11. Older Adults:<i>Standards of Medical Care in Diabetes—2018</i>

,

doi:10.2337/dc18-s011

Cited by 128 publications

(72 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…First, use of sulfonylureas and thiazolidinediones is decreasing, in accordance with practice guidelines to avoid these classes in older patients. 4,5,12 Second, use of newer classes of diabetes medications has been sparse in older adults, with GLP-1 receptor agonists used particularly infrequently. Third, whereas use of DPP-4 inhibitors has increased substantially in older adults, they have lower glycemic efficacy than other classes and thus may not substitute for insulin.…”

Section: Discussionmentioning

confidence: 99%

“…1–3 Selecting the optimal treatment regimen for older adults with type 2 diabetes requires special considerations. 4– 6 Older adults with diabetes often have multiple comorbid conditions that may present medication contraindications or interactions that limit the use of certain pharmacologic classes. 4–8 Functional and cognitive limitations become more common with aging which could limit the use of complex regimens.…”

mentioning

confidence: 99%

“…4– 6 Older adults with diabetes often have multiple comorbid conditions that may present medication contraindications or interactions that limit the use of certain pharmacologic classes. 4–8 Functional and cognitive limitations become more common with aging which could limit the use of complex regimens. 4–6,9 Further, preventing hypoglycemia is critical for older patients, and guidelines recommend avoiding medications with the highest hypoglycemia risk, particularly long-acting sulfonylureas and sliding-scale insulin.…”

mentioning

confidence: 99%

“…4–8 Functional and cognitive limitations become more common with aging which could limit the use of complex regimens. 4–6,9 Further, preventing hypoglycemia is critical for older patients, and guidelines recommend avoiding medications with the highest hypoglycemia risk, particularly long-acting sulfonylureas and sliding-scale insulin. 4–6,10–12 …”

mentioning

confidence: 99%

“…14,15 Practice guidelines for older adults provide little direction for clinicians choosing between older medications with greater hypoglycemia risk and newer medications with less established evidence. 4–6 …”

mentioning

confidence: 99%

See 4 more Smart Citations

Differences in National Diabetes Treatment Patterns and Trends between Older and Younger Adults

Pilla

Segal

Alexander

et al. 2019

J American Geriatrics Society

View full text Add to dashboard Cite

BACKGROUND/OBJECTIVES: The treatment of type 2 diabetes in older adults requires special considerations including avoidance of hypoglycemia, yet variation in diabetes treatment with aging is not well understood. In this study, we compared nationally representative diabetes treatment patterns and trends between older adults (≥65 y) and younger adults (30–64 y). DESIGN: Repeated cross-sectional physician surveys from 2006 to 2015. SETTING: The National Ambulatory Medical Care Survey, an annual probability sample of visits to office-based US physicians. PARTICIPANTS: Adults with type 2 diabetes using one or more diabetes medications. MEASUREMENTS: Proportions of visits in which patients treated with each diabetes medication class were compared between older and younger adults in 2-year intervals. RESULTS: From 2006 to 2015, the average number of yearly visits for older and younger adults was 25.4 million and 24.2 million, respectively. In 2014–2015, visits for older compared with younger adults involved less use of metformin (56.0% vs 70.0%; p < .001) and glucagon-like peptide 1 receptor agonists (2.9% vs 6.2%; p = .004), and more use of long-acting insulin (30.2% vs 22.4%; p = .017); other classes were used similarly. During the study period, long-acting insulin use increased markedly in older adults, particularly between 2010 and 2015 where it rose from 12.5% to 30.2% of visits (P-trend <.001). In younger adult visits, long-acting insulin use increased modestly (17.2% to 22.4%) and at a slower rate compared with older adult visits (p < .001). CONCLUSION: The ambulatory treatment of type 2 diabetes differs between older and younger adults, with the treatment of older adults characterized by low use of newer diabetes medications and a greater and rapidly increasing use of long-acting insulin. These findings call for further research clarifying the comparative effectiveness and safety of newer diabetes medications and long-acting insulin to optimize diabetes care for older patients.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Differences in National Diabetes Treatment Patterns and Trends between Older and Younger Adults

Pilla

Segal

Alexander

et al. 2019

J American Geriatrics Society

View full text Add to dashboard Cite

show abstract

Trends in Prevalence of Diabetes and Control of Risk Factors in Diabetes Among US Adults, 1999-2018

