Monitoring diabetes in people over 75
Recommendations for monitoring diabetes
in people aged over 75 years
National data by ethnicity
Appropriate testing of HbA1c
In elderly people with diabetes, HbA1c should be tested annually as part of an annual diabetes review.1 Some patients may need to be tested more often; however more frequent testing is not necessary in patients with stable, well controlled diabetes.
Ongoing HbA1c testing is important for monitoring glycaemic control and predicting the risk of further complications.
Testing for microalbuminuria
Diabetic nephropathy is one of the most common forms of chronic kidney failure in the developed world and occurs in more than 30% of people with diabetes.4 Diabetic nephropathy generally takes six to 15 years to develop and therefore is more prevalent in older people with a long history of diabetes.4
Microalbuminuria is the first sign of nephropathy, but not all people with microalbuminuria will progress to full nephropathy. If detected early, microalbuminuria can be reversible with good glycaemic control and management of blood pressure.
Nationally, the rate of microalbumin testing in elderly patients is lower than we would expect. In older patients, the specifity of the albumin:creatinine ratio is reduced,5 however it remains the best way to detect early stage microalbuminuria and regular monitoring is important in people with diabetes, regardless of their age.
- Diabetes New Zealand. Annual diabetes check-up. Available from: www.diabetes.org.nz (Accessed May, 2012).
- Ministry of Health. Pharmaceutical Collection. (Accessed May, 2012).
- Ministry of Health. Laboratory Claims Collection. (Accessed May, 2012).
- Philips A. Diabetic nephropathy. Medicine 2011;39(8):470-4.
- Houlihan C, Tsalamandris C, Akdeniz A, Jerums G. Albumin creatinine ratio: a screening test with limitations. Am J Kid Dis 2002;38(6):1183-9.
- National data excludes Nelson Marlborough DHB and South Canterbury DHB areas due to laboratory data recording discrepancies in these areas.