
Introduction 201
Important Considerations for Diabetes Care 203
Importance of Monitoring Glucose Levels 207
Other Management Issues 207
Hypoglycaemia 208
Diabetes Foot Disease 209
Nutritional Deficiency and Weight Loss 209
Frailty 210
Education 210
Communication and Collaboration 211
Use of Audit 211
Measuring Outcomes 212
Summary 212
Clinical Practice Question 213
References 214
14 Nutrition 215
Rihan Said and Grace Zaman
Introduction 215
Nutritional Deficiencies 216
Causes of Malnutrition in the Elderly 216
Recommendations 217
Specific Recommendations for Older People with Diabetes 218
Practical Steps for Nutritional Care in the Elderly 218
Screening 218
Assessment 219
Intervention 219
Enteral Nutrition 221
Types of Enteral Tubes 221
Types of Feeds 221
Enteral Feed Delivery Options 221
Management of Blood Glucose 221
Parenteral Nutrition 222
Management of Blood Glucose 223
General Considerations for Patients on Nutritional Support 224
Summary 224
Clinical Practice Questions 225
References 226
15 Sexual Health 229
Pann Ei Hnynn Si and Ahmed H Abdelhafiz
Introduction 229
Ageing and Sexual Function 230
Diabetes and Sexual Dysfunction 230
Sexual Dysfunction in Men 231
Aetiology and Pathogenesis 231
Diagnosis 232
Treatment 233
Sexual Dysfunction in Women 236
Aetiology and Pathogenesis 236
Diagnosis 237
Treatment 237
Summary 238
Clinical Practice Questions 238
References 239
16a Special Issues in Old Age: Frailty 241
Alan J Sinclair and Ahmed H Abdelhafiz
Introduction 241
Frailty-diabetes Inter- relationship 242
Effect of Diabetes on Frailty 244
Effects of Frailty on Diabetes 245
Outcome Effects 249
Metabolic Effects 249
Sarcopenic Obese Phenotype 254
Anorexic Malnourished Phenotype 254
Prevention and Management 255
Screening 255
Non- pharmacological Therapy 256
Pharmacological Therapy 257
Special Considerations 259
Glycaemic Control 259
Choice of Hypoglycaemic Agent 260
Sarcopenic Obese Phenotype 260
Anorexic Malnourished Phenotype 260
Goals of Therapy 261
Summary 262
Future Perspectives 262
Clinical Practice Question 263
References 264
16b Special Issues in Old Age: Multimorbidity 266
Alan J Sinclair and Ahmed H Abdelhafiz
Introduction 266
Multimorbidity 267
Multimorbidity-Frailty Interaction 268
Multimorbidity Effects on Diabetes 268
Clusters of Multimorbidity 269
Clinical Implications 270
Summary 272
Future Perspectives 272
Clinical Practice Question 273
References 273
16c Special Issues in Old Age: Type 1 Diabetes Mellitus 275
Alex M Summerbell and Ahmed H Abdelhafiz
Introduction 275
Epidemiology and Diagnosis 276
Management 276
Insulin Therapy 278
Monitoring 279
Reducing Hypoglycaemia 280
Goals of Therapy 282
Summary 282
Clinical Practice Question 282
References 283
16d Special Issues in Old Age: Cognitive Health Agility, Cognitive Dysfunction, Dementia and Diabetes 285
Tali Cukierman- Yaffe
Introduction 286
Population Studies Demonstrating the Relationship Between Cognitive Dysfunction, Dementia and Diabetes 286
Implications of the Relationship Between Diabetes and Cognitive Dysfunction 287
The Effect of Cognitive Dysfunction on Self- care Capacity in Older People with Diabetes 288
Assessment of Cognitive Health Agility in Older People with Diabetes 290
Prevention and Treatment of Cognitive Dysfunction in Older People with Diabetes 291
The Effect of Current Diabetes Pharmacological Agents on Cognitive Dysfunction 291
Glucose Control 292
Insulin 293
Dipeptidyl Peptidase- 4 Inhibitors 294
Glucagon- like Peptide- 1 Receptor Analysts 294
The Multidomain Approach 295
Summary, Knowledge Gaps and Future Research 296
Clinical Practice Question 296
References 298
16e Special Issues in Old Age: Depression 299
Sara- Louise Wylie
Introduction 299
Depression and Diabetes 300
Presentation 300
Evaluation 302
Screening 302
Diagnosis 303
Assessment 304
Management 307
Lifestyle 307
Pharmacological Therapy 308
Psychotherapy 309
Collaborative Care 310
Summary 310
Clinical Practice Question 310
References 311
16f Special Issues in Old Age: Foot Care 313
Solomon Muzulu
Introduction 313
Epidemiology 314
Pathogenesis 314
Ageing and Diabetic Foot Ulcer Disease 315
Assessment of a Diabetic Foot 316
Testing for Peripheral Sensory Neuropathy 316
10- g Monofilament Test 317
128- Hz Tuning Fork 318
Ipswich Touch Test 318
Checking for Peripheral Vascular Disease 318
Management 318
Offloading 320
Debridement 320
Dressings 320
Infection Control 320
Ischaemia Relief 321
Glycaemic Control 322
Prevention 322
Summary 323
Clinical Practice Question 323
References 324
16g Special Issues in Old Age: Skin Care 326
Grace Keegan and Sarah Mahmoud
Introduction 326
Age- related Skin Changes 327
Diabetes Mellitus- related Skin Conditions 327
Primary Skin Conditions 328
Acanthosis Nigricans 328
Necrobiosis Lipoidica 328
Diabetic Dermopathy 329
Bullous Eruption of Diabetes Mellitus 329
Diabetes- related Skin Infections 330
Bacterial Infections 330
Fungal Infections 331
Diabetes Medications- related Skin Adverse Effects 334
Insulin 334
Sodium Glucose Transporter- 2 Inhibitors 334
Summary 334
Clinical Practice Question 335
References 335
16h Special Issues in Old Age: Falls and Bone Health 336
Nandkishor V Athavale
Introduction 336
Epidemiology 337
Pathophysiology of Fracture Risk in Diabetes 337
Pathophysiology and Risk Factors for Falls in Diabetes 338
Assessment of the Risk of Falls in the Community 339
Assessment of Bone Health in Community 340
Management and Prevention 344
Falls 344
Fractures 345
