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 .
Assessing the Safety of Sitagliptin in Older Participants in the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS)
OBJECTIVE Limited data exist regarding safety and efficacy of antihyperglycemic drugs in older patients with type 2 diabetes . The Trial Evaluating Cardiovascular Outcomes with Sitagliptin ( TECOS ) was a r and omized , double-blind , placebo-controlled trial assessing the impact of sitagliptin on a primary composite outcome of cardiovascular death , nonfatal stroke , nonfatal myocardial infa rct ion , or unstable angina hospitalizations in patients with type 2 diabetes ( HbA1c ≥6.5 % [ 48 mmol/mol ] and ≤8.0 % [ 64 mmol/mol ] ) and cardiovascular disease . We analyzed baseline characteristics and clinical outcomes for TECOS participants aged ≥75 years . RESEARCH DESIGN AND METHODS Clinical and safety event summaries are presented for older versus younger participants and for the treatment groups within the older cohort . RESULTS Of 14,351 participants with age recorded , 2,004 ( 14 % ) were ≥75 years old ( mean age 78.3 years [ SD 3.1 ] ) , with 68 % men and type 2 diabetes duration median 12.0 years ( IQR 7 , 21 ) . During 2.9 years median follow-up , older participants had higher rates of the primary outcome ( 6.46 vs. 3.67 events per 100 person-years ; hazard ratio 1.72 [ 95 % CI 1.52–1.94 ] ) , death ( 2.52 [ 2.20–2.89 ] ) , severe hypoglycemia ( 1.53 [ 1.15–2.03 ] ) , and fractures ( 1.84 [ 1.44–2.35 ] ) . In the older cohort , sitagliptin did not significantly impact the primary composite ( 1.10 [ 0.89–1.36 ] ) , death ( 1.05 [ 0.83–1.32 ] ) , heart failure hospitalization ( 0.99 [ 0.65–1.49 ] ) , severe hypoglycemia ( 1.03 [ 0.62–1.71 ] ) , rates of acute pancreatitis and pancreatic cancer , or serious adverse events . CONCLUSIONS Among older patients with well-controlled type 2 diabetes and cardiovascular disease , sitagliptin had neutral effects on cardiovascular risk and raised no significant safety concerns
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 .