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 .
Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes.
BACKGROUND The effects of empagliflozin , an inhibitor of sodium-glucose cotransporter 2 , in addition to st and ard care , on cardiovascular morbidity and mortality in patients with type 2 diabetes at high cardiovascular risk are not known . METHODS We r and omly assigned patients to receive 10 mg or 25 mg of empagliflozin or placebo once daily . The primary composite outcome was death from cardiovascular causes , nonfatal myocardial infa rct ion , or nonfatal stroke , as analyzed in the pooled empagliflozin group versus the placebo group . The key secondary composite outcome was the primary outcome plus hospitalization for unstable angina . RESULTS A total of 7020 patients were treated ( median observation time , 3.1 years ) . The primary outcome occurred in 490 of 4687 patients ( 10.5 % ) in the pooled empagliflozin group and in 282 of 2333 patients ( 12.1 % ) in the placebo group ( hazard ratio in the empagliflozin group , 0.86 ; 95.02 % confidence interval , 0.74 to 0.99 ; P=0.04 for superiority ) . There were no significant between-group differences in the rates of myocardial infa rct ion or stroke , but in the empagliflozin group there were significantly lower rates of death from cardiovascular causes ( 3.7 % , vs. 5.9 % in the placebo group ; 38 % relative risk reduction ) , hospitalization for heart failure ( 2.7 % and 4.1 % , respectively ; 35 % relative risk reduction ) , and death from any cause ( 5.7 % and 8.3 % , respectively ; 32 % relative risk reduction ) . There was no significant between-group difference in the key secondary outcome ( P=0.08 for superiority ) . Among patients receiving empagliflozin , there was an increased rate of genital infection but no increase in other adverse events . CONCLUSIONS Patients with type 2 diabetes at high risk for cardiovascular events who received empagliflozin , as compared with placebo , had a lower rate of the primary composite cardiovascular outcome and of death from any cause when the study drug was added to st and ard care . ( Funded by Boehringer Ingelheim and Eli Lilly ; EMPA-REG OUTCOME Clinical Trials.gov number , NCT01131676 . )
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 .