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 .
Insulin provision therapy and mortality in older adults with diabetes mellitus and stable ischemic heart disease: Insights from BARI-2D trial.
IMPORTANCE Optimal strategies for glucose control in very old adults with diabetes and stable ischemic heart disease ( SIHD ) are unclear . OBJECTIVE To compare the effects of insulin provision ( IP ) therapy versus insulin sensitizing ( IS ) therapy for glycemic control in older ( ≥75years ) and younger ( < 75years ) adults with type II diabetes ( DM ) and SIHD . DESIGN , SETTING , AND PARTICIPANTS Adults enrolled in the Bypass Angioplasty Revascularization Investigation 2 Diabetes ( BARI 2D ) were studied . The BARI 2D study population ( all with type II DM and SIHD ) was r and omized twice : ( 1 ) between revascularization plus intensive medical therapy versus intensive medical therapy alone , and ( 2 ) between IP versus IS therapies . The primary endpoint was all-cause-mortality over five-year follow-up . In this sub study outcomes related to IP vs. IS are assessed in relation to age . Adults aged ≥75years who received IP versus IS are compared to those < 75years who received  IP  versus IS . Multivariate Cox regression analysis was used to evaluate the effects of IP vs. IS on outcomes in the two age groups . RESULTS 2368 subjects with SIHD and DM were enrolled in BARI 2D ; 182 ( 8 % ) were ≥75years . Compared to younger subjects , the older cohort had lower BMI , higher diuretic use , worse kidney function , and