2) Statement of accreditation and faculty disclosures can be viewed at https://t.co/PHlIpplEO4. @ckd_CE is your ONLY source for #accredited #serialized #tweetorials in the #renal space. #FOAMed #Cardiotwitter @MedTweetorials @GoggleDocs #Endotwitter #nephtwitter
— @CKD_ce (@ckd_ce) October 26, 2022
4) Let’s hold a poll to decide! At what age do YOU consider a person as “older”?
— @CKD_ce (@ckd_ce) October 26, 2022
5b) As HCPs, age thresholds for clinical management can also be ad hoc
— @CKD_ce (@ckd_ce) October 26, 2022
Age is just a number! pic.twitter.com/LYjHrQjoQk
7) The @IDF also usefully suggested #HbA1c, #BP & #lipid goals according to functional status pic.twitter.com/M9GcTGd0bV
— @CKD_ce (@ckd_ce) October 26, 2022
9) And, of course, most important of all is supporting the autonomy of the older individual living with T2D; what are their ideas, concerns & expectations of treatment?
— @CKD_ce (@ckd_ce) October 26, 2022
11) When managing diabetes in the older person, we as HCPs need to take an individualised and holistic approach to care – one size does not fit all! pic.twitter.com/kBbU5HUA86
— @CKD_ce (@ckd_ce) October 26, 2022
13) So, how common is diabetes as one gets older?
— @CKD_ce (@ckd_ce) October 26, 2022
Let’s hold another poll!
What is the prevalence of diabetes in those aged over 75 years?
15a) Let’s now focus on #frailty – what do we exactly mean by frailty? pic.twitter.com/tH9c9yKUcV
— @CKD_ce (@ckd_ce) October 26, 2022
15c) Relative minor insults (e.g., a UTI or new drug) result in significant loss of function with a higher risk of hospital or care home admission
— @CKD_ce (@ckd_ce) October 26, 2022
When I was a junior doctor, these were the I frequently admitted “off-legs”
16) Diagnosing #frailty requires our clinical judgement alongside evidence such as:
— @CKD_ce (@ckd_ce) October 26, 2022
•Slow gait speed
•Muscle weakness or low grip strength
•Unintentional weight loss
•Low physical activity levels
•Self-reported exhaustion pic.twitter.com/ucAVit0Zzg
18a) Why is #frailty important in #diabetes?
— @CKD_ce (@ckd_ce) October 26, 2022
Frailty is a common finding and may be present in 32-48% of adults>65 years with diabetes
19a) This Position Statement from the Association of British Clinical Diabetologists @ABCDiab addresses frailty and its association with diabetes
— @CKD_ce (@ckd_ce) October 26, 2022
20a) Sadly, older frail people living with #T2D and other significant comorbidities are less likely to survive long enough to appreciate the microvascular & macrovascular benefits of longer-term intensive diabetes management (glycaemic, lipid & BP control)
— @CKD_ce (@ckd_ce) October 26, 2022
21a) The expert consensus statement also helpfully & holistically gives recommendations on treatment escalation & de-escalation for the older adult living with #T2D according to #frailty status
— @CKD_ce (@ckd_ce) October 26, 2022
22) For the older adult with #T2D who is healthy/pre-frail/mild #frailty: pic.twitter.com/9ezdHNs0Tu
— @CKD_ce (@ckd_ce) October 26, 2022
24) As you can see priorities for #glycaemic control may shift in older moderately #frail individuals living with #T2D to favour safety and avoidance of #hypoglycaemia
— @CKD_ce (@ckd_ce) October 26, 2022
26a) Importantly, we should also be aware that older people have different or exaggerated adverse effect profiles due to medication (e.g. #hypoglycaemia, acute kidney injury #AKI, postural hypotension)
— @CKD_ce (@ckd_ce) October 26, 2022
26c) This helpful 9-minute video by @drmiketodorovic explains these changes in more detailhttps://t.co/aXxCg9HNmT
— @CKD_ce (@ckd_ce) October 26, 2022
27b) A very recent small #RCT published in @DiabetesCareADA explored the efficacy of lifestyle intervention in older adults w/ #diabetes & found that lifestyle intervention strategies can be highly successful in improving metabolic & functional health in these patients pic.twitter.com/Z6WUjKeWDS
— @CKD_ce (@ckd_ce) October 26, 2022
28b) This includes evaluation of multiple issues – physical, #cognitive, #affective, social, financial, environmental, #spiritual – that influence an older person’s health
— @CKD_ce (@ckd_ce) October 26, 2022
29a) And that folks, is all! I hoped you enjoyed this tweetorial and found it helpful and thought-provoking
— @CKD_ce (@ckd_ce) October 26, 2022
29c) His book “Being Mortal” is an exploration of #aging & death in our society & the potential harms of medicalising this rather than accepting it as part of our culture pic.twitter.com/fGVdbF5anN
— @CKD_ce (@ckd_ce) October 26, 2022
30) So now–& you can duly acknowledge your mortality as you do this–go to https://t.co/SnAi0VbCsa & print out your certificate for 0.5h CE/#CME: #physicians #nurses #pharmacists #NPs #PAs. I am @drkevinfernando & I 🙏 for joining us! Follow us & also follow @cardiomet_ce!
— @CKD_ce (@ckd_ce) October 26, 2022