Features of treating type 2 diabetes mellitus in the elderly

Authors

  • W.A. El Zein Department of endocrinology, Belarusian State Medical University, Minsk, Republic of Belarus
  • T.V. Mokhort MD, PhD, Professor, Head of the Department of endocrinology, Belarusian State Medical University, Minsk, Republic of Belarus http://orcid.org/0000-0002-5040-3460

DOI:

https://doi.org/10.22141/2224-0721.15.6.2019.185412

Keywords:

type 2 diabetes mellitus, elderly, co-morbidities associated with diabetes mellitus, target blood glucose levels, glucose-lowering drugs, review

Abstract

Diabetes mellitus (DM) is becoming one of the most common health problems in the elderly. Worldwide prevalence of DM among subjects over 65 years of age was 123 million in 2017, and it is expected that in 2045 the number of such persons will double. Elderly patients with DM have a higher risk of common geriatric syndromes, including frailty, cognitive impairment and dementia, urinary incontinence, traumatic falls and fractures, disability, side effects of polypharmacy, which have an important impact on quality of life and may interfere with anti-diabetic treatment. This analytical review of the li­terature discusses glycemic targets, as well as the best treatment options for elderly people with type 2 diabetes mellitus based on current international guidelines.

Downloads

Download data is not yet available.

References

Roglic G. WHO Global report on diabetes: A summary. Int J Non-Commun Dis. 2016;1(1):3-8.

LeRoith D, Biessels GJ, Braithwaite SS, et al. Treatment of diabetes in older adults: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2019 May 1;104(5):1520-1574. doi: 10.1210/jc.2019-00198.

International Diabetes Federation. IDF Diabetes Atlas. 8th Ed. 2017. Available from: https://www.idf.org/e-library/epidemiology-research/diabetes-atlas/134-idf-diabetes-atlas-8th-edition.html.

The population of Belarus is aging faster than the population of the world as a whole. Available from: https://www.belta.by/society/view/naselenie-belarusi-stareet-bystree-chem-naselenie-mira-v-tselom-96430-2012. Accessed: Apr 2012. (in Russian).

Longo M, Bellastella G, Maiorino MI, Meier JJ, Esposito K, Giugliano D. Diabetes and Aging: From Treatment Goals to Pharmacologic Therapy. Front Endocrinol (Lausanne). 2019 Feb 18;10:45. doi: 10.3389/fendo.2019.00045.

Tchkonia T, Kirkland JL. Aging, Cell Senescence, and Chronic Disease: Emerging Therapeutic Strategies. JAMA. 2018 Oct 2;320(13):1319-1320. doi: 10.1001/jama.2018.12440.

Tchkonia T, Morbeck DE, Von Zglinicki T, et al. Fat tissue, aging, and cellular senescence. Aging Cell. 2010 Oct;9(5):667-84. doi: 10.1111/j.1474-9726.2010.00608.x.

Kalyani RR, Golden SH, Cefalu WT. Diabetes and Aging: Unique Considerations and Goals of Care. Diabetes Care. 2017 Apr;40(4):440-443. doi: 10.2337/dci17-0005.

Menke A, Casagrande S, Geiss L, Cowie CC. Prevalence of and Trends in Diabetes Among Adults in the United States, 1988-2012. JAMA. 2015 Sep 8;314(10):1021-9. doi: 10.1001/jama.2015.10029.

American Diabetes Association. Older Adults: Standards of Medical Care in Diabetes—2019. Diabetes Care 2019 Jan; 42(Supplement 1): S139-S147. doi: 10.2337/dc19-S012.

Pedersen BK, Febbraio MA. Muscle as an endocrine organ: focus on muscle-derived interleukin-6. Physiol Rev. 2008 Oct;88(4):1379-406. doi: 10.1152/physrev.90100.2007.

Huang CC, Weng SF, Tsai KT, et al. Long-term Mortality Risk After Hyperglycemic Crisis Episodes in Geriatric Patients With Diabetes: A National Population-Based Cohort Study. Diabetes Care. 2015 May;38(5):746-51. doi: 10.2337/dc14-1840.

