The 4 perspectives were: (1) Recognizing and Defining the Problem Eight domains of interest were initially agreed and discussed: hypoglycemia, therapy, care home diabetes, influence of comorbidities, glucose targets, family/carer perspectives, diabetes education, and patient safety. For those participants joining Sirolimus research buy for the teleconference only, a brief summary of each domain was prepared by the moderator and each participant was given an opportunity to contribute further. We partly addressed the judgmental issue by asking participants to rank their level of agreement with each of the 4 perspectives according to the following scale (which was discussed and agreed

in advance): Figure options Download full-size image Download high-quality image (88 K) Download as PowerPoint slide The definitions of each grading scale are given in Appendix B. The moderator used a “voting” system when final comments and solutions were being offered

so as to reach consensus. After the conference weekend, the moderator produced a draft report and provided all participants with a chance to make further contributions. These were received, tabulated, and redistributed to members, and a second roundtable and international teleconference was held in Oxford, UK, in January 2011. A final consensus was then agreed. At the start of the roundtable, participants ranked the order of importance of the domains. For this part only, we show the influence of global experts in modifying the emphasis of the ranking grades. The overall ranking is shown in Table 1. Each domain was discussed in detail during the moderated discussions (available on request). The following statements selleck chemical were agreed by consensus and a comment given in each case. These statements pertain to patients 70 years and older. Consensus statements (1) The clinician must consider Etofibrate individual comorbidities, and cognitive and functional status when determining what glucose goals should be agreed with the patient and/or carer. Consensus statements (1) Because of the high risk of associated comorbidities in older people with diabetes, we recommend that regular CGA (Comprehensive

Geriatric Assessment) is used to identify related functional loss and the impact of disability. Consensus statements (1) Increasing age and progressive functional loss pose significant risks for patient safety. Delayed treatment and undertreatment are also important considerations. Hypoglycemia is defined for the purpose of this statement as a blood glucose level less than 4 mmol/L. Consensus statements (1) In older people, hypoglycemia is a highly prevalent and underrecognized disorder with severe consequences (eg, falls, cognitive impairment, hospital admission, and so forth). Consensus statements (1) All patients should participate as actively as possible in a tailored physical activity program involving resistance training, balance exercises, and cardiovascular fitness training.