Telemedicine interventions can improve communication and connection between older patients and their providers , and improve glycemic control .
Summary A systematic review confirmed the efficacy and safety of metformin as first-line therapy of type 2 diabetes in the older adult , but multiple reports highlighted the risk for vitamin B12 deficiency .
R and omized controlled trials showed the efficacy and safety of antihyperglycemic agents in the elderly , including some with longer duration and lesser risk for hypoglycemia .
R and omized clinical trials showed cardiovascular protection with SGLT-2i ( empagliflozin , canagliflozin ) and GLP-1RA ( liraglutide , semaglutide ) .
Purpose of Review The current approach to diabetes in the elderly incorporates components from the comprehensive geriatric approach .
The most up date d guidelines from the American Diabetes Association reflect influence from the consensus made in 2012 with the American Geriatrics Society .
Notably , the framework included the evaluation for geriatric syndromes ( falls and urinary incontinence ) , functional and cognitive abilities .
The goal for this review is to provide an up date d summary of treatment strategies for community-dwelling older adults .
Recent Findings Findings on cardiovascular protection with sodium-glucose co-transporter 2 inhibitors ( SGLT-2i ) and some glucagon-like peptide 1 receptor agonists ( GLP-1RA ) support their use for older patients with diabetes .
Functional medicine concepts can offer additional adjuvant strategies to support the therapeutic interventions and management of diabetes in the elderly .
The most current guidelines recommend addressing for geriatric syndromes , physical and cognitive function in the elderly , in order to individualize targets and therapeutic strategies .
Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes
Background Canagliflozin is a sodium – glucose cotransporter 2 inhibitor that reduces glycemia as well as blood pressure , body weight , and albuminuria in people with diabetes . We report the effects of treatment with canagliflozin on cardiovascular , renal , and safety outcomes . Methods The CANVAS Program integrated data from two trials involving a total of 10,142 participants with type 2 diabetes and high cardiovascular risk . Participants in each trial were r and omly assigned to receive canagliflozin or placebo and were followed for a mean of 188.2 weeks . The primary outcome was a composite of death from cardiovascular causes , nonfatal myocardial infa rct ion , or nonfatal stroke . Results The mean age of the participants was 63.3 years , 35.8 % were women , the mean duration of diabetes was 13.5 years , and 65.6 % had a history of cardiovascular disease .  The rate of the primary outcome was lower with canagliflozin than with placebo ( occurring in 26.9 vs. 31.5 participants per 1000 patient‐years ; hazard ratio , 0.86 ; 95 % confidence interval [ CI ] , 0.75 to 0.97 ; P<0.001 for noninferiority ; P=0.02 for superiority ) . Although on the basis of the prespecified hypothesis testing sequence the renal outcomes are not viewed as statistically significant , the results showed a possible benefit of canagliflozin with respect to the progression of albuminuria ( hazard ratio , 0.73 ; 95 % CI , 0.67 to 0.79 ) and the composite outcome of a sustained 40 % reduction in the estimated glomerular filtration rate , the need for renal‐replacement therapy , or death from renal causes ( hazard ratio , 0.60 ; 95 % CI , 0.47 to 0.77 ) . Adverse reactions were consistent with the previously reported risks associated with canagliflozin except for an increased risk of amputation ( 6.3 vs. 3.4 participants per 1000 patient‐years ; hazard ratio , 1.97 ; 95 % CI , 1.41 to 2.75 ) ; amputations were primarily at the level of the toe or metatarsal . Conclusions In two trials involving patients with type 2 diabetes and an elevated risk of cardiovascular disease , patients treated with canagliflozin had a lower risk of cardiovascular events than those who received placebo but a greater risk of amputation , primarily at the level of the toe or metatarsal . ( Funded by Janssen Research and Development ; CANVAS and CANVAS‐R Clinical Trials.gov numbers , NCT01032629 and NCT01989754 , respectively .
Telemedicine interventions can improve communication and connection between older patients and their providers , and improve glycemic control .
Summary A systematic review confirmed the efficacy and safety of metformin as first-line therapy of type 2 diabetes in the older adult , but multiple reports highlighted the risk for vitamin B12 deficiency .
R and omized controlled trials showed the efficacy and safety of antihyperglycemic agents in the elderly , including some with longer duration and lesser risk for hypoglycemia .
R and omized clinical trials showed cardiovascular protection with SGLT-2i ( empagliflozin , canagliflozin ) and GLP-1RA ( liraglutide , semaglutide ) .
Purpose of Review The current approach to diabetes in the elderly incorporates components from the comprehensive geriatric approach .
The most up date d guidelines from the American Diabetes Association reflect influence from the consensus made in 2012 with the American Geriatrics Society .
Notably , the framework included the evaluation for geriatric syndromes ( falls and urinary incontinence ) , functional and cognitive abilities .
The goal for this review is to provide an up date d summary of treatment strategies for community-dwelling older adults .
Recent Findings Findings on cardiovascular protection with sodium-glucose co-transporter 2 inhibitors ( SGLT-2i ) and some glucagon-like peptide 1 receptor agonists ( GLP-1RA ) support their use for older patients with diabetes .
Functional medicine concepts can offer additional adjuvant strategies to support the therapeutic interventions and management of diabetes in the elderly .
The most current guidelines recommend addressing for geriatric syndromes , physical and cognitive function in the elderly , in order to individualize targets and therapeutic strategies .