2) Statement of accreditation and faculty disclosures can be viewed at https://t.co/gvXca4XKOU. @cardiomet_CE is your ONLY source for #accredited #serialized #tweetorials in the #cardiometabolic space. #FOAMed #Cardiotwitter @MedTweetorials @GoggleDocs #Endotwitter
— cardio-met (@cardiomet_CE) September 28, 2022
4) Let’s hold a poll to decide! At what age do YOU consider a person as “older”?
— cardio-met (@cardiomet_CE) September 28, 2022
5b) As HCPs, age thresholds for clinical management can also be ad hoc
— cardio-met (@cardiomet_CE) September 28, 2022
Age is just a number! pic.twitter.com/rcUylyKYsq
7) The @IDF also usefully suggested #HbA1c, #BP & #lipid goals according to functional status pic.twitter.com/RXOkmJjZyY
— cardio-met (@cardiomet_CE) September 28, 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?
— cardio-met (@cardiomet_CE) September 28, 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!
— cardio-met (@cardiomet_CE) September 28, 2022
13) So, how common is #diabetes as one gets older?
— cardio-met (@cardiomet_CE) September 28, 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/lJImhmAli4
— cardio-met (@cardiomet_CE) September 28, 2022
15c) Relatively 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
— cardio-met (@cardiomet_CE) September 28, 2022
When I was a junior doctor, these were the I frequently admitted “off-legs”
17) In the 🇬🇧, @NICE recommends using the #PRISMA_7 questionnaire to help identify #frailty. A score of 3 or more suggests the need for clinical review
— cardio-met (@cardiomet_CE) September 28, 2022
Frailty is a dynamic condition that can worsen or improve over time pic.twitter.com/VQONXbhSJq
18b) #Diabetes is associated with an accelerated aging process & #sarcopenia–a progressive decline in muscle mass leading to impaired strength & functioning
— cardio-met (@cardiomet_CE) September 28, 2022
Diabetes, sarcopenia and frailty are associated with increased disability, morbidity, and mortality pic.twitter.com/eaU9p8qsQs
19b) It provides recommendations for defining & frailty, clinical recommendations to guide clinical decision-making as well as ideas for clinical audit in frailty
— cardio-met (@cardiomet_CE) September 28, 2022
🔓https://t.co/rrfWO2wzZE pic.twitter.com/AUfTr3Bz3e
20b) A recently published expert consensus statement recommended treatment goals, interventions, and targets according to frailty status in older adults living with #T2D
— cardio-met (@cardiomet_CE) September 28, 2022
🔓https://t.co/RzYeE7K9XH
I have summarised the consensus statement here:
🔓https://t.co/Ln3YdPLsSZ pic.twitter.com/NVQPz3o1Mz
21b) As HCPs, we’re very proficient at prescribing drugs but perhaps not so proficient at #de_prescribing drugs… pic.twitter.com/zzXhWj9y5x
— cardio-met (@cardiomet_CE) September 28, 2022
23) And for the older adult with #T2D who has moderate #frailty: pic.twitter.com/0H3NcW8cSL
— cardio-met (@cardiomet_CE) September 28, 2022
25) And finally, for the older adult with #T2D who has severe #frailty: pic.twitter.com/xdkRSPNBMs
— cardio-met (@cardiomet_CE) September 28, 2022
26b) This is driven by changes in pharmacodynamics (“how the drug alters the body” e.g., increased sensitivity to #psychotropic drugs) and pharmacokinetics (“how the body alters the drug” e.g., reduced #renal elimination of drugs) that occur normally with aging
— cardio-met (@cardiomet_CE) September 28, 2022
27a) Management of #diabetes in the older person should still comprise diet and exercise interventions, as appropriate, as these individuals may also suffer from #malnutrition or #sarcopenia
— cardio-met (@cardiomet_CE) September 28, 2022
28a) Finally, functional deficits/frailty can also potentially be reversed with what is now termed a comprehensive #geriatric assessment.
— cardio-met (@cardiomet_CE) September 28, 2022
28c) Again, when I @drkevinfernando was a junior doctor this sounds like the good old-fashioned Day Hospital I used to work in! A new name for an old concept…
— cardio-met (@cardiomet_CE) September 28, 2022
see @GeriSoc 🔓https://t.co/mgUE9Hf4IO pic.twitter.com/qEGDQdQsA3
29b) I’ll leave you with a powerful book to read by @Atul_Gawande – the American surgeon, writer & public health researcher.
— cardio-met (@cardiomet_CE) September 28, 2022
30) So now–and you can duly acknowledge your mortality as you do this–go to https://t.co/hJqgyj15gU and print out your certificate for 0.5h CE/#CME: #physicians #nurses #pharmacists #NPs #PAs. I am @drkevinfernando and I thank you for joining us!
— cardio-met (@cardiomet_CE) September 28, 2022