Summary 345
Clinical Practice Question 345
References 346
16i Special Issues in Old Age: Avoiding Hospitalisation 347
Demelza Emmerton and Ahmed H Abdelhafiz
Introduction 347
Risk Factors for Hospitalisation 348
Avoiding Hospitalisation 349
Patient- Related Interventions 349
Physical Function 349
Mental Function 351
Polypharmacy 351
Healthcare System- related Interventions 352
Community Setting 352
Care- home Setting 353
Emergency Setting 353
Summary 355
Clinical Practice Question 355
References 356
16j Special Issues in Old Age: Use of Technology 357
Anna Kahkoska, Aastha Dubal, Josh Weinstein and Ruth S Weinstock
Introduction 358
What Is Diabetes Technology? 358
What Is Remote Patient Monitoring? 359
Diabetes Technology and Remote Patient Monitoring in Older Adults 360
Management 362
Continuous Glucose Monitoring 362
What Is Continuous Glucose Monitoring? 362
What Is the Evidence for Continuous Glucose Monitoring as Part of Management for Older Adults with Diabetes? 362
What Are Challenges for Continuous Glucose Monitoring Use in Older Adults? 363
Automated Insulin Delivery Systems 363
What Is Automated Insulin Delivery? 363
Evidence on Automated Insulin Delivery for Older Adults 364
Clinical Guidelines for Automated Insulin Delivery Usage among Older Adults with Type 1 Diabetes 364
What Are Challenges for Automated Insulin Delivery Use in Older Adults? 364
Integration of Diabetes Technologies with Remote Patient Monitoring 365
What Are the Key Issues? 366
Clinical Practice Questions 368
References 369
16k Special Issues in Old Age: Annual Reviews 371
Puja Merwaha and Ahmed H Abdelhafiz
Introduction 371
Diabetes Phenotype in Older People 372
Multimorbidity 372
Geriatric Syndromes 373
Frailty 373
Functional Implications 373
Annual Review Contents 374
Demographics 374
History 374
Physical Examination 374
Vascular Complications 376
Sexual Function 376
Cognition and Mood 376
Physical Function and Frailty 377
Foot Care 377
Diet and Nutrition 377
Medication Review 377
Infection Prevention 378
Summary 378
Clinical Practice Question 378
References 380
16l Special Issues in Old Age: Mouth Care 381
Nali Ahmed and Ahmed H Abdelhafiz
Introduction 381
Age- related Oral Changes 382
Diabetes- related Oral Changes 382
Common Oral Conditions in Older People with Diabetes 384
Periodontal Disease 384
Dental Caries 384
Dry Mouth 385
Candida 386
Oral Cancer 386
Taste Impairment 387
Mouth Care 387
Education 387
Glycaemic Control 388
Preventative Measures 388
Summary 389
Clinical Practice Question 390
References 390
16m Special Issues in Old Age: Pain Management 392
Pann Ei Hnynn Si and Ahmed H Abdelhafiz
Introduction 392
Aetiology 393
Assessment 393
Pain in Care- home Residents 396
Management 397
Non- pharmacological Therapy 397
Pharmacological Therapy 398
Prevention 401
Clinical Practice Question 401
References 402
17 Deintensification of Therapy 405
Antoine Christiaens
Introduction 405
Key Issues 407
Management 407
Identifying Patients Who Might Benefit 407
Deintensifying Glucose- lowering Treatment in Older Patients 409
Implementing Deintensification in Daily Clinical Practice 410
Clinical Practice Questions 411
References 412
18 Diabetes in End- of- Life Care 413
June James
Introduction 413
Background 414
What is End of Life and How is the Need for End- of- life Care Identified? 414
Management of Diabetes in End- of- Life Care 419
Medicines Management and De- escalation of Therapies 419
Steroids and Cancer 422
Nutrition and Enteral Feeding 424
Advanced Care Planning 424
Treatment Withdrawal 424
Workforce Training and Competencies 424
Summary 425
Clinical Practice Questions 425
References 426
Answers to Clinical Practice Questions 429
Index 445
Este título pertence ao(s) assunto(s) indicados(s). Para ver outros títulos clique no assunto desejado.
Clinical gerontology; geriatrics; geriatric health; diabetes education; diabetes research; internal medicine; long term care; type 1 diabetes; type 2 diabetes; frailty; sarcopenia; dementia; diabetes self-care; diabetes monitoring
Contributors xxvii
Foreword xxxiii
Preface xxxv
About the Companion Website xxxvii
Characteristics and Care Needs xxxix
Ahmed H Abdelhafiz, Ann Middleton and Alan J Sinclair
Introduction xxxix
Characteristics xli
Care Needs xliii
Physical Function xliii
Mental Function xliii
Care Delivery xlvi
Family Support xlvi
Care Organisation xlvii
Continuity of Care xlvii
Care Homes xlviii
Conclusion xlix
Clinical Practice Question xlix
References xlix
1 Epidemiology and Pathophysiology 1
Sarah L Sy
Introduction 1
Epidemiology 2
Pathophysiology of Diabetes in Older Adults 3
Age- related Alterations in Glucose Metabolism 3
Genetics 5
Lifestyle and Environmental Factors 5
Other Factors 6
What Are the Key Issues? 6
Prevention of Diabetes in Older Adults 6
Hypoglycaemia 7
Management 7
Summary 7
Clinical Practice Question 9
References 9
2 Screening and Diagnosis 11
Isabelle Bourdel- Marchasson
Introduction 11
Background 12
Key Issues 14
Screening 14
Diagnosis 16
Clinical Practice Questions 17
References 18
3 Lifestyle Interventions 21
Abdiazizi Yusuf and Ahmed H Abdelhafiz
Introduction 21
Impact of Lifestyle Changes 22
Lifestyle Intervention 23
Nutrition 24
Exercise 25
Synergy Between Nutrition and Exercise 27
Care Homes 27
Summary 28
Clinical Practice Question 28
References 29
4 Oral Hypoglycaemic Therapy 31
Nahian Kazi and Ahmed H Abdelhafiz
Introduction 31
Hypoglycaemic Agents 32
Low Hypoglycaemia- Risk Agents 32
