All patients included in the research (both intervention and control groups, totaling a
sample size of N=220 participants) will undergo geriatric assessment using the CFS and
TaGA-10 tools. Using the CFS, the investigators will classify patients with scores of 1
to 3 as "functionally independent," 4 to 5 as "functionally dependent," and scores 6 to 8
as "frail." Patients will be randomized by random permuted block randomization, with
block sizes of 2 and 4, stratified by frailty status ("functionally independent",
"functionally dependent", or "frail").
Patients allocated to the control group will receive usual treatment without any
additional procedures.
For the intervention group, before making decisions in the case discussion, the
investigators will provide the physician a short note containing a suggested care plan as
follows:
Functionally independent (CFS 1-3): Glycemic targets should be equal to the general
population, disregarding age. Consider seeking long-term treatment effects. Target
suggested HbA1c around 7.0%.
Functionally dependent (CFS 4-5): Consider higher glycemic targets by 0.5% compared
to the general adult population. Aim for short- and medium-term treatment effects.
Target suggested HbA1c less than 8.0%.
Frail (CFS 6-8): Consider higher glycemic targets by 1.5% compared to the general
adult population. Aim to reduce treatment complications. Do not expect medium- and
long-term treatment effects. Target suggested HbA1c less than 8.5%.
These care plans are based on the Diabetes Canada Clinical Practice Guidelines Expert
Committee guideline recommendations. Patients with a CFS of 9 will be excluded due to the
recommendation of not measuring HbA1c to this group.
The investigators will initially approach the physicians at the outpatient clinic to
apply the informed consent process and request possible eligible patients from the
physician. Each physician will sign a consent form to participate in the entire study.
Afterward, the investigators will check the patient's eligibility and apply the informed
consent. If any of the participants (physician or patient) disagree with participating in
the research, the pair will not be included. Physicians and patients wishing to withdraw
consent to participate in the research can do so at any time; in this case, the pair will
be treated as lost to follow-up.
The application of the Clinical Frailty Scale, with an estimated duration of 1 minute,
will be conducted immediately after obtaining informed consent from the patient. The
physician will attend to the patient, and during the discussion with the preceptor, the
investigators will apply the TaGA-10 scale in the office. At this time, the patient will
also be randomized with the assistance of the RedCap program. For the intervention group,
the investigators will provide the physician with a geriatric assessment proposing a
glycated hemoglobin target.
Information not requiring in-person assessment will be collected from medical records or
during a telephone interview. The adequacy of the therapeutic approach (main outcome)
will be measured in one week by reviewing the consult record or interviewing the
physician.
The second and third evaluations will be conducted by telephone contact 3 and 6 months
after the first visit. During this contact, the incidence of falls, infections,
hypoglycemia, hospitalizations, and death will be queried, as long as the consult of new
measurements of HbA1c on medical records. The data will be stored using the institutional
computer in the institutional Google Drive and will be processed and analyzed using the
RedCap program. The data will be anonymized for the analysis.