Palta P, Huang ES, Kalyani RR, Golden SH, Yeh HC. Hemoglobin A1c and Mortality in Older Adults With and Without Diabetes: Results From the National Health and Nutrition Examination Surveys (1988-2011). Diabetes Care. 2017 Apr;40(4):453-460. doi: 10.2337/dci16-0042.

Du YF, Ou HY, Beverly EA, Chiu CJ. Achieving glycemic control in elderly patients with type 2 diabetes: a critical comparison of current options. Clin Interv Aging. 2014 Nov 18;9:1963-80. doi: 10.2147/CIA.S53482.

Garber AJ, Abrahamson MJ, Barzilay JI, et al. Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the comprehensive type 2 diabetes management algorithm – 2018 executive summary. Endocr Pract. 2018 Jan;24(1):91-120. doi: 10.4158/CS-2017-0153.

Huang ES. Management of diabetes mellitus in older people with comorbidities. BMJ. 2016 Jun 15;353:i2200. doi: 10.1136/bmj.i2200.

Xu WL, von Strauss E, Qiu CX, Winblad B, Fratiglioni L. Uncontrolled diabetes increases the risk of Alzheimer’s disease: a population-based cohort study. Diabetologia. 2009 Jun;52(6):1031-9. doi: 10.1007/s00125-009-1323-x.

Wallander M, Axelsson KF, Nilsson AG, Lundh D, Lorentzon M. Type 2 Diabetes and Risk of Hip Fractures and Non-Skeletal Fall Injuries in the Elderly: A Study From the Fractures and Fall Injuries in the Elderly Cohort (FRAILCO). J Bone Miner Res. 2017 Mar;32(3):449-460. doi: 10.1002/jbmr.3002.

Bhasin S, Brito JP, Cunningham GR, et al. Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018 May 1;103(5):1715-1744. doi: 10.1210/jc.2018-00229.

American Geriatrics Society Expert Panel on Care of Older Adults with Diabetes Mellitus, Moreno G, Mangione CM, Kimbro L, Vaisberg E. Guidelines abstracted from the American Geriatrics Society Guidelines for Improving the Care of Older Adults with Diabetes Mellitus: 2013 update. J Am Geriatr Soc. 2013 Nov;61(11):2020-6. doi: 10.1111/jgs.12514.

Longo M, Bellastella G, Maiorino MI, Meier JJ, Esposito K, Giugliano D. Diabetes and aging: from treatment goals to pharmacologic therapy. Front Endocrinol (Lausanne). 2019 Feb 18;10:45. doi: 10.3389/fendo.2019.00045.

Abdelhafiz AH, Sinclair AJ. Deintensification of hypoglycaemic medications-use of a systematic review approach to highlight safety concerns in older people with type 2 diabetes. J Diabetes Complications. 2018 Apr;32(4):444-450. doi: 10.1016/j.jdiacomp.2017.11.011.

Alwhaibi M, Balkhi B, Alhawassi TM, et al. Polypharmacy among patients with diabetes: a cross-sectional retrospective study in a tertiary hospital in Saudi Arabia. BMJ Open. 2018 May 24;8(5):e020852. doi: 10.1136/bmjopen-2017-020852.

Aguilar D, Chan W, Bozkurt B, Ramasubbu K, Deswal A. Metformin use and mortality in ambulatory patients with diabetes and heart failure. Circ Heart Fail. 2011 Jan;4(1):53-8. doi: 10.1161/CIRCHEARTFAILURE.110.952556.

Schlender L, Martinez YV, Adeniji C, et al. Efficacy and safety of metformin in the management of type 2 diabetes mellitus in older adults: a systematic review for the development of recommendations to reduce potentially inappropriate prescribing. BMC Geriatr. 2017 Oct 16;17(Suppl 1):227. doi: 10.1186/s12877-017-0574-5.

Rizzo MR, Barbieri M, Fava I, et al. Sarcopenia in Elderly Diabetic Patients: Role of Dipeptidyl Peptidase 4 Inhibitors. J Am Med Dir Assoc. 2016 Oct 1;17(10):896-901. doi: 10.1016/j.jamda.2016.04.016.

Scirica BM, Braunwald E, Raz I, et al. Heart failure, saxagliptin, and diabetes mellitus: observations from the SAVOR-TIMI 53 randomized trial. Circulation. 2014 Oct 28;130(18):1579-88. doi: 10.1161/CIRCULATIONAHA.114.010389.