Metformin 32
Dipeptidyl Peptidase- 4 Inhibitors 34
Sodium Glucose Transporter- 2 Inhibitors 34
Glucagon- like Peptide- 1 Receptor Agonists 35
Thiazolidinediones 35
Alpha- glucosidase Inhibitors 36
High Hypoglycaemia Risk Agents 36
Sulfonylureas 36
Meglitinides 37
Therapeutic Approach 37
Summary 38
Future Perspectives 39
Clinical Practice Question 39
References 40
5 Insulin Therapy 41
Giuseppe Maltese
Introduction 41
Basal Insulin Analogues 42
Rapid- acting Analogues 44
Treatment Regimens 45
Summary 47
Clinical Practice Question 47
References 47
6 Use of Continuous Glucose Monitoring in Older People with Diabetes 49
Giuseppe Maltese
Introduction 50
Continuous Glucose Monitoring 50
Patient Assessment 52
Challenges 54
Clinical Practice Question 54
References 55
7 Education: Key Features for Achieving Success 57
Kirsty Winkley and Angus Forbes
Introduction 57
Key Issues 58
Diabetes Complications 59
Other Comorbidities Not Specific to Diabetes 60
Polypharmacy 60
Anti- diabetes Oral and Injectable Agents 60
Hypoglycaemia 62
Risk of Falls and Fractures 63
Cognitive Impairment 63
Nutrition 64
Management 64
Determine Frailty Risk 64
Deprescribing and Optimisation 65
Glucose Monitoring and Insulin Delivery Technologies 66
Physical Exercise 66
Healthy Diet 67
Diabetes Self- management Education for Older People 67
Clinical Practice Question 68
References 68
8 Carers and Care Needs 71
Puja Merwaha and Ahmed H Abdelhafiz
Introduction 71
Care Needs 72
Carer Groups 73
Role of Carers 73
Benefit of Care on Outcomes 74
Caring for Carers 74
Carers' Burden 75
Supporting Carers 75
Summary 76
Clinical Practice Question 78
References 78
9a Macrovascular Complications: Peripheral Arterial Disease 81
Leocadio Rodriguez- Manas, Rubi E Sandoval- Santoyo and Marta Castro-Rodriguez
Epidemiology 81
Risk Factors 81
Prevalence 82
Pathogenesis 82
Consequences of Peripheral Arterial Disease 83
Investigations 83
Anamnesis 83
Physical Examination 84
Non- invasive Tests 84
Invasive Tests 85
Management 85
Risk Factor Modification 85
Exercise Rehabilitation 85
Foot Care 86
Pharmacological Therapy 86
Antiplatelet Therapy 86
Cilostazol 86
Revascularisation 86
Clinical Practice Question 86
References 87
9b Macrovascular Complications: Coronary Arterial Disease 89
Leocadio Rodriguez-Manas, Rubi E., Sandoval-Santoyo and Marta Castro Rodriguez
Epidemiology 89
Pathogenesis 90
Medical Treatment 90
Indications for Revascularisation 91
Management of Cardiovascular Risk Factors According to Baseline Functional and Cognitive Status 92
Effect of Glycaemic Control on Cardiovascular Events 92
Effect of Blood Pressure Control 92
Lipid Monitoring 93
Physical Exercise and Diet 93
Frailty Management 93
Management 93
Summary 95
Clinical Practice Question 95
References 96
9c Macrovascular Complications: Cerebrovascular Disease 97
Abubakhr Subkhan, Arshad Majid and Ali Ali
Introduction 97
Epidemiology 98
Risk Factors 98
Aetiology and Pathophysiology 99
Presentation 99
Stroke and Transient Ischaemic Attack 101
Cerebral Small Vessel Disease and Dementia 101
Management of Cerebrovascular Disease 102
Acute Stroke 102
Management of Risk Factors 104
Prognosis 105
Summary 106
Clinical Practice Question 106
References 107
10a Microvascular Complications: Diabetic Eye Disease 109
Archith Kamath and Nachiketa Acharya
Introduction 110
Epidemiology 110
Presentation 110
Pathophysiology 111
Management 113
Primary Care 113
Secondary Care 115
Summary 117
Clinical Practice Questions 117
References 118
10b Microvascular Complications: Diabetic Kidney Disease 119
Mohsen El Kossi
Introduction 119
Diabetic Kidney Disease 120
Definitions and Diagnoses 120
Management 121
Lifestyle 121
Glycaemic Control 122
Blood Pressure Control 122
Lipid Control 123
Diabetic Kidney Disease- related Complications 124
Anaemia 124
Mineral Bone Disorder 124
Metabolic Acidosis and Fluid Retention 125
Nephrology Referral 125
Summary 126
Clinical Practice Question 127
References 127
10c Microvascular Complications: Peripheral Neuropathy 129
Mitra Tavakoli
Introduction 130
Prevalence and Risk Factors 130
Clinical Manifestations and Complications 131
Diagnosis and Assessment 132
Management of Diabetic Neuropathy 135
Diabetes Foot Care in Care Homes 136
Summary 138
Clinical Practice Question 138
References 139
11a Vascular Risk Factors: Hypertension 141
Pann Ei Hnynn Si and Ahmed H Abdelhafiz
Introduction 141
Age- related Blood Pressure Changes 142
Definition 142
Diagnosis 144
Types 144
Management 145
Recommended Targets 145
Medications 146
Considerations in Older People 147
Orthostatic Hypotension 147
Falls 148
Systolic Hypertension 148
Frailty 148
Dementia 149
Comorbidity 149
Polypharmacy 149
Summary 149
Clinical Practice Question 151
References 151
11b Vascular Risk Factors: Dyslipidaemia 153
Pann Ei Hnynn, Si and Ahmed H Abdelhafiz
Introduction 153
Ageing and Lipid Profile 154
Diabetes and Lipid Profile 154
Diabetes and Risk of Atherosclerotic Cardiovascular Disease 155
Atherosclerotic Cardiovascular Disease Risk Reduction 156
Lipid- lowering Agents 157
Goals of Therapy in Old Age 160
Recommendations from Guidelines 160
Goals in Frailty 162
Summary 162
Clinical Practice Question 162
References 164
12a Metabolic Decompensation: Hyperglycaemic Crisis 165
Puja Merwaha and Ahmed H Abdelhafiz
Introduction 165
Epidemiology 166
Precipitating Factors 166
Pathogenesis 168
Clinical Presentation 168
Diagnosis 169
Management 171
Correction of Hypovolaemia 172
Correction of Hyperglycaemia 173
