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 .
Once-weekly dulaglutide versus bedtime insulin glargine, both in combination with prandial insulin lispro, in patients with type 2 diabetes (AWARD-4): a randomised, open-label, phase 3, non-inferiority study
BACKGROUND For patients with type 2 diabetes who do not achieve target glycaemic control with conventional insulin treatment , advancing to a basal-bolus insulin regimen is often recommended . We aim ed to compare the efficacy and safety of long-acting glucagon-like peptide-1 receptor agonist dulaglutide with that of insulin glargine , both combined with pr and ial insulin lispro , in patients with type 2 diabetes . METHODS We did this 52 week , r and omised , open-label , phase 3 , non-inferiority trial at 105 study sites in 15 countries . Patients ( aged ≥18 years ) with type 2 diabetes inadequately controlled with conventional insulin treatment were r and omly assigned ( 1:1:1 ) , via a computer-generated r and omisation sequence with an interactive voice-response system , to receive once-weekly dulaglutide 1·5 mg , dulaglutide 0·75 mg , or daily bedtime glargine . R and omisation was stratified by country and metformin use . Participants and study investigators were not masked to treatment allocation , but were unaware of dulaglutide dose assignment . The primary outcome was a change in glycated haemoglobin A1c ( HbA1c ) from baseline to week 26 , with a 0·4 % non-inferiority margin . Analysis was by intention to treat . This trial is registered with Clinical Trials.gov , number NCT01191268 . FINDINGS Between Dec 9 , 2010 , and Sept 21 , 2012 , we r and omly assigned 884 patients to receive dulaglutide 1·5 mg ( n=295 ) , dulaglutide 0·75 mg ( n=293 ) , or glargine ( n=296 ) . At 26 weeks , the adjusted mean change in HbA1c was greater in patients receiving dulaglutide 1·5 mg ( -1·64 % [ 95 % CI -1·78 to -1·50 ] , -17·93 mmol/mol [ -19·44 to -16·42 ] ) and dulaglutide 0·75 mg ( -1·59 % [ -1·73 to -1·45 ] , -17·38 mmol/mol [ -18·89 to -15·87 ] ) than in those receiving glargine ( -1·41 % [ -1·55 to -1·27 ] , -15·41 mmol/mol [ -16·92 to -13·90 ] ) . The adjusted mean difference versus glargine was -0·22 % ( 95 % CI -0·38 to -0·07 , -2·40 mmol/mol [ -4·15 to -0·77 ] ; p=0·005 ) for dulaglutide 1·5 mg and -0·17 % ( -0·33 to -0·02 , -1·86 mmol/mol [ -3·61 to -0·22 ] ; p=0·015 ) for dulaglutide 0·75 mg . Five ( < 1 % ) patients died after r and omisation because of septicaemia ( n=1 in the dulaglutide 1·5 mg group ) ; pneumonia ( n=1 in the dulaglutide 0·75 mg group ) ; cardiogenic shock ; ventricular fibrillation ; and an unknown cause ( n=3 in the glargine group ) . We recorded serious adverse events in 27 ( 9 % ) patients in the dulaglutide 1·5 mg group , 44 ( 15 % ) patients in the dulaglutide 0·75 mg group , and 54 ( 18 % ) patients in the glargine group . The most frequent adverse events , arising more often with dulaglutide than glargine , were nausea , diarrhoea , and vomiting . INTERPRETATION Dulaglutide in combination with lispro result ed in a significantly greater improvement in glycaemic control than did glargine and represents a new treatment option for patients unable to achieve glycaemic targets with conventional insulin treatment . FUNDING Eli Lilly and Company
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 .