Management of Type 2 Diabetes Mellitus in Older Patients: Current and Emerging Treatment Options

Abstract

Elderly patients with type 2 diabetes mellitus (T2DM) are a rapidly emerging population that presents unique clinical challenges. This diverse patient group can differ widely in terms of physical and mental status, which can increase their risk of complications including hypoglycemia, falls, and depression. These factors can negatively impact their glycemic control, safety, and quality of life. The risk of hypoglycemic events is elevated among elderly patients with diabetes. In many cases, these events are related to antidiabetic therapy and the pursuit of strict glycemic control. Fear of a hypoglycemic episode, on the part of the patient and/or healthcare provider, is another major barrier to achieving glycemic control. Hypoglycemic events, even in the absence of awareness of the event (asymptomatic), can have negative consequences. To help manage these risks, several national and international organizations have proposed guidelines to address individualized treatment goals for older adults with diabetes. This article reviews current treatment guidelines for setting glycemic targets in elderly patients with T2DM, and discusses the role of emerging treatment options in this patient population.

Switching to insulin glargine 300 units/mL in real‐world older patients with type 2 diabetes (DELIVER 3)

“…Older adults with type 2 diabetes (T2D) have an elevated risk of hypoglycaemia compared with younger adults . Not surprisingly, hypoglycaemia has been associated with increased healthcare resource utilization and hospitalizations .…”

“…3 Older adults with type 2 diabetes (T2D) have an elevated risk of hypoglycaemia compared with younger adults. 4,5 Not surprisingly, hypoglycaemia has been associated with increased healthcare resource utilization and hospitalizations. 6 Additionally, among older adults with T2D, hypoglycaemia has been associated with cognitive decline, dementia, falls, accidents and fractures.…”

Achieving glycemic control in elderly patients with type 2 diabetes: a critical comparison of current options

“…DPP4 inhibitors resulted in reductions in A1C for patients whose baseline A1C levels were higher 130. These excellent tolerability profiles, low risk of hypoglycemia, and once-daily dosing make this drug class suitable for frail and debilitated elderly patients 7,12,22…”

“…Diabetic patients with depressive symptoms may need more attention in treating their condition,5 particularly women 6. Age-associated alteration in metabolism and excretion of medication is also a concern in the selection of antidiabetic treatment 7. Older people are also at increased risk of undernutrition and skeletal muscle loss, which is generally even more evident with the presence of diabetes 8,9.…”

Fatty Liver Disease among other Comorbidities Requiring Early Diagnosis in Pediatric Obesity

“…Concerning the use of metformin in T2D, the initial enthusiasm has waned and probably the concomitant use of insulin would be advisable [70]. The long-acting basal insulin analogs such as insulin detemir, insulin glargine or even insulin degludec [71] used in the adult reduce nocturnal hypoglycemic episodes and can be used in pediatric patients in not well controlled type 2 diabetic patients. It is important to consider how the use of low caloric sweeteners could play an important role in prevention of T2D in patients at risk besides the reduction of caloric intake [72].…”