Correction of Acidosis 174
Correction of Electrolytes 175
Complications 175
Prevention 176
Clinical Practice Question 176
References 177
12b Metabolic Decompensation: Hypoglycaemia 178
Srikanth Bellary, Ahmed H Abdelhafiz and Alan J Sinclair
Introduction 179
Definition 179
Recognition 179
Epidemiology 180
Pathophysiology 180
Clinical Consequences 181
Impact on Cognition 182
Impact on Frailty 182
Management 183
Summary 185
Clinical Practice Question 185
References 186
13a Management of Diabetes in Hospital 189
Julie Lewis and Chris Cottrell
Introduction 189
Fundamentals of Care 190
Key Considerations for Effective Inpatient Care for Older People with Diabetes 192
The Inpatient Setting 192
Pressure Damage and Footcare Assessment 193
Planning Care 193
Key Considerations to Reduce Unscheduled Admission to Hospital 193
Monitoring Requirements 196
Education and Training 196
Summary 197
Clinical Practice Questions 198
References 199
13b Management of Diabetes in Care Homes 201
Lynne Reedman and Alan J Sinclair
Introduction 201
Important Considerations for Diabetes Care 203
Importance of Monitoring Glucose Levels 207
Other Management Issues 207
Hypoglycaemia 208
Diabetes Foot Disease 209
Nutritional Deficiency and Weight Loss 209
Frailty 210
Education 210
Communication and Collaboration 211
Use of Audit 211
Measuring Outcomes 212
Summary 212
Clinical Practice Question 213
References 214
14 Nutrition 215
Rihan Said and Grace Zaman
Introduction 215
Nutritional Deficiencies 216
Causes of Malnutrition in the Elderly 216
Recommendations 217
Specific Recommendations for Older People with Diabetes 218
Practical Steps for Nutritional Care in the Elderly 218
Screening 218
Assessment 219
Intervention 219
Enteral Nutrition 221
Types of Enteral Tubes 221
Types of Feeds 221
Enteral Feed Delivery Options 221
Management of Blood Glucose 221
Parenteral Nutrition 222
Management of Blood Glucose 223
General Considerations for Patients on Nutritional Support 224
Summary 224
Clinical Practice Questions 225
References 226
15 Sexual Health 229
Pann Ei Hnynn Si and Ahmed H Abdelhafiz
Introduction 229
Ageing and Sexual Function 230
Diabetes and Sexual Dysfunction 230
Sexual Dysfunction in Men 231
Aetiology and Pathogenesis 231
Diagnosis 232
Treatment 233
Sexual Dysfunction in Women 236
Aetiology and Pathogenesis 236
Diagnosis 237
Treatment 237
Summary 238
Clinical Practice Questions 238
References 239
16a Special Issues in Old Age: Frailty 241
Alan J Sinclair and Ahmed H Abdelhafiz
Introduction 241
Frailty-diabetes Inter- relationship 242
Effect of Diabetes on Frailty 244
Effects of Frailty on Diabetes 245
Outcome Effects 249
Metabolic Effects 249
Sarcopenic Obese Phenotype 254
Anorexic Malnourished Phenotype 254
Prevention and Management 255
Screening 255
Non- pharmacological Therapy 256
Pharmacological Therapy 257
Special Considerations 259
Glycaemic Control 259
Choice of Hypoglycaemic Agent 260
Sarcopenic Obese Phenotype 260
Anorexic Malnourished Phenotype 260
Goals of Therapy 261
Summary 262
Future Perspectives 262
Clinical Practice Question 263
References 264
16b Special Issues in Old Age: Multimorbidity 266
Alan J Sinclair and Ahmed H Abdelhafiz
Introduction 266
Multimorbidity 267
Multimorbidity-Frailty Interaction 268
Multimorbidity Effects on Diabetes 268
Clusters of Multimorbidity 269
Clinical Implications 270
Summary 272
Future Perspectives 272
Clinical Practice Question 273
References 273
16c Special Issues in Old Age: Type 1 Diabetes Mellitus 275
Alex M Summerbell and Ahmed H Abdelhafiz
Introduction 275
Epidemiology and Diagnosis 276
Management 276
Insulin Therapy 278
Monitoring 279
Reducing Hypoglycaemia 280
Goals of Therapy 282
Summary 282
Clinical Practice Question 282
References 283
16d Special Issues in Old Age: Cognitive Health Agility, Cognitive Dysfunction, Dementia and Diabetes 285
Tali Cukierman- Yaffe
Introduction 286
Population Studies Demonstrating the Relationship Between Cognitive Dysfunction, Dementia and Diabetes 286
Implications of the Relationship Between Diabetes and Cognitive Dysfunction 287
The Effect of Cognitive Dysfunction on Self- care Capacity in Older People with Diabetes 288
Assessment of Cognitive Health Agility in Older People with Diabetes 290
Prevention and Treatment of Cognitive Dysfunction in Older People with Diabetes 291
The Effect of Current Diabetes Pharmacological Agents on Cognitive Dysfunction 291
Glucose Control 292
Insulin 293
Dipeptidyl Peptidase- 4 Inhibitors 294
Glucagon- like Peptide- 1 Receptor Analysts 294
The Multidomain Approach 295
Summary, Knowledge Gaps and Future Research 296
Clinical Practice Question 296
References 298
16e Special Issues in Old Age: Depression 299
Sara- Louise Wylie
Introduction 299
Depression and Diabetes 300
Presentation 300
Evaluation 302
Screening 302
Diagnosis 303
Assessment 304
Management 307
Lifestyle 307
Pharmacological Therapy 308
Psychotherapy 309
Collaborative Care 310
Summary 310
Clinical Practice Question 310
References 311
16f Special Issues in Old Age: Foot Care 313
Solomon Muzulu
Introduction 313
Epidemiology 314
Pathogenesis 314
Ageing and Diabetic Foot Ulcer Disease 315
Assessment of a Diabetic Foot 316
Testing for Peripheral Sensory Neuropathy 316
10- g Monofilament Test 317
128- Hz Tuning Fork 318
Ipswich Touch Test 318
Checking for Peripheral Vascular Disease 318
Management 318
Offloading 320
Debridement 320
Dressings 320
Infection Control 320
Ischaemia Relief 321
