Management of type 2 diabetes mellitus in the elderly

Soe, Kyaw; Sacerdote, Alan; Karam, Jocelyne; Bahtiyar, Gül

doi:10.1016/j.maturitas.2011.07.006

Cited by 34 publications

(27 citation statements)

References 85 publications

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“…[1][2][3] According to an analysis performed by the Italian Association of Clinical Diabetologists (AMD), 60% of the 414,814 patients with type 2 diabetes who referred to national diabetes centers in 2009 were older than 65 years. 4 Treatment of elderly patients with diabetes is challenging because of the high prevalence of comorbidities, diabetes complications, polypharmacy and frailty.…”

Section: Introductionmentioning

confidence: 99%

“…4 Treatment of elderly patients with diabetes is challenging because of the high prevalence of comorbidities, diabetes complications, polypharmacy and frailty. 2 In addition geriatric syndromes including cognitive dysfunction, functional impairment, depression, falls with fractures and persistent pain may negatively affect health outcomes and self-care abilities. 5,6 The substantial under-representation of patients older than 65 years in randomized clinical trials regarding glucose-lowering treatments and thus the lack of evidence guiding therapeutic decisions is an additional issue in the management of diabetes in this age group.…”

Section: Introductionmentioning

confidence: 99%

“…5 This is partly reflected in current national and international guidelines for the management of diabetes, which recommend the use of individualized glycemic targets in the elderly to optimally balance potential benefits and risks of treatment. 2,[14][15][16] While the general target of glycated hemoglobin (HbA1c) levels <7% might be still reasonable for certain elderly patients, less stringent targets (e.g., HbA1c <7.5%-8.0%) might be more appropriate for frail, older patients, including those with severe CKD. 2,14,15,17 Dipeptidyl peptidase-4 (DPP-4) inhibitors have emerged in recent years as a class of oral glucose-lowering agents suitable for elderly patients, since they are generally well tolerated, have a low risk for hypoglycemia and lack significant drug interactions.…”

Section: Introductionmentioning

confidence: 99%

“…2,[14][15][16] While the general target of glycated hemoglobin (HbA1c) levels <7% might be still reasonable for certain elderly patients, less stringent targets (e.g., HbA1c <7.5%-8.0%) might be more appropriate for frail, older patients, including those with severe CKD. 2,14,15,17 Dipeptidyl peptidase-4 (DPP-4) inhibitors have emerged in recent years as a class of oral glucose-lowering agents suitable for elderly patients, since they are generally well tolerated, have a low risk for hypoglycemia and lack significant drug interactions. 2,14,18,19 inhibitors stimulate the release of insulin in a glucose-dependent manner by counteracting the inactivation of incretins.…”

Section: Introductionmentioning

confidence: 99%

“…2,14,15,17 Dipeptidyl peptidase-4 (DPP-4) inhibitors have emerged in recent years as a class of oral glucose-lowering agents suitable for elderly patients, since they are generally well tolerated, have a low risk for hypoglycemia and lack significant drug interactions. 2,14,18,19 inhibitors stimulate the release of insulin in a glucose-dependent manner by counteracting the inactivation of incretins. 18,20 Linagliptin is a potent, long-acting DPP-4 inhibitor approved for the treatment of type 2 diabetes mellitus as monotherapy or as combination therapy with other oral antidiabetic agents or insulin.…”

Section: Introductionmentioning

confidence: 99%

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Linagliptin is associated to increased treatment adherence and satisfaction in elderly outpatients with diabetes and advanced chronic kidney disease

et al. 2016

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The treatment of diabetes in frail elderly patients with decreased renal function is challenging and insufficiently supported by evidence. Due to their good tolerability and low hypoglycemic risk, oral dipeptidyl peptidase-4 (DPP-4) inhibitors have emerged as a reasonable option for glycemic control in the elderly. The aim was to evaluate the efficacy and safety of linagliptin, a long acting, oral DPP-4 inhibitor with a predominantly nonrenal elimination route, in elderly patients with severe chronic kidney disease (CKD). This was a retrospective, observational study in outpatients with type 2 diabetes and advanced-stage CKD (estimated glomerular filtration rate <30 mL/min per 1.73 m 2 ) referring to a diabetes clinic in Italy. Patients were switched from basal insulin to oral linagliptin 5 mg once daily and observed for 14 months. Assessed variables included glycemic control (HbA1c target, 7.5%-8.0%), adherence to treatment (Morisky questionnaire) and patient satisfaction (diabetes treatment satisfaction questionnaire). Adverse events, including hypoglycemic episodes, were also recorded. Thirty patients [mean (±standard deviation) age 70.2 (±8.2) years, HbA1c 7.6% (±0.3), fasting blood glucose 173.9 (±23.5) mg/dL] with type-2 diabetes and advanced CKD were included. The switch to linagliptin did not affect significantly glycemic control, was well tolerated and associated with a reduction in hypoglycemic episodes. Adherence to treatment was better with linagliptin than basal insulin and patient satisfaction significantly improved after switching. Linagliptin appears as a valid option for glycemic control in elderly diabetes patients with severe CKD in treatment with low-dose insulin. However adequately designed longterm studies are needed to confirm these findings.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Linagliptin is associated to increased treatment adherence and satisfaction in elderly outpatients with diabetes and advanced chronic kidney disease

et al. 2016

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Psychological interventions for diabetes-related distress in adults with type 2 diabetes mellitus

Chew¹,

Vos

Heijmans

et al. 2015

Cochrane Database of Systematic Reviews

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Background: Many adults with type 2 diabetes mellitus (T2DM) experience a psychosocial burden and mental health problems associated with the disease. Diabetes-related distress (DRD) has distinct effects on self-care behaviours and disease control. Improving DRD in adults with T2DM could enhance psychological well-being, health-related quality of life, self-care abilities and disease control, also reducing depressive symptoms.

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Psychological interventions for diabetes-related distress in adults with type 2 diabetes mellitus

Chew

Vos

Metzendorf

et al. 2017

Cochrane Database of Systematic Reviews

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Low-quality evidence showed that none of the psychological interventions would improve DRD more than usual care. Low-quality evidence is available for improved self-efficacy and HbA1c after psychological interventions. This means that we are uncertain about the effects of psychological interventions on these outcomes. However, psychological interventions probably have no substantial adverse events compared to usual care. More high-quality research with emotion-focused programmes, in non-US and non-European settings and in low- and middle-income countries, is needed.

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Management of type 2 diabetes mellitus in the elderly

Cited by 34 publications

References 85 publications

Linagliptin is associated to increased treatment adherence and satisfaction in elderly outpatients with diabetes and advanced chronic kidney disease

Linagliptin is associated to increased treatment adherence and satisfaction in elderly outpatients with diabetes and advanced chronic kidney disease

Psychological interventions for diabetes-related distress in adults with type 2 diabetes mellitus

Psychological interventions for diabetes-related distress in adults with type 2 diabetes mellitus

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