Sergio Tondini, Massimo Boemi, P Marnini, PM Bollati, V Fiore, Maria Chiara Rossi, Antonio Nicolucci, Carlo Giorda, Antonio Ceriello, Maria Antonietta Pellegrini and Diabetes in the Elderly Study Groups
Objectives: The present study aims at exploring current approaches of Italian diabetologists, with regards to fundamental parameters in quality of care of elderly patients with type II diabetes, focusing at the same time on existing critical areas.
Research project and methodology: The results of clinical data, gathered during year 2009, were extracted from electronic medical records. The following parameters, taken from a source population of elderly people with diabetes aged ≥ 65 years, were assessed: glycated haemoglobin (Hb1Ac); renal function; lipid profile; arterial blood pressure; foot and eye examination. In addition, specific favorable and unfavorable outcomes of therapeutical intervention were also evaluated.
Results: We assessed a total of 414,814 patients with type II diabetes in 236 diabetic centers; 39.9% were aged <65 years, 34.9% between 65 and 74 years and 25.2% >74 years. We observed a high adherence to guidelines in the measurement of Hb1Ac regardless of age, while there was a shortage in the frequency of detection of the lipid profile and blood pressure in the elderly patients. Similarly, there was a significant reduction in the percentage of patients monitored for microalbuminuria, foot and retinopathy with increasing age.
In 11% of elderly patients, Hb1Ac levels were >9%, whereas in 24.9% Hb1Ac was <6.5. A poor lipid control was observed in about 30% of elderly patients, while the percentage of older patients lacking an optimal blood pressure control was more than twice.
Conclusions: As a whole, Italian diabetes care centers seem to provide a different quality of care to elderly type 2 diabetic patients compared to younger individuals. The data call for a higher attention for this class of frial subjects for the definition of reference objectives for elderly people.