Glycaemic Control 322
Prevention 322
Summary 323
Clinical Practice Question 323
References 324
16g Special Issues in Old Age: Skin Care 326
Grace Keegan and Sarah Mahmoud
Introduction 326
Age- related Skin Changes 327
Diabetes Mellitus- related Skin Conditions 327
Primary Skin Conditions 328
Acanthosis Nigricans 328
Necrobiosis Lipoidica 328
Diabetic Dermopathy 329
Bullous Eruption of Diabetes Mellitus 329
Diabetes- related Skin Infections 330
Bacterial Infections 330
Fungal Infections 331
Diabetes Medications- related Skin Adverse Effects 334
Insulin 334
Sodium Glucose Transporter- 2 Inhibitors 334
Summary 334
Clinical Practice Question 335
References 335
16h Special Issues in Old Age: Falls and Bone Health 336
Nandkishor V Athavale
Introduction 336
Epidemiology 337
Pathophysiology of Fracture Risk in Diabetes 337
Pathophysiology and Risk Factors for Falls in Diabetes 338
Assessment of the Risk of Falls in the Community 339
Assessment of Bone Health in Community 340
Management and Prevention 344
Falls 344
Fractures 345
Summary 345
Clinical Practice Question 345
References 346
16i Special Issues in Old Age: Avoiding Hospitalisation 347
Demelza Emmerton and Ahmed H Abdelhafiz
Introduction 347
Risk Factors for Hospitalisation 348
Avoiding Hospitalisation 349
Patient- Related Interventions 349
Physical Function 349
Mental Function 351
Polypharmacy 351
Healthcare System- related Interventions 352
Community Setting 352
Care- home Setting 353
Emergency Setting 353
Summary 355
Clinical Practice Question 355
References 356
16j Special Issues in Old Age: Use of Technology 357
Anna Kahkoska, Aastha Dubal, Josh Weinstein and Ruth S Weinstock
Introduction 358
What Is Diabetes Technology? 358
What Is Remote Patient Monitoring? 359
Diabetes Technology and Remote Patient Monitoring in Older Adults 360
Management 362
Continuous Glucose Monitoring 362
What Is Continuous Glucose Monitoring? 362
What Is the Evidence for Continuous Glucose Monitoring as Part of Management for Older Adults with Diabetes? 362
What Are Challenges for Continuous Glucose Monitoring Use in Older Adults? 363
Automated Insulin Delivery Systems 363
What Is Automated Insulin Delivery? 363
Evidence on Automated Insulin Delivery for Older Adults 364
Clinical Guidelines for Automated Insulin Delivery Usage among Older Adults with Type 1 Diabetes 364
What Are Challenges for Automated Insulin Delivery Use in Older Adults? 364
Integration of Diabetes Technologies with Remote Patient Monitoring 365
What Are the Key Issues? 366
Clinical Practice Questions 368
References 369
16k Special Issues in Old Age: Annual Reviews 371
Puja Merwaha and Ahmed H Abdelhafiz
Introduction 371
Diabetes Phenotype in Older People 372
Multimorbidity 372
Geriatric Syndromes 373
Frailty 373
Functional Implications 373
Annual Review Contents 374
Demographics 374
History 374
Physical Examination 374
Vascular Complications 376
Sexual Function 376
Cognition and Mood 376
Physical Function and Frailty 377
Foot Care 377
Diet and Nutrition 377
Medication Review 377
Infection Prevention 378
Summary 378
Clinical Practice Question 378
References 380
16l Special Issues in Old Age: Mouth Care 381
Nali Ahmed and Ahmed H Abdelhafiz
Introduction 381
Age- related Oral Changes 382
Diabetes- related Oral Changes 382
Common Oral Conditions in Older People with Diabetes 384
Periodontal Disease 384
Dental Caries 384
Dry Mouth 385
Candida 386
Oral Cancer 386
Taste Impairment 387
Mouth Care 387
Education 387
Glycaemic Control 388
Preventative Measures 388
Summary 389
Clinical Practice Question 390
References 390
16m Special Issues in Old Age: Pain Management 392
Pann Ei Hnynn Si and Ahmed H Abdelhafiz
Introduction 392
Aetiology 393
Assessment 393
Pain in Care- home Residents 396
Management 397
Non- pharmacological Therapy 397
Pharmacological Therapy 398
Prevention 401
Clinical Practice Question 401
References 402
17 Deintensification of Therapy 405
Antoine Christiaens
Introduction 405
Key Issues 407
Management 407
Identifying Patients Who Might Benefit 407
Deintensifying Glucose- lowering Treatment in Older Patients 409
Implementing Deintensification in Daily Clinical Practice 410
Clinical Practice Questions 411
References 412
18 Diabetes in End- of- Life Care 413
June James
Introduction 413
Background 414
What is End of Life and How is the Need for End- of- life Care Identified? 414
Management of Diabetes in End- of- Life Care 419
Medicines Management and De- escalation of Therapies 419
Steroids and Cancer 422
Nutrition and Enteral Feeding 424
Advanced Care Planning 424
Treatment Withdrawal 424
Workforce Training and Competencies 424
Summary 425
Clinical Practice Questions 425
References 426
Answers to Clinical Practice Questions 429
Index 445
Foreword xxxiii
Preface xxxv
About the Companion Website xxxvii
Characteristics and Care Needs xxxix
Ahmed H Abdelhafiz, Ann Middleton and Alan J Sinclair
Introduction xxxix
Characteristics xli
Care Needs xliii
Physical Function xliii
Mental Function xliii
Care Delivery xlvi
Family Support xlvi
Care Organisation xlvii
Continuity of Care xlvii
Care Homes xlviii
Conclusion xlix
Clinical Practice Question xlix
References xlix
1 Epidemiology and Pathophysiology 1
Sarah L Sy
Introduction 1
Epidemiology 2
Pathophysiology of Diabetes in Older Adults 3
Age- related Alterations in Glucose Metabolism 3
Genetics 5
Lifestyle and Environmental Factors 5
Other Factors 6
What Are the Key Issues? 6
Prevention of Diabetes in Older Adults 6
