New IDF Guideline for managing type 2 diabetes in older people

Dunning, Trisha; Sinclair, Alan J.; Colagiuri, Stephen

doi:10.1016/j.diabres.2014.03.005

Cited by 138 publications

(129 citation statements)

References 4 publications

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“…While our data broadly support the targets identified in current guidelines for diabetes in older people, 9,10,28,29 they also suggest that some of the factors used in these guidelines for indicating the need for less stringent glycaemic control do not adequately reflect the complex interaction between ageing and the exposures that follow a diagnosis of diabetes. Furthermore, while these guidelines promote individual targets there remains an emphasis on fixed glycaemic targets to moderate therapy, rather than managing or reducing the exposure to glycaemic variability.…”

Section: Discussionsupporting

confidence: 54%

Mean HbA1c, HbA1c variability, and mortality in people with diabetes aged 70 years and older: a retrospective cohort study

Forbes

Murrells

Mulnier

et al. 2018

The Lancet Diabetes & Endocrinology

159

151

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Evidence before this studyWe have searched PubMed and Scopus from 1990-2017, to identify relevant studies that contain terms for older people; all-cause mortality; glycaemic control; glycaemic variability (with synonyms). We also identified current international guidelines for older people. Overall, the data on optimal glycaemic targets for older people are scant, particularly from prospective studies. In terms of the association between glycaemic control and mortality in older populations the finding have suggested a 'J' shaped distribution in that relationship, although the point at which a significant mortality hazard is observed at the lower end of the glycaemic range has varied between studies. In terms of glycaemic variability, it has been identified that longer term variations in glycaemic control are associated with mortality risk. However, these analyses have not been graduated for magnitude or direction of variability. In addition, previous analyses have not considered the impact of low HbA1c levels, which are associated with mortality risk independent of diabetes intervention. Added value of this studyIn this large population study we are the first group to consider both glycaemic control and glycaemic variability together. We have also employed a new metric for variability which considers exposure to clinically significant changes in glycaemic control. This metric enabled us to assess the direction of change as well as the overall variability. Integrating glycaemic control and variability in our modelling enabled us to consider the importance of stability as a potential factor in understanding the mortality hazard in this population. Additional nuances to our analysis include: consideration of low HbA1c values; higher levels of granularity compared to previous studies in terms of glycaemic thresholds, with 0.5%(5.5mmol/l) HbA1c increments; consideration of gender differences; and the distinction between those who develop diabetes in midlife and those who develop it in older age. Implications of all the available evidenceOur data suggest that we may need to rethink how we consider glycaemic targets in the older diabetes population, in a number of ways: firstly, that variability expresses significant hazard in older people; secondly, that variability may be independent of diabetes therapies and may be related to other factors related to aging; thirdly, stability seems to attenuate hazard in medium to higher ranges of glycaemic control; and finally, there may be some important gender differences in relation to glycaemic control and hazard which are not considered in current guidelines. Therefore, while we recognise that observational data can often raise more questions than answers; we would advocate that we reconsider glycaemic control not simply as a target to direct therapeutic management, but as an important piece of information in relation to assessing individual risk. Perhaps in the past we have been too polarised in our view of glycaemia as purely indicative of optimal control, rather than as a p...

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Section: Discussionsupporting

confidence: 54%

Mean HbA1c, HbA1c variability, and mortality in people with diabetes aged 70 years and older: a retrospective cohort study

Forbes

Murrells

Mulnier

et al. 2018

The Lancet Diabetes & Endocrinology

159

151

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“…Therefore, when managing elderly patients to be treated with ipragliflozin, it is important to evaluate potential risk factors, such as dehydration, in regular medical checks by assessing the patient's physical status and general well-being and to control hyperglycemia-related symptoms such as dehydration and encouraging the consumption of fluids. [16,17] Urinary tract and genital tract infections were more common with the SGLT2 inhibitors dapagliflozin and canagliflozin, marketed in the US and the EU, than with other antidiabetic drugs. [18] However, these episodes were often reported to be mild and resolved or improved following appropriate treatments.…”

Section: Discussionmentioning

confidence: 99%

Safety of ipragliflozin in elderly Japanese patients with type 2 diabetes mellitus (STELLA-ELDER): Interim results of a post-marketing surveillance study

Terauchi

Yokote

Nakamura

et al. 2016

Expert Opinion on Pharmacotherapy

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Objective: To determine the incidence of adverse drug reactions (ADRs) associated with ipragliflozin in elderly Japanese patients with type 2 diabetes mellitus. Research design and methods: We report interim results of a postmarketing surveillance survey. Japanese physicians recorded ADRs in elderly patients (≥65 years old) who were first prescribed with ipragliflozin within 3 months of its launch (April 2014). Main outcome measures: Incidence of ADRs within 1 year of starting treatment with ipragliflozin. Results: 898 ADRs occurred in 721/7,170 patients (10.06%). Skin complication-, volume depletion-, genital infection-, polyuria/pollakiuria-, urinary tract infection-, and hypoglycemia-related ADRs occurred in 2.23%, 1.90%, 1.45%, 1.32%, 0.77%, and 0.32%, respectively. ADRs were classified as serious in 44 (0.61%) patients. Half of the ADRs occurred within 30 days of starting treatment. There were no cases of Stevens-Johnson syndrome or toxic epidermal necrolysis. Most (92.1%) of the ADRs resolved or improved. Glycated hemoglobin, fasting blood glucose, body weight, and systolic blood pressure decreased by 0.6% (baseline 7.8%), 22.7 mg/dL (baseline 163.0 mg/dL), 2.3 kg (baseline 67.4 kg), and 3.1 mmHg (baseline 133.2 mmHg), respectively, from baseline to treatment discontinuation/last visit. Conclusions: Ipragliflozin is well tolerated and reduced surrogate endpoints in elderly Japanese patients with type 2 diabetes mellitus. Clinicaltrials.gov identifier: NCT02297620ARTICLE HISTORY

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“…3 On the other hand, digestive disorders (such as abdominal pain, diarrhea, vomiting, and, very rarely, lactic acidosis) represent the most common side effects of metformin for T2DM. 7 Although metformin is recommended as a first-line drug in elderly T2DM patients, 8 there is an increasing safety concern that the elderly may be more vulnerable to gastrointestinal side effects. Thus the maximal dosage allowed for clinical use in many Chinese hospitals is 1,500 mg/day, especially in the elderly.…”

Section: Introductionmentioning

confidence: 99%

Helicobacter pylori Infection Decreases Metformin Tolerance in Patients with Type 2 Diabetes Mellitus

Huang

Sun

Wang

et al. 2015

Diabetes Technology & Therapeutics

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New IDF Guideline for managing type 2 diabetes in older people

Cited by 138 publications

References 4 publications

Mean HbA1c, HbA1c variability, and mortality in people with diabetes aged 70 years and older: a retrospective cohort study

Mean HbA1c, HbA1c variability, and mortality in people with diabetes aged 70 years and older: a retrospective cohort study

Safety of ipragliflozin in elderly Japanese patients with type 2 diabetes mellitus (STELLA-ELDER): Interim results of a post-marketing surveillance study

Helicobacter pylori Infection Decreases Metformin Tolerance in Patients with Type 2 Diabetes Mellitus

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