Zannad F, Cannon CP, Cushman WC, et al. Heart failure and mortality outcomes in patients with type 2 diabetes taking alogliptin versus placebo in EXAMINE: a multicentre, randomised, double-blind trial. Lancet. 2015 May 23;385(9982):2067-76. doi: 10.1016/S0140-6736(14)62225-X.

Bethel MA, Engel SS, Green JB, et al. Assessing the Safety of Sitagliptin in Older Participants in the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS). Diabetes Care. 2017 Apr;40(4):494-501. doi: 10.2337/dc16-1135.

Schott G, Martinez YV, Ediriweera de Silva RE, et al. Effectiveness and safety of dipeptidyl peptidase 4 inhibitors in the management of type 2 diabetes in older adults: a systematic review and development of recommendations to reduce inappropriate prescribing. BMC Geriatr. 2017 Oct 16;17(Suppl 1):226. doi: 10.1186/s12877-017-0571-8.

Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med. 2015 Nov 26;373(22):2117-28. doi: 10.1056/NEJMoa1504720.

Kambara T, Shibata R, Osanai H, et al. Use of sodium glucose cotransporter 2 inhibitors in older patients with type 2 diabetes mellitus. Geriatr Gerontol Int. 2018 Jan;18(1):108-114. doi: 10.1111/ggi.13149.

Goda M, Yamakura T, Sasaki K, Tajima T, Ueno M. Safety and efficacy of canagliflozin in elderly patients with type 2 diabetes mellitus: a 1-year post-marketing surveillance in Japan. Curr Med Res Opin. 2018 Feb;34(2):319-327. doi: 10.1080/03007995.2017.1392293.

Meneilly GS, Roy-Duval C, Alawi H, et al. Lixisenatide Therapy in Older Patients With Type 2 Diabetes Inadequately Controlled on Their Current Antidiabetic Treatment: The GetGoal-O Randomized Trial. Diabetes Care. 2017 Apr;40(4):485-493. doi: 10.2337/dc16-2143.

Rosenstock J, Handelsman Y, Vidal J, et al. Propensity-score-matched comparative analyses of simultaneously administered fixed-ratio insulin glargine 100 U and lixisenatide (iGlarLixi) vs sequential administration of insulin glargine and lixisenatide in uncontrolled type 2 diabetes. Diabetes Obes Metab. 2018 Dec;20(12):2821-2829. doi: 10.1111/dom.13462.

Maiorino MI, Chiodini P, Bellastella G, Capuano A, Esposito K, Giugliano D. Insulin and Glucagon-Like Peptide 1 Receptor Agonist Combination Therapy in Type 2 Diabetes: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Diabetes Care. 2017 Apr;40(4):614-624. doi: 10.2337/dc16-1957.

Maiorino MI, Petrizzo M, Capuano A, Giugliano D, Esposito K. The development of new basal insulins: is there any clinical advantage with their use in type 2 diabetes? Expert Opin Biol Ther. 2014 Jun;14(6):799-808. doi: 10.1517/14712598.2014.895812.

Yale JF, Aroda VR, Charbonnel B, et al. Glycaemic control and hypoglycaemia risk with insulin glargine 300 U/mL versus glargine 100 U/mL: A patient-level meta-analysis examining older and younger adults with type 2 diabetes. Diabetes Metab. 2018 Oct 23. pii: S1262-3636(18)30196-4. doi: 10.1016/j.diabet.2018.10.002.

Maiorino MI, Bellastella G, Esposito K, Giugliano D. Premixed insulin regimens in type 2 diabetes. Endocrine. 2017 Jan;55(1):45-50. doi: 10.1007/s12020-016-0917-6.

Downloads

Published

2021-09-01

How to Cite

El Zein, W., & Mokhort, T. (2021). Features of treating type 2 diabetes mellitus in the elderly. INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine), 15(6), 488–500. https://doi.org/10.22141/2224-0721.15.6.2019.185412

Issue

Vol. 15 No. 6 (2019)

Section

Literature Review

License

Copyright (c) 2019 W.A. El Zein, T.V. Mokhort

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Most read articles by the same author(s)