Hypoglycaemia 7
Management 7
Summary 7
Clinical Practice Question 9
References 9
2 Screening and Diagnosis 11
Isabelle Bourdel- Marchasson
Introduction 11
Background 12
Key Issues 14
Screening 14
Diagnosis 16
Clinical Practice Questions 17
References 18
3 Lifestyle Interventions 21
Abdiazizi Yusuf and Ahmed H Abdelhafiz
Introduction 21
Impact of Lifestyle Changes 22
Lifestyle Intervention 23
Nutrition 24
Exercise 25
Synergy Between Nutrition and Exercise 27
Care Homes 27
Summary 28
Clinical Practice Question 28
References 29
4 Oral Hypoglycaemic Therapy 31
Nahian Kazi and Ahmed H Abdelhafiz
Introduction 31
Hypoglycaemic Agents 32
Low Hypoglycaemia- Risk Agents 32
Metformin 32
Dipeptidyl Peptidase- 4 Inhibitors 34
Sodium Glucose Transporter- 2 Inhibitors 34
Glucagon- like Peptide- 1 Receptor Agonists 35
Thiazolidinediones 35
Alpha- glucosidase Inhibitors 36
High Hypoglycaemia Risk Agents 36
Sulfonylureas 36
Meglitinides 37
Therapeutic Approach 37
Summary 38
Future Perspectives 39
Clinical Practice Question 39
References 40
5 Insulin Therapy 41
Giuseppe Maltese
Introduction 41
Basal Insulin Analogues 42
Rapid- acting Analogues 44
Treatment Regimens 45
Summary 47
Clinical Practice Question 47
References 47
6 Use of Continuous Glucose Monitoring in Older People with Diabetes 49
Giuseppe Maltese
Introduction 50
Continuous Glucose Monitoring 50
Patient Assessment 52
Challenges 54
Clinical Practice Question 54
References 55
7 Education: Key Features for Achieving Success 57
Kirsty Winkley and Angus Forbes
Introduction 57
Key Issues 58
Diabetes Complications 59
Other Comorbidities Not Specific to Diabetes 60
Polypharmacy 60
Anti- diabetes Oral and Injectable Agents 60
Hypoglycaemia 62
Risk of Falls and Fractures 63
Cognitive Impairment 63
Nutrition 64
Management 64
Determine Frailty Risk 64
Deprescribing and Optimisation 65
Glucose Monitoring and Insulin Delivery Technologies 66
Physical Exercise 66
Healthy Diet 67
Diabetes Self- management Education for Older People 67
Clinical Practice Question 68
References 68
8 Carers and Care Needs 71
Puja Merwaha and Ahmed H Abdelhafiz
Introduction 71
Care Needs 72
Carer Groups 73
Role of Carers 73
Benefit of Care on Outcomes 74
Caring for Carers 74
Carers' Burden 75
Supporting Carers 75
Summary 76
Clinical Practice Question 78
References 78
9a Macrovascular Complications: Peripheral Arterial Disease 81
Leocadio Rodriguez- Manas, Rubi E Sandoval- Santoyo and Marta Castro-Rodriguez
Epidemiology 81
Risk Factors 81
Prevalence 82
Pathogenesis 82
Consequences of Peripheral Arterial Disease 83
Investigations 83
Anamnesis 83
Physical Examination 84
Non- invasive Tests 84
Invasive Tests 85
Management 85
Risk Factor Modification 85
Exercise Rehabilitation 85
Foot Care 86
Pharmacological Therapy 86
Antiplatelet Therapy 86
Cilostazol 86
Revascularisation 86
Clinical Practice Question 86
References 87
9b Macrovascular Complications: Coronary Arterial Disease 89
Leocadio Rodriguez-Manas, Rubi E., Sandoval-Santoyo and Marta Castro Rodriguez
Epidemiology 89
Pathogenesis 90
Medical Treatment 90
Indications for Revascularisation 91
Management of Cardiovascular Risk Factors According to Baseline Functional and Cognitive Status 92
Effect of Glycaemic Control on Cardiovascular Events 92
Effect of Blood Pressure Control 92
Lipid Monitoring 93
Physical Exercise and Diet 93
Frailty Management 93
Management 93
Summary 95
Clinical Practice Question 95
References 96
9c Macrovascular Complications: Cerebrovascular Disease 97
Abubakhr Subkhan, Arshad Majid and Ali Ali
Introduction 97
Epidemiology 98
Risk Factors 98
Aetiology and Pathophysiology 99
Presentation 99
Stroke and Transient Ischaemic Attack 101
Cerebral Small Vessel Disease and Dementia 101
Management of Cerebrovascular Disease 102
Acute Stroke 102
Management of Risk Factors 104
Prognosis 105
Summary 106
Clinical Practice Question 106
References 107
10a Microvascular Complications: Diabetic Eye Disease 109
Archith Kamath and Nachiketa Acharya
Introduction 110
Epidemiology 110
Presentation 110
Pathophysiology 111
Management 113
Primary Care 113
Secondary Care 115
Summary 117
Clinical Practice Questions 117
References 118
10b Microvascular Complications: Diabetic Kidney Disease 119
Mohsen El Kossi
Introduction 119
Diabetic Kidney Disease 120
Definitions and Diagnoses 120
Management 121
Lifestyle 121
Glycaemic Control 122
Blood Pressure Control 122
Lipid Control 123
Diabetic Kidney Disease- related Complications 124
Anaemia 124
Mineral Bone Disorder 124
Metabolic Acidosis and Fluid Retention 125
Nephrology Referral 125
Summary 126
Clinical Practice Question 127
References 127
10c Microvascular Complications: Peripheral Neuropathy 129
Mitra Tavakoli
Introduction 130
Prevalence and Risk Factors 130
Clinical Manifestations and Complications 131
Diagnosis and Assessment 132
Management of Diabetic Neuropathy 135
Diabetes Foot Care in Care Homes 136
Summary 138
Clinical Practice Question 138
References 139
11a Vascular Risk Factors: Hypertension 141
Pann Ei Hnynn Si and Ahmed H Abdelhafiz
Introduction 141
Age- related Blood Pressure Changes 142
Definition 142
Diagnosis 144
Types 144
Management 145
Recommended Targets 145
Medications 146
Considerations in Older People 147
Orthostatic Hypotension 147
Falls 148
Systolic Hypertension 148
Frailty 148
Dementia 149
Comorbidity 149
Polypharmacy 149
Summary 149
Clinical Practice Question 151
References 151
11b Vascular Risk Factors: Dyslipidaemia 153
