TREATMENT OF TYPE 2 DIABETES MELLITUS IN THE OLDER ADULT: A REVIEW Review

International Collaboration

cited authors

  • Pratley, Richard E., Heller, Simon R., Miller, Mary Alice

funding text

  • Dr. Pratley performed consultancy and advisory work for Eli Lilly and Company for this work and also received travel support to attend meetings. He has also received honoraria or research support from AstraZeneca/BMS, Eisai, GlaxoSmithKline, Janssen, Mannkind, Merck, Novartis, Novo Nordisk, Pfizer, Sanaa, Takeda, and Zealand Pharmaceuticals. As of June 2011, all honoraria have been directed to a nonprofit foundation benefiting research and education in diabetes. Dr. Heller worked a consultant for Eli Lilly and Company and also received travel support to attend meetings; he has also undertaken consultancy/advisory work for Amylin, Takeda, NovoNordisk, and Lifescan. Dr. Miller is an employee of Eli Lilly and Company and owns Lilly stock.

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 mid course of diabetes and, as a group, manifest significant comorbiditics 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

Publication Date

  • July 1, 2014

webpage

published in

category

start page

  • 722

end page

  • 736

volume

  • 20

issue

  • 7

WoS Citations

  • 4

WoS References

  • 63