Guidance on managing type 1 diabetes in older people

Sinclair AJ, Dunning T, Dhatariya K (2019) Clinical guidelines for type 1 diabetes mellitus with an emphasis on older adults: an Executive Summary. Diabet Med 37: 53–70

• The number of people aged over 70 years who have type 1 diabetes is increasing. These individuals have an increased risk of comorbidity, frailty and dementia.
• A Diabetes UK position statement has been issued summarising the recommendations of the first guideline specifically considering the needs of older people with type 1 diabetes.
• There is currently a shortfall in the care of adults with type 1 diabetes and the recommendations aim to support practitioners in patient assessment and risk stratification, enabling an individualised integrated approach to management.
• The principles underpinning the guideline include the creation of an individualised care plan, reducing patient distress, increasing the availability of educational support, implementing local health strategies to minimise complications, assisting practitioners with therapeutic decision-making based on comprehensive assessment and risk stratification, and ensuring palliative patients experience a dignified death.
• Key general and specific clinical recommendations are provided based on patients’ functional level and self-management ability. 
• Eleven areas are covered in the full guideline: clinical diagnosis; creating management plans; education on diabetes self-management; nutritional therapy; physical activity, exercise and lifestyle modification; insulin; technology use; hypoglycaemia; cardiovascular risk management; microvascular risk management; and inpatient management of diabetes and ketoacidosis. The summary focuses on five of these areas.

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