Pann Ei Hnynn, Si and Ahmed H Abdelhafiz
Introduction 153
Ageing and Lipid Profile 154
Diabetes and Lipid Profile 154
Diabetes and Risk of Atherosclerotic Cardiovascular Disease 155
Atherosclerotic Cardiovascular Disease Risk Reduction 156
Lipid- lowering Agents 157
Goals of Therapy in Old Age 160
Recommendations from Guidelines 160
Goals in Frailty 162
Summary 162
Clinical Practice Question 162
References 164
12a Metabolic Decompensation: Hyperglycaemic Crisis 165
Puja Merwaha and Ahmed H Abdelhafiz
Introduction 165
Epidemiology 166
Precipitating Factors 166
Pathogenesis 168
Clinical Presentation 168
Diagnosis 169
Management 171
Correction of Hypovolaemia 172
Correction of Hyperglycaemia 173
Correction of Acidosis 174
Correction of Electrolytes 175
Complications 175
Prevention 176
Clinical Practice Question 176
References 177
12b Metabolic Decompensation: Hypoglycaemia 178
Srikanth Bellary, Ahmed H Abdelhafiz and Alan J Sinclair
Introduction 179
Definition 179
Recognition 179
Epidemiology 180
Pathophysiology 180
Clinical Consequences 181
Impact on Cognition 182
Impact on Frailty 182
Management 183
Summary 185
Clinical Practice Question 185
References 186
13a Management of Diabetes in Hospital 189
Julie Lewis and Chris Cottrell
Introduction 189
Fundamentals of Care 190
Key Considerations for Effective Inpatient Care for Older People with Diabetes 192
The Inpatient Setting 192
Pressure Damage and Footcare Assessment 193
Planning Care 193
Key Considerations to Reduce Unscheduled Admission to Hospital 193
Monitoring Requirements 196
Education and Training 196
Summary 197
Clinical Practice Questions 198
References 199
13b Management of Diabetes in Care Homes 201
Lynne Reedman and Alan J Sinclair
Introduction 201
Important Considerations for Diabetes Care 203
Importance of Monitoring Glucose Levels 207
Other Management Issues 207
Hypoglycaemia 208
Diabetes Foot Disease 209
Nutritional Deficiency and Weight Loss 209
Frailty 210
Education 210
Communication and Collaboration 211
Use of Audit 211
Measuring Outcomes 212
Summary 212
Clinical Practice Question 213
References 214
14 Nutrition 215
Rihan Said and Grace Zaman
Introduction 215
Nutritional Deficiencies 216
Causes of Malnutrition in the Elderly 216
Recommendations 217
Specific Recommendations for Older People with Diabetes 218
Practical Steps for Nutritional Care in the Elderly 218
Screening 218
Assessment 219
Intervention 219
Enteral Nutrition 221
Types of Enteral Tubes 221
Types of Feeds 221
Enteral Feed Delivery Options 221
Management of Blood Glucose 221
Parenteral Nutrition 222
Management of Blood Glucose 223
General Considerations for Patients on Nutritional Support 224
Summary 224
Clinical Practice Questions 225
References 226
15 Sexual Health 229
Pann Ei Hnynn Si and Ahmed H Abdelhafiz
Introduction 229
Ageing and Sexual Function 230
Diabetes and Sexual Dysfunction 230
Sexual Dysfunction in Men 231
Aetiology and Pathogenesis 231
Diagnosis 232
Treatment 233
Sexual Dysfunction in Women 236
Aetiology and Pathogenesis 236
Diagnosis 237
Treatment 237
Summary 238
Clinical Practice Questions 238
References 239
16a Special Issues in Old Age: Frailty 241
Alan J Sinclair and Ahmed H Abdelhafiz
Introduction 241
Frailty-diabetes Inter- relationship 242
Effect of Diabetes on Frailty 244
Effects of Frailty on Diabetes 245
Outcome Effects 249
Metabolic Effects 249
Sarcopenic Obese Phenotype 254
Anorexic Malnourished Phenotype 254
Prevention and Management 255
Screening 255
Non- pharmacological Therapy 256
Pharmacological Therapy 257
Special Considerations 259
Glycaemic Control 259
Choice of Hypoglycaemic Agent 260
Sarcopenic Obese Phenotype 260
Anorexic Malnourished Phenotype 260
Goals of Therapy 261
Summary 262
Future Perspectives 262
Clinical Practice Question 263
References 264
16b Special Issues in Old Age: Multimorbidity 266
Alan J Sinclair and Ahmed H Abdelhafiz
Introduction 266
Multimorbidity 267
Multimorbidity-Frailty Interaction 268
Multimorbidity Effects on Diabetes 268
Clusters of Multimorbidity 269
Clinical Implications 270
Summary 272
Future Perspectives 272
Clinical Practice Question 273
References 273
16c Special Issues in Old Age: Type 1 Diabetes Mellitus 275
Alex M Summerbell and Ahmed H Abdelhafiz
Introduction 275
Epidemiology and Diagnosis 276
Management 276
Insulin Therapy 278
Monitoring 279
Reducing Hypoglycaemia 280
Goals of Therapy 282
Summary 282
Clinical Practice Question 282
References 283
16d Special Issues in Old Age: Cognitive Health Agility, Cognitive Dysfunction, Dementia and Diabetes 285
Tali Cukierman- Yaffe
Introduction 286
Population Studies Demonstrating the Relationship Between Cognitive Dysfunction, Dementia and Diabetes 286
Implications of the Relationship Between Diabetes and Cognitive Dysfunction 287
The Effect of Cognitive Dysfunction on Self- care Capacity in Older People with Diabetes 288
Assessment of Cognitive Health Agility in Older People with Diabetes 290
Prevention and Treatment of Cognitive Dysfunction in Older People with Diabetes 291
The Effect of Current Diabetes Pharmacological Agents on Cognitive Dysfunction 291
Glucose Control 292
Insulin 293
Dipeptidyl Peptidase- 4 Inhibitors 294
Glucagon- like Peptide- 1 Receptor Analysts 294
The Multidomain Approach 295
Summary, Knowledge Gaps and Future Research 296
Clinical Practice Question 296
References 298
16e Special Issues in Old Age: Depression 299
Sara- Louise Wylie
Introduction 299
Depression and Diabetes 300
Presentation 300
