Type 2 diabetes: frailty in older people

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Summary covers glycaemic targets for older people, priorities for improving high-quality diabetes care, and a useful frailty assessment pathway.

One of the main changes to the GP contract—as laid out in Investment and evolution: a five-year framework for GP contract reform to implement The NHS Long Term Plan—is the introduction of new Quality and Outcomes Framework (QOF) indicators for the management of type 2 diabetes mellitus (T2DM). New glucose targets will be set to avoid under-treatment for adults under 65 years; however, for older people, GPs will be required to assess frailty and, where this is diagnosed, patients should be managed using individualised glucose targets. Medications that may be doing harm should be stopped based on clinical judgment with a view to reducing hypoglycaemic episodes, falls, and therefore the risk of fractures and hospitalisation. This paradigm shift means that achieving tight control of HbA1c levels for people with frailty will no longer be incentivised.  

To help you with implementation of the new QOF indicators for patients with frailty, we have published a Guidelines summary on Type 2 diabetes mellitus in older people: a brief statement of key principles of modern day management including the assessment of frailty. A national collaborative stakeholder initiative. This summary includes a frailty assessment pathway, recommended therapeutic targets, treatment de-escalation thresholds, and much more.

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