| Description |
Diabetes is a complex, multifaceted condition that involves genetics, behavior patterns, environmental factors, cultural and religious beliefs, socioeconomic status, existing co-morbid conditions, and age. The purpose of this integrated literature review was to establish clinical guideline recommendations based on existing literature, expert opinion and clinical practice. This project was proposed as an integrated literature review of current recommendations for glycemic goals in diabetic patients over the age of 75. In addition to an integrated literature review, this project included results of an e-mail questionnaire that explored factors that influence decision making for local and regional clinicians who provide diabetes care for the elderly. The objectives of this project were: 1) Develop an integrative review and summary of literature specifically addressing the unique needs of diabetes management in persons age 75 and older; 2) Determine current practice by means of a questionnaire to health care providers that treat the elderly population with diabetes; 3) Submit recommendations arising from the review to the Utah and Wyoming Diabetes Prevention and Control Programs; and 4) Present findings and results of this project to the staff and health care providers at St. John's Hospital in Jackson, Wyoming. After obtaining IRB approval, the questionnaire was distributed to approximately 2000 healthcare providers. Four-hundred and fifty-three responses were obtained, with 200 of these involved in primary care. A majority (89%) acknowledged the importance of specific guidelines for this population, yet only 20.5% reported using specific guidelines. Eighteen percent of respondents reported a hemoglobin A1C (A1C) <7.0% was optimal in the elderly; 7.6%, stated 7.0% to 7.9%; 23.4 percent state 8.0%. The general consensus of the literature review stressed individualized treatment of diabetes in the elderly and quality of life as priorities of management. Specific recommendations for management of the elderly with diabetes include; individual patient assessment including comorbid conditions and risk of hypoglycemia, avoidance of "diabetic diet", encouraging exercise, frequent reassessment of medications, evaluation of limitations, simplification of regimes, and relaxed A1C guidelines. Aggressive pursuit of an A1C of < 7% is not recommended, particularly in the frail elderly. The Utah Diabetes Prevention and Control Program is now considering these recommendations for revisions to the Utah State Diabetes Practice Recommendations. The objectives were fulfilled upon: 1) Approval of the integrative review and recommendations by content experts and committee chair; 2) Completion of a questionnaire of health care providers that treat elderly population with diabetes; 3) Submission of results of survey and integrated review with recommendations for specific and realistic glycemic goals for aged diabetics to the Utah and Wyoming Diabetes Prevention and Control Programs; and 4) Presentation of recommendations in January 2013 to the staff at St. Johns Hospital. The DNP Essentials addressed in this project include: Essential I: Scientific Underpinnings for Practice and Essential III: Clinical Scholarship and Analytical Methods for Evidence-Based Practice. |