Evaluation 302
Screening 302
Diagnosis 303
Assessment 304
Management 307
Lifestyle 307
Pharmacological Therapy 308
Psychotherapy 309
Collaborative Care 310
Summary 310
Clinical Practice Question 310
References 311
16f Special Issues in Old Age: Foot Care 313
Solomon Muzulu
Introduction 313
Epidemiology 314
Pathogenesis 314
Ageing and Diabetic Foot Ulcer Disease 315
Assessment of a Diabetic Foot 316
Testing for Peripheral Sensory Neuropathy 316
10- g Monofilament Test 317
128- Hz Tuning Fork 318
Ipswich Touch Test 318
Checking for Peripheral Vascular Disease 318
Management 318
Offloading 320
Debridement 320
Dressings 320
Infection Control 320
Ischaemia Relief 321
Glycaemic Control 322
Prevention 322
Summary 323
Clinical Practice Question 323
References 324
16g Special Issues in Old Age: Skin Care 326
Grace Keegan and Sarah Mahmoud
Introduction 326
Age- related Skin Changes 327
Diabetes Mellitus- related Skin Conditions 327
Primary Skin Conditions 328
Acanthosis Nigricans 328
Necrobiosis Lipoidica 328
Diabetic Dermopathy 329
Bullous Eruption of Diabetes Mellitus 329
Diabetes- related Skin Infections 330
Bacterial Infections 330
Fungal Infections 331
Diabetes Medications- related Skin Adverse Effects 334
Insulin 334
Sodium Glucose Transporter- 2 Inhibitors 334
Summary 334
Clinical Practice Question 335
References 335
16h Special Issues in Old Age: Falls and Bone Health 336
Nandkishor V Athavale
Introduction 336
Epidemiology 337
Pathophysiology of Fracture Risk in Diabetes 337
Pathophysiology and Risk Factors for Falls in Diabetes 338
Assessment of the Risk of Falls in the Community 339
Assessment of Bone Health in Community 340
Management and Prevention 344
Falls 344
Fractures 345
Summary 345
Clinical Practice Question 345
References 346
16i Special Issues in Old Age: Avoiding Hospitalisation 347
Demelza Emmerton and Ahmed H Abdelhafiz
Introduction 347
Risk Factors for Hospitalisation 348
Avoiding Hospitalisation 349
Patient- Related Interventions 349
Physical Function 349
Mental Function 351
Polypharmacy 351
Healthcare System- related Interventions 352
Community Setting 352
Care- home Setting 353
Emergency Setting 353
Summary 355
Clinical Practice Question 355
References 356
16j Special Issues in Old Age: Use of Technology 357
Anna Kahkoska, Aastha Dubal, Josh Weinstein and Ruth S Weinstock
Introduction 358
What Is Diabetes Technology? 358
What Is Remote Patient Monitoring? 359
Diabetes Technology and Remote Patient Monitoring in Older Adults 360
Management 362
Continuous Glucose Monitoring 362
What Is Continuous Glucose Monitoring? 362
What Is the Evidence for Continuous Glucose Monitoring as Part of Management for Older Adults with Diabetes? 362
What Are Challenges for Continuous Glucose Monitoring Use in Older Adults? 363
Automated Insulin Delivery Systems 363
What Is Automated Insulin Delivery? 363
Evidence on Automated Insulin Delivery for Older Adults 364
Clinical Guidelines for Automated Insulin Delivery Usage among Older Adults with Type 1 Diabetes 364
What Are Challenges for Automated Insulin Delivery Use in Older Adults? 364
Integration of Diabetes Technologies with Remote Patient Monitoring 365
What Are the Key Issues? 366
Clinical Practice Questions 368
References 369
16k Special Issues in Old Age: Annual Reviews 371
Puja Merwaha and Ahmed H Abdelhafiz
Introduction 371
Diabetes Phenotype in Older People 372
Multimorbidity 372
Geriatric Syndromes 373
Frailty 373
Functional Implications 373
Annual Review Contents 374
Demographics 374
History 374
Physical Examination 374
Vascular Complications 376
Sexual Function 376
Cognition and Mood 376
Physical Function and Frailty 377
Foot Care 377
Diet and Nutrition 377
Medication Review 377
Infection Prevention 378
Summary 378
Clinical Practice Question 378
References 380
16l Special Issues in Old Age: Mouth Care 381
Nali Ahmed and Ahmed H Abdelhafiz
Introduction 381
Age- related Oral Changes 382
Diabetes- related Oral Changes 382
Common Oral Conditions in Older People with Diabetes 384
Periodontal Disease 384
Dental Caries 384
Dry Mouth 385
Candida 386
Oral Cancer 386
Taste Impairment 387
Mouth Care 387
Education 387
Glycaemic Control 388
Preventative Measures 388
Summary 389
Clinical Practice Question 390
References 390
16m Special Issues in Old Age: Pain Management 392
Pann Ei Hnynn Si and Ahmed H Abdelhafiz
Introduction 392
Aetiology 393
Assessment 393
Pain in Care- home Residents 396
Management 397
Non- pharmacological Therapy 397
Pharmacological Therapy 398
Prevention 401
Clinical Practice Question 401
References 402
17 Deintensification of Therapy 405
Antoine Christiaens
Introduction 405
Key Issues 407
Management 407
Identifying Patients Who Might Benefit 407
Deintensifying Glucose- lowering Treatment in Older Patients 409
Implementing Deintensification in Daily Clinical Practice 410
Clinical Practice Questions 411
References 412
18 Diabetes in End- of- Life Care 413
June James
Introduction 413
Background 414
What is End of Life and How is the Need for End- of- life Care Identified? 414
Management of Diabetes in End- of- Life Care 419
Medicines Management and De- escalation of Therapies 419
Steroids and Cancer 422
Nutrition and Enteral Feeding 424
Advanced Care Planning 424
Treatment Withdrawal 424
Workforce Training and Competencies 424
Summary 425
Clinical Practice Questions 425
References 426
Answers to Clinical Practice Questions 429
Index 445
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