Diabetes in Older Adults: A Consensus Report

National Trends in Treatment Initiation for Nursing Home Residents With Diabetes Mellitus, 2008 to 2010

“…It will be of interest in future studies to determine whether this pattern changes with the adoption of current clinical guidelines recommending less stringent glycemic targets in NH residents, especially for those who are frail or with limited life expectancy. 7,9,36 Use of combination products containing two glucose-lowering medications in our NH sample was similar to that documented in studies of younger individuals in the community. 37 Our study has several limitations.…”

“…6 As in our study, they found stable use of metformin, which is often considered first-line therapy for diabetes in older adults due to its low risk for hypoglycemia and low cost, as well as decreasing use of the sulfonylurea glyburide and thiazolidinedione medications from 2005 to 2011. 6,7 In contrast, we found that decreases in sulfonylurea initiations were driven by all medications in the class, not only glyburide. At the end of our study period, the decrease in glyburide use as a proportion of all sulfonylurea initiations suggested a shift in practice toward use of sulfonylureas with a more favorable adverse effect profile.…”

“…This low uptake is perhaps due to limited prescriber experience with the drugs, cost, route of administration, Medicare Part D plan formulary inclusion and status, lack of studies in older patients, and concern about undesirable side effects in a frail population. 4,7 Previously published literature on trends in glucose lowering medications only focused on young, ambulatory patients or among NH residents, those residing in the Veterans Affairs (VA) NHs. 6 Our study adds to the literature by focusing on a nationally representative sample of nursing home residents, on the new initiation of prescribing of glucose-lowering medications, and on trends in individual and combination medication products.…”

“…2,3 Information on how these NH residents are treated pharmacologically is limited despite the necessity for monitoring the quality of prescribing in all health care settings. [4][5][6][7] Quantifying patterns of treatment initiation is an essential part of assessing quality of pharmaceutical care and informs future efforts to provide guidance for selecting treatments for diabetes. [8][9][10] The objective of this study was to describe national trends in the use of different glucoselowering medications in the management of diabetes in NH residents from 2008 to 2010.…”

Coronary Artery Disease and Diabetes Mellitus

“…Here less stringent HbA1c goals may be appropriate (7.5-8.0% or possibly even slightly higher). 17,18 Antidiabetic drug safety Until recently, insulin and then oral agents based on metformin and sulfonylureas dominated the therapy of DM. There are now several additional classes of drugs approved for diabetes management: α-glucosidase inhibitors, thiazolidinediones, meglitinides, glucagon-like peptide analogues, amylin analogues, dipeptidyl peptidase IV inhibitors and sodium-glucose cotransporter 2 (SGLT-2) inhibitors.…”