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Clinical Guidelines for Older Adults With Diabetes Mellitus—Reply
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In Reply: Drs Aspray and Unwin raise questions about the difficulty in extrapolating evidence from younger to older patients. It is important to consider more broadly that clinicians must make a calculated guess when translating the average effect of an intervention measured for a population studied in a clinical trial to an individual patient in a practice, irrespective of the age difference.1
Nevertheless, I agree that this problem is especially true for the older adult population that is particularly heterogeneous with respect to comorbidity, frailty, and disability. This "calculated guess" or judgment remains a poorly understood cognitive process. Clinical trials must include older patients who are representative of those seen in practices, and tools must be developed for assessing where individuals fit in the clinical spectrum to more accurately individualize medical advice.
Financial Disclosures: None reported.
Samuel C. Durso, MD
sdurso@jhmi.edu
Division of Geriatrics and Gerontology
Johns Hopkins University School of Medicine
Baltimore, Md
1. Schattner A, Fletcher RH. Research evidence and the individual patient. Q J Med. 2003;96:1-5.
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Letters Section Editor: Robert M. Golub, MD, Senior Editor.
JAMA. 2006;296:1840.
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