Wang

et al. 2021

JAMA

258

211

View full text Add to dashboard Cite

IMPORTANCEUnderstanding population-wide trends in prevalence and control of diabetes is critical to planning public health approaches for prevention and management of the disease. OBJECTIVE To determine trends in prevalence of diabetes and control of risk factors in diabetes among US adults between 1999-2000 and 2017-2018. DESIGN, SETTING, AND PARTICIPANTS Ten cycles of cross-sectional National Health and Nutrition Examination Survey (NHANES) data between 1999-2000 and 2017-2018 were included. The study samples were weighted to be representative of the noninstitutionalized civilian resident US population. Adults aged 18 years or older were included, except pregnant women. EXPOSURES Survey cycle.MAIN OUTCOMES AND MEASURES Diabetes was defined by self-report of diabetes diagnosis, fasting plasma glucose level of 126 mg/dL or more, or hemoglobin A 1c (HbA 1c ) level of 6.5% or more. Three risk factor control goals were individualized HbA 1c targets, blood pressure less than 130/80 mm Hg, and low-density lipoprotein cholesterol level less than 100 mg/dL. Prevalence of diabetes and proportion of adults with diagnosed diabetes who achieved risk factor control goals, overall and by sociodemographic variables, were estimated. RESULTS Among the 28 143 participants included (weighted mean age, 48.2 years; 49.3% men), the estimated age-standardized prevalence of diabetes increased significantly from 9.8% (95% CI, 8.6%-11.1%) in 1999-2000 to 14.3% (95% CI, 12.9%-15.8%) in 2017-2018 (P for trend < .001). From 1999-2002 to 2015-2018, the estimated age-standardized proportion of adults with diagnosed diabetes who achieved blood pressure less than 130/80 mm Hg (P for trend = .007) and low-density lipoprotein cholesterol level less than 100 mg/dL (P for trend < .001) increased significantly, but not individualized HbA 1c targets (P for trend = .51). In 2015-2018, 66.8% (95% CI, 63.2%-70.4%), 48.2% (95% CI, 44.6%-51.8%), and 59.7% (95% CI, 54.2%-65.2%) of adults with diagnosed diabetes achieved individualized HbA 1c targets, blood pressure less than 130/80 mm Hg, and low-density lipoprotein cholesterol level less than 100 mg/dL, respectively. Only 21.2% of these adults (95% CI, 15.5%-26.8%) achieved all 3. During the entire study period, these 3 goals were significantly less likely to be achieved among young adults aged 18 to 44 years (vs older adults Ն65 years: estimated proportion, 7.4% vs 21.7%; adjusted odds ratio, 0.32 [95% CI, 0.16-0.63]), non-Hispanic Black adults (vs non-Hispanic White adults: estimated age-standardized proportion, 12.5% vs 20.6%; adjusted odds ratio, 0.60 [95% CI, 0.40-0.90]), and Mexican American adults (vs non-Hispanic White adults: estimated age-standardized proportion, 10.9% vs 20.6%; adjusted odds ratio, 0.48 [95% CI, 0.31-0.77]). CONCLUSIONS AND RELEVANCEBased on NHANES data from US adults, the estimated prevalence of diabetes increased significantly between 1999-2000 and 2017-2018. Only an estimated 21% of adults with diagnosed diabetes achieved all 3 risk factor control goals in 2015-2018.

show abstract

Use and Discontinuation of Insulin Treatment Among Adults Aged 75 to 79 Years With Type 2 Diabetes

et al. 2019

View full text Add to dashboard Cite

IMPORTANCE Among older individuals with type 2 diabetes, those with poor health have greater risk and derive less benefit from tight glycemic control with insulin. OBJECTIVE To examine whether insulin treatment is used less frequently and discontinued more often among older individuals with poor health compared with those in good health. DESIGN, SETTING, AND PARTICIPANTSThis longitudinal cohort study included 21 531 individuals with type 2 diabetes followed for up to 4 years starting at age 75 years. Electronic health record data from the Kaiser Permanente Northern California Diabetes Registry was collected to characterize insulin treatment and glycemic control over time. Data were collected from

show abstract

11. Older Adults:Standards of Medical Care in Diabetes—2018

Cited by 128 publications

References 40 publications

Differences in National Diabetes Treatment Patterns and Trends between Older and Younger Adults

Differences in National Diabetes Treatment Patterns and Trends between Older and Younger Adults

Trends in Prevalence of Diabetes and Control of Risk Factors in Diabetes Among US Adults, 1999-2018

Use and Discontinuation of Insulin Treatment Among Adults Aged 75 to 79 Years With Type 2 Diabetes

Contact Info

Product

Resources

About