Background The application of clinical practice guidelines (CPGs) across the spectrum of individuals living with diabetes can be challenging, particularly in older adults, where factors such as frailty and multimorbidity exacerbate the complexity of management. Objective This systematic review aimed to explore the guidance provided within diabetes CPGs for management of individuals who are older and/or frail, including recommendations for haemoglobin A1C (HbA1c) target and pharmacotherapeutic management. Methods A systematic search was completed in Medline and Embase to identify national or international type 2 diabetes CPGs published in the last 10 years. Data extracted included recommendations for HbA1c targets and pharmacotherapy in older and frail adults, frailty screening and deprescribing. Quality of included CPGs was appraised with the AGREE II tool. Results Twenty-three CPGs were included, within which older adults and frailty were discussed in 21 and 14 CPGs, respectively. Specific HbA1c targets for older and/or frail adults were provided by 15 CPGs, the majority of which suggested a strict target (<7.0%–7.5%) in healthier older adults and a more relaxed target (<8.0%–8.5%) in those who are frail or medically complex. Ten CPGs provided recommendations for insulin therapy and 16 provided recommendations for non-insulin antihyperglycaemic agents that were specific to older and/or frail populations, which primarily focused on minimising risk of hypoglycaemia. Conclusion Most diabetes CPGs recommend strict HbA1c targets in healthier older adults, with more relaxed targets in those living with frailty or medical complexity. However, significant variability exists in pharmacotherapy recommendations and there were proportionately less recommendations for individuals who are frail.

中文翻译：

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针对老年和体弱的 2 型糖尿病成人患者的指南建议的系统评价


背景 临床实践指南 （CPG） 在糖尿病患者中的应用可能具有挑战性，尤其是在老年人中，虚弱和共存等因素加剧了管理的复杂性。目的 本系统综述旨在探讨糖尿病 CPG 中为老年人和/或虚弱个体管理提供的指导，包括血红蛋白 A1C （HbA1c） 目标和药物治疗管理的建议。方法 在 Medline 和 Embase 中完成系统检索，以确定过去 10 年发表的国内或国际 2 型糖尿病 CPG。提取的数据包括对老年和体弱成人的 HbA1c 靶标和药物治疗的建议、虚弱筛查和取消处方。使用 AGREE II 工具评估内含 CPG 的质量。结果 共纳入 23 个 CPGs，其中 21 个和 14 个 CPG 分别讨论了老年人和虚弱。15 项 CPG 为老年人和/或体弱的成年人提供了特定的 HbA1c 目标，其中大多数建议在更健康的老年人中采用严格的目标 （<7.0%–7.5%），在体弱或身体复杂的人群中采用更宽松的目标 （<8.0%–8.5%）。10项CPGs提供了胰岛素治疗的建议，16项提供了针对老年人和/或虚弱人群的非胰岛素降糖药的建议，主要侧重于降低低血糖风险。结论大多数糖尿病 CPG 建议对更健康的老年人进行严格的 HbA1c 目标，对身体虚弱或医疗复杂性的人进行更宽松的目标。 然而，药物治疗建议存在显著差异，并且针对虚弱个体的建议成比例地较少。