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May 2009 sees the publication of the first of the Society’s re-vamped Best Practice Guides, produced by a working group from the Diabetes Special Interest Group (SIG). Diabetes is a major source of morbidity and mortality among older patients, costing at least 5% of the total NHS budget.

Half of all people with diabetes in the UK are aged over 65 years and a quarter over 75 years. Although the condition has its own National Service Framework (NSF), mention of the older patient is only to be found there in a section referring to prisoners and others living in institutions! Thus, it is imperative that geriatricians know how to manage these patients.

The guide outlines the range of co-morbidities associated with diabetes including macrovascular and microvascular disease (the targets of most pharmacological interventions) as well as more specialist concerns for the geriatrician, including gait and balance disorder, visual impairment and dementia. It is well referenced, with 23 key citations, although intentionally avoids a lengthy review of drug intervention studies, which would soon be out of date!

It is an interesting time in diabetes care, with a range of new drugs, including the GLP-1 analogue exenatide and the gliptins, whose role in routine management is still to be divined. We also have newer evidence on the risks and benefits of glycaemic control, as Gillian Hawthorne presented at the Spring 2009 meeting of the Society, including metformin, the glitazones and sulphonylureas. The National Institute for Clinical Excellence (NICE) will surely be incorporating the expanding evidence base into its current review.

This year also sees the publication of Alan Sinclair’s cyclopaedic review of Diabetes in Old Age, and the Institute of Diabetes for Older People (IDOP, www.instituteofdiabetes.org), led by Alan, will hopefully offer a focus for diabetes research in this neglected area. As a Special Interest Group of the BGS, we are very keen to recruit interested geriatricians and others, who want to support postgraduate education in diabetes care. We will be arranging a meeting for Autumn 2009, with a plan to develop an education programme for 2010. Interested members of the Society (and others) can contact us through the editor.

Terry Aspray

1. Aspray, TJ; Yarnall, AJ; Croxson, SC; Chillala, J; Sinclair, AJ. Diabetes British Geriatrics Society Best Practice Guide 6.4. May 2009 http://www.bgs.org.uk/Publications/Compendium/compend_6-4_Diabetes.html.
2. Management of type 2 diabetes - Managing blood glucose levels http://www.nice.org.uk/guidance/G
3. Sinclair AJ, ed. Diabetes in Old Age. Chichester, John Wiley and Sons, 2009.

BGS Newsletter, July 2009
Issue 22 ISSN 1748-6343 22