Endocrine Society GUIDELINES Bundle (free trial)

Treatment of Diabetes in Older Patients

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106 Commerce Street, Suite 105 Lake Mary, FL 32746 TEL: 407.878.7606 • FAX: 407.878.7611 Order additional copies at GuidelineCentral.com Copyright © 2019 All rights reserved ESDIA1933d Disclaimer is pocket guide attempts to define principles of practice that should produce high-quality patient care. It focuses on the needs of primary care practice, but also is applicable to providers at all levels. is pocket guide should not be considered exclusive of other methods of care reasonably directed at obtaining the same results. e ultimate judgment concerning the propriety of any course of conduct must be made by the clinician aer consideration of each individual patient situation. Neither IGC, the medical associations, nor the authors endorse any product or service associated with the distributor of this clinical reference tool. Source LeRoith D, Biessels GJ, Braithwaite SS, Casanueva FF, Draznin B, Halter JB, Hirsch IB, McDonnell ME, Molitch ME, Murad MH, Sinclair AJ. Treatment of diabetes in older adults: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2019:104(5) Abbreviations ACE, angiotensin-converting enzyme; ACR, albumin/creatinine ratio; ARB, angiotensin receptor blocker; ADA, American Diabetes Association; ADL, activity of daily living ; BP, blood pressure; CGM, continuous glucose monitoring ; CHF, congestive heart failure; CKD, chronic kidney disease; CVD, cardiovascular disease; DPP, Diabetes Prevention Program; DPP-4, dipeptidyl peptidase-4; FPG, fasting plasma glucose; GLP-1, glucagon-like-peptide 1; GFR, glomerular filtration rate; IADL, instrumental activity of daily living ; IFG, impaired fasting glucose; IGT, impaired glucose tolerance; LDL-C, low-density lipoprotein cholesterol; MCI, mild cognitive impairment; OGTT, oral glucose tolerance test; PG, plasma glucose; RCT, randomized control trial; SGLT2, sodium-glucose cotransporter 2; SDM, shared decision-making ; SU, sulfonylurea; T1D, type 1 diabetes; T2D, type 2 diabetes; TZD, thiazolidinedione Grading System Quality of Evidence High Quality Moderate Quality Low Quality Very Low Quality Description of Evidence • Well-performed RCTs • Very strong evidence from unbiased observational studies • RCTs with some limitations • Strong evidence from unbiased observational studies • RCTs with serious flaws • Some evidence from observational studies • Unsystematic clinical observations • Very indirect evidence from observational studies Strength of Recommendation Strong (1): "ES recommends…" Benefits clearly outweigh harms and burdens or vice versa 1|⊕⊕⊕⊕ 1|⊕⊕⊕ 1|⊕⊕ 1|⊕ Conditional (2): "ES suggests…" Benefits closely balanced with harms and burdens 2|⊕⊕⊕⊕ 2|⊕⊕⊕ 2|⊕⊕ 2|⊕ Ungraded Good Practice Statement UGPS

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