Improving the care of elderly diabetic patients: the final report of the St Vincent Joint Task Force for Diabetes

Diabetes mellitus is an important, growing health problem for the elderly population. Hyperglycaemia and hypoglycaemia, microvascular and large vessel complications all adversely affect the quality of life of elderly patients, while placing a heavy demand on limited health care resources [1]. A recently published consensus document on the management of non-insulin-dependent diabetes (the commonest type in elderly subjects) warns us not to 'overtreat' our elderly patients [2], but the authors are unable to define what they mean by 'elderly'. Failure to characterize patients in terms of functional and mental ability may prevent many patients receiving their appropriate level of diabetic care. Older patients require a management approach that differs from that for younger adults because of the presence of co-morbidity, age-related changes in functional ability, the threat of and susceptibility to hypoglycaemia, and the increased role of informal carers. Representatives of government health departments, patients' organizations, and diabetes experts met, under the aegis of the World Health Organisation for Europe and the International Diabetes Federation, in St Vincent, Italy, in 1989. They unanimously agreed on several general goals. These included a sustained improvement in health and quality of life, as well as the promotion of independence, equity and selfsufficiency for all people with diabetes, including elderly subjects. Five-year targets for the prevention of microand macrovascular complications were identified, as was the importance of educating patients and carers in diabetes management (Table 1) [3]. To advise on the implementation of this initiative, the Department of Health and the British Diabetic Association jointly established a Task Force in 1992, which produced a final report in 1995 addressing the goals and targets of the original Declaration [4] (see Table 1). The report highlighted the importance of achieving uniform standards for diabetes care, with the expectation that improved education would lead to patients taking the lead in managing their disease. Although the report can be criticized for not establishing a specific sub-group for diabetes in older patients, it did recognize old people as having special needs and requiring improvements in care for every aspect of diabetes management, education and research. The importance of multisystem disease in older people was noted. A key recommendation was that local diabetes service advisory groups (LDSAGs) should take a lead in establishing comprehensive healthcare policies for all people with diabetes (irrespective of age) within each health district. These groups should develop a localitybased service, incorporating a diabetes register as a prerequisite for assessing need and attaining St Vincent targets [5].