Diabetes in Older People

Meneilly, Graydon S.; Knip, Aileen; Miller, David B.; Sherifali, Diana; Tessier, Daniel; Zahedi, Afshan

doi:10.1016/j.jcjd.2017.10.021

Cited by 91 publications

(89 citation statements)

References 251 publications

(218 reference statements)

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“…These findings have thus resulted in less intense treatment targets worldwide compared to “conventional” glucose control targets . Current Thailand diabetic guidelines for healthy elderly patients suggest HbA1c of less than 7%, similar to the Canadian guidelines . Other published guidelines are less intensive: the European and the International Diabetes Federation global guidelines suggest HbA1c goal of 7‐7.5% and the American Diabetes Association suggests HbA1c of less than 7.5% .…”

Section: Discussionmentioning

confidence: 99%

Temporal trends in optimal diabetic care and complications of elderly type 2 diabetes patients in Thailand: A nationwide study

Kaewput

Mungthin

Jindarat

et al. 2018

J Evidence Based Medicine

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Background:This study aimed to assess the nationwide trends in optimal diabetic care and complications of elderly type 2 diabetes mellitus (T2DM) patients over a 6-year period in Thailand.Methods: T2DM patients aged 65 years or older who received medical care at public hospitals in Thailand from 2010 to 2015 were included. The optimal T2DM care in elderly patients was defined as (1) blood pressure (BP) < 140/90, (2) hemoglobin A1C (HbA1c) < 7%, (3) low-density lipoprotein cholesterol (LDL-C) < 100 mg/dL, (4) use of antiplatelet medications, and (5) use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) in hypertensive patients. T2DM treatment-related complications included hospital admissions due to dysglycemia.Results: A total of 54 295 elderly T2DM patients were enrolled in this study. From 2010 to 2015, there was an increasing trend in the achievement of BP control and use of antiplatelet medications (P for trend < 0.01), whereas there was a decreasing trend in the achievement of HbA1c and LDL-C control among elderly T2DM patients (P for trend < 0.001). There was an increasing trend in the use of ACEI/ARB among elderly T2DM patients with hypertension (P for trend < 0.001). Hospital admissions due to dysglycemia decreased over the study period (P for trend < 0.001). Conclusion:There has been a trend change for diabetic care among elderly T2DM patients in Thailand. Further studies are needed to assess the impact on patient outcomes. K E Y W O R D Sdiabetes in elderly, diabetic care, diabetic complications, glycemic control, type 2 diabetes mellitus 22wileyonlinelibrary.com/journal/jebm J Evid Based Med. 2019;12:22-28.

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Section: Discussionmentioning

confidence: 99%

Temporal trends in optimal diabetic care and complications of elderly type 2 diabetes patients in Thailand: A nationwide study

Kaewput

Mungthin

Jindarat

et al. 2018

J Evidence Based Medicine

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“…Однако, несмотря на опасность гипогликемии в пожилом возрасте, гликемический контроль является важным фактором предотвращения диабетиче-ских осложнений (часто летальных), продления жизни, а также улучшения качества жизни [5]. Известно, что риск развития макрососудистых осложнений у пожилых пациентов значительно выше, чем у молодого и среднего возраста с СД2 [25][26][27]. К сожалению, существует ограниченное количество исследований (субанализов), изучающих влияние сахароснижающей терапии на сердечно-сосудистые и другие осложнения, смертность в этой популяции пациентов [28].…”

Section: лечениеunclassified

Type 2 diabetes mellitus in elderly patients treated with endocrinologists in clinical practice

Biryukova¹

2020

Diabetes mellitus

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A large-scale epidemic of type 2 diabetes mellitus (T2DM) is observed with advanced ageing worldwide. The prevalence of T2DM significantly increases with age. Therefore, this review aimed to summarise the data on T2DM in advanced and older aged patients. The primary geriatric syndromes, which should be considered for the management of older patients (cognitive impairment, sarcopenia, orthostatic hypotension, falls, urinary incontinence, senile asthenia, etc.), are presented. The causes of the high risk for hypoglycaemia in elderly patients are analysed. Improving the treatment for T2DM is a priority of modern medicine. Using antihyperglycaemic therapy is especially difficult in this population due to the high risk of hypoglycaemia and the multi-organ pathology leading to polypharmacy. Therefore, special attention is paid to treatment recommendations. Hypoglycaemic drugs used in elderly patients should be low risk of hypoglycaemia, without nephro- and hepatic toxicity, safe for cardiovascular organs, easy to administer. Furthermore, advantages and limitations of using various groups of hypoglycaemic drugs in elderly patients are discussed. DPP-4 inhibitors are also considered in detail. Modern data on mechanisms of hypoglycaemic action of DPP-4 inhibitors are presented. Possibilities of using sitagliptin in elderly patients were also considered. Finally, evidence-based studies demonstrating the obvious advantages of sitagliptin for the treatment of T2DM in the elderly and advanced aged population are discussed.

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“…Among individuals without clinical cardiovascular disease, a series of clinical considerations should be prioritized prior to intensifying therapy. For the elderly, DPP‐4is are the preferred option, given the simplicity of prescribing, their tolerability and the low concern of hypoglycaemia, as documented in elderly‐specific treatment guidelines . Although GLP‐1RAs and SGLT2is can be considered for the elderly, caution is warranted, as gastrointestinal side effects have been documented for the former and volume‐related adverse effects for the latter, both symptoms being more common in the elderly population.…”

Section: An Algorithm For Intensification Beyond Basal Insulinmentioning

confidence: 99%

A practical approach and algorithm for intensifying beyond basal insulin in type 2 diabetes

Goldenberg

Assimakopoulos

Gilbert

et al. 2018

Diabetes Obesity Metabolism

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Despite the availability of long-term data demonstrating the benefits of timely and aggressive intensification of antihyperglycaemic regimens among individuals with type 2 diabetes, intensification beyond basal insulin continues to be suboptimal and a global challenge. This review summarizes the evidence surrounding the various options of advancing glucose-lowering management beyond basal insulin and provides a practical algorithm to assist in optimizing patient care and enhancing glycaemic target achievements.

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Diabetes in Older People

Cited by 91 publications

References 251 publications

Temporal trends in optimal diabetic care and complications of elderly type 2 diabetes patients in Thailand: A nationwide study

Temporal trends in optimal diabetic care and complications of elderly type 2 diabetes patients in Thailand: A nationwide study

Type 2 diabetes mellitus in elderly patients treated with endocrinologists in clinical practice

A practical approach and algorithm for intensifying beyond basal insulin in type 2 diabetes

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