The risks and benefits of implementing glycemic control guidelines in frail older adults with XXXX .

@entity1 @entity6 @entity7593 @entity341 @entity4053 @entity4854 @entity734 @entity1602 @entity413 @entity2449
OBJECTIVES: To determine the hypo- and @entity1602 outcomes associated with implementing the @entity7593 ( @entity7593 ) guideline for a glycosylated hemoglobin (HbA1c) level of less than 8% in frail older adults with @entity6 ( @entity6 ). DESIGN: Guideline implementation. SETTING: Program of All-Inclusive Care for the Elderly. @entity1 : All @entity1 in the before (October 2002-December 2004, n=338), early (January 2005-June 2006, n=289) and late (July 2006-December 2008, n=385) periods of guideline implementation with a diagnosis of @entity6 and at least one HbA1c measurement. INTERVENTION: Clinician education in 2005 with annual monitoring of the proportion of each clinician's @entity1 with @entity6 with HbA1c less than 8%. MEASUREMENTS: @entity4053 (blood @entity413 <50 mg/dL), @entity4854 (blood @entity413 >400 mg/dL), and severe @entity4053 ( @entity341 ( @entity341 ) visit for @entity4053 ). RESULTS: @entity1 in the before, early, and late periods were similar in age, race and ethnicity, comorbidities, and functional @entity734 . Antihyperglycemic medication use was greater in the late period, with more @entity1 using @entity2449 (28% before, 42% late, P<.001) and insulin (23% before, 34% late, P<.001) and achieving the @entity7593 glycemic target of HbA1c of less than 8% (74% before, 84% late, P<.001). Episodes of @entity4854 (per 100 @entity1 -years) were dramatically lower in the late period (159 before, 46 late, P<.001), and episodes of @entity4053 were similar (10.1 before, 9.3 late, P=.50). There were more episodes of severe @entity4053 in the early period (1.1 before, 2.9 early, P=.03). CONCLUSION: Implementing the @entity7593 glycemic control guideline for frail older adults led to fewer @entity1602 episodes but more severe hypoglycemic episodes requiring @entity341 visits in the early implementation period. Future glycemic control guideline implementation efforts should be coupled with close monitoring for severe @entity4053 in the early guideline implementation period.
