Curtis Triplitt1. 1. Texas Diabetes Institute, San Antonio, Texas 78207, USA. curtis.triplitt@uhs-sa.com
Abstract
OBJECTIVES: This clinical review highlights emerging data regarding the complex relationship among glycosylated hemoglobin (A1C) goals, risk of cardiovascular disease, and hypoglycemia in elderly patients with type 2 diabetes mellitus (T2DM). According to the ADVANCE and VADT trials, lowering patients' A1C levels did not decrease the risk of cardiovascular disease, and the ACCORD trial found a slightly higher risk of cardiovascular disease with tighter glycemic control. Long-term follow-up data from the UKPDS indicated good glycemic control, when achieved early in newly diagnosed patients, lowered cardiovascular risk over the long-term (at least 15 to 20 years). Moreover, tight glycemic control, if it results in severe hypoglycemic events, may pose a serious risk among elderly patients with T2DM. DATA SOURCES: Live symposium presentation based on clinical practice and research, medical literature, and studies published between October 2005 and January 2010 on managing diabetes in older adults, government statistics, and medical society guidelines. CONCLUSIONS: If it can be achieved safely, early glycemic control is beneficial to elderly patients with T2DM. Treatment goals for older adults should be an individualized process and must include a number of considerations. Pharmacists need to manage the dual issues of avoiding intensive lowering of A1C levels and averting the risk of hypoglycemia.
OBJECTIVES: This clinical review highlights emerging data regarding the complex relationship among glycosylated hemoglobin (A1C) goals, risk of cardiovascular disease, and hypoglycemia in elderly patients with type 2 diabetes mellitus (T2DM). According to the ADVANCE and VADT trials, lowering patients' A1C levels did not decrease the risk of cardiovascular disease, and the ACCORD trial found a slightly higher risk of cardiovascular disease with tighter glycemic control. Long-term follow-up data from the UKPDS indicated good glycemic control, when achieved early in newly diagnosed patients, lowered cardiovascular risk over the long-term (at least 15 to 20 years). Moreover, tight glycemic control, if it results in severe hypoglycemic events, may pose a serious risk among elderly patients with T2DM. DATA SOURCES: Live symposium presentation based on clinical practice and research, medical literature, and studies published between October 2005 and January 2010 on managing diabetes in older adults, government statistics, and medical society guidelines. CONCLUSIONS: If it can be achieved safely, early glycemic control is beneficial to elderly patients with T2DM. Treatment goals for older adults should be an individualized process and must include a number of considerations. Pharmacists need to manage the dual issues of avoiding intensive lowering of A1C levels and averting the risk of hypoglycemia.