Richard E Pratley1, Simon R Heller2, Mary Alice Miller3. 1. Florida Hospital Diabetes and Translational Research Institutes, Sanford Burnham Medical Research Institute, Orlando, Florida. 2. Sheffield Teaching Hospitals Foundation Trust, University of Sheffield, Sheffield, United Kingdom. 3. Eli Lilly and Company, Indianapolis, Indiana.
Abstract
OBJECTIVE: This review summarizes the particular challenges of diabetes in older individuals and the evidence base guiding the selection of treatment targets and strategies in this population. METHODS: An in-depth literature search was conducted to identify the evidence base from randomized, controlled, and population-based epidemiological studies, as well as guidelines derived from expert opinion. RESULTS: Older patients are a highly heterogeneous population with respect to the pathogenesis and course of diabetes and, as a group, manifest significant comorbidities that impact treatment goals and strategies. There is a lack of consensus regarding "optimal" glucose targets in older patients with diabetes. Hypoglycemia is more common in the older patient, contributes to increased morbidity and reduced quality of life, and limits treatment in many cases. Duration of diabetes, comorbidities, life expectancy, and functional status are other important factors to consider when identifying appropriate glycemic goals and choosing an antihyperglycemic agent for older patients with type 2 diabetes mellitus (T2DM). CONCLUSION: Current, limited treatment recommendations in older patients with T2DM are based on expert opinion due to the general lack of evidence from randomized controlled trials. This underscores the importance of individualizing pharmacologic therapy in these patients with a focus on the risk-to-benefit ratio. Additional trials in older patients are needed to assess drug safety, efficacy, and dosing.
OBJECTIVE: This review summarizes the particular challenges of diabetes in older individuals and the evidence base guiding the selection of treatment targets and strategies in this population. METHODS: An in-depth literature search was conducted to identify the evidence base from randomized, controlled, and population-based epidemiological studies, as well as guidelines derived from expert opinion. RESULTS: Older patients are a highly heterogeneous population with respect to the pathogenesis and course of diabetes and, as a group, manifest significant comorbidities that impact treatment goals and strategies. There is a lack of consensus regarding "optimal" glucose targets in older patients with diabetes. Hypoglycemia is more common in the older patient, contributes to increased morbidity and reduced quality of life, and limits treatment in many cases. Duration of diabetes, comorbidities, life expectancy, and functional status are other important factors to consider when identifying appropriate glycemic goals and choosing an antihyperglycemic agent for older patients with type 2 diabetes mellitus (T2DM). CONCLUSION: Current, limited treatment recommendations in older patients with T2DM are based on expert opinion due to the general lack of evidence from randomized controlled trials. This underscores the importance of individualizing pharmacologic therapy in these patients with a focus on the risk-to-benefit ratio. Additional trials in older patients are needed to assess drug safety, efficacy, and dosing.
Authors: Richard E Pratley; Scott S Emerson; Edward Franek; Matthew P Gilbert; Steven P Marso; Darren K McGuire; Thomas R Pieber; Bernard Zinman; Charlotte T Hansen; Melissa V Hansen; Thomas Mark; Alan C Moses; John B Buse Journal: Diabetes Obes Metab Date: 2019-04-15 Impact factor: 6.577
Authors: Simon R Heller; Richard E Pratley; Alan Sinclair; Andreas Festa; Jacek Kiljański; Cynthia S Brusko; Ran Duan; Robert J Heine Journal: Diabetes Obes Metab Date: 2017-08-08 Impact factor: 6.577