American Geriatrics Society reverses recommendation on elderly diabetics' aspirin use

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Elderly people with type 2 diabetes should not take aspirin to prevent cardiovascular disease, according to draft guidelines from the American Geriatrics Society. The organization reversed its previous recommendation on aspirin usage in its recently updated “Guidelines for Improving the Care of the Older Adult with Diabetes Mellitus.”

This is the first update since the guidelines were originally issued in 2003. The changes were recommended by a panel of experts from the fields of medicine, nursing, pharmacy and research.

The AGS reversed its previous recommendation based on two large studies, which found that taking aspirin did not improve cardiovascular health outcomes for adults with type 2 diabetes. Considering that aspirin poses a risk of “adverse side effects and bleeding,” the drug should not be used as a means of primary prevention for CVD by geriatric diabetics, the new guideline states.

However, there is “strong evidence” that aspirin may be an effective means of secondary prevention for elderly diabetics who have already had a stroke or heart attack, the guidelines state.

In another change, the updated guideline places “special emphasis” on weighing life expectancy and quality of life issues with glycemic control interventions.

“It is likely that there is an association between moderate glycemic control and enhancement of wound healing, reduction of symptoms associated with hyperglycemia such as polyuria and fatigue, and possibly maximization of cognitive function,” the guidelines state. “However, the available data suggest that many of these shorter-term benefits may be achieved with less-aggressive glycemic targets than those recommended in most of the national DM guidelines.”

The AGS is accepting comments on the revised guidelines through April 15. Comments can be submitted here.