Treatment of Diabetes in Older Adults: An Endocrine Society* Clinical Practice Guideline

Abstract

Objective The objective is to formulate clinical practice guidelines for the treatment of diabetes in older adults. Conclusions Diabetes, particularly type 2, is becoming more prevalent in the general population, especially in individuals over the age of 65 years. The underlying pathophysiology of the disease in these patients is exacerbated by the direct effects of aging on metabolic regulation. Similarly, aging effects interact with diabetes to accelerate the progression of many common diabetes complications. Each section in this guideline covers all aspects of the etiology and available evidence, primarily from controlled trials, on therapeutic options and outcomes in this population. The goal is to give guidance to practicing health care providers that will benefit patients with diabetes (both type 1 and type 2), paying particular attention to avoiding unnecessary and/or harmful adverse effects.

Predictors for self‐management in older adults with type 2 diabetic nephropathy

“…Alrahbi and Alghenaimi found that the support and planning of healthcare providers, family members and friends can affect the self‐management of diabetic patients. LeRoith et al () showed that individuals aged 65 and older with diabetes should be provided with a multidisciplinary team to develop personalised care goals and to monitor implementation. Thus, the present and previous findings support the ability of integrated care to enhance patients' diabetes care knowledge and physical condition and to improve the relationship between patients and healthcare providers.…”

“…Control of diabetic nephropathy requires self-management of the disease, including optimising blood sugar, which helps to reduce complications, as well as the provision of multifaceted care programmes by medical professionals to reduce disease progression, which can include complex drug treatment (Hahr & Molitch, 2015;Thomas, 2018). Patients with diabetes also may be at risk of developing hypoglycaemia or of re-admission (Thomas, 2018), and thus, active self-management and monitoring of renal function and blood glucose levels are extremely important (Hahr & Molitch, 2015;Keke et al, 2017;LeRoith et al, 2019;Thomas, 2018).…”

“…Diabetes resulted in $7.27 billion in healthcare costs in 2017; these costs are estimated to increase to $7.76 billion by 2045, most of which will be due to patients who are at least 70 years old (International Diabetes Federation, ). In addition, the number of individuals over the age of 65 who are diagnosed with type 2 diabetes is increasing (LeRoith et al, ). The incidence of diabetes in this age group was 25.2% in the United States in 2015 (American Diabetes Association, ) and 35.4% in Australia in 2014–2015 (Australian Institute of Health & Welfare, ).…”

“…Diabetes resulted in $7.27 billion in healthcare costs in 2017; these costs are estimated to increase to $7.76 billion by 2045, most of which will be due to patients who are at least 70 years old (International Diabetes Federation, 2017). In addition, the number of individuals over the age of 65 who are diagnosed with type 2 diabetes is increasing (LeRoith et al, 2019). The incidence of diabetes in this age group was The process of diabetes self-management is complex (Alrahbi & Alghenaimi, 2017), and diabetes education is important to make diabetes patients more aware of how to self-manage the disease in terms of physical activity, nutrition, medication, glycaemic control and psychosocial adjustment (Joslin Diabetes Centre, 2019).…”

Benefits of insulin degludec/liraglutide are maintained even in patients discontinuing sulphonylureas or dipeptidyl peptidase‐4 inhibitors upon initiation of degludec/liraglutide therapy: A post hoc analysis of the DUAL II and DUAL IX trials

“…23 Moreover, the latest guidelines recommend avoiding the use of SUs to reduce the risk of hypoglycaemia, particularly in older patients with T2D. 10 However, as discontinuation of previous OADs can lead to a deterioration in glycaemic control, many patients continue to receive SUs in combination with basal insulin therapy. 24,25 Moreover, there may be a concern among physicians that patients might experience a transient deterioration in glycaemic control when switching to a lower daily insulin dose (16 U) with IDegLira from a previous higher basal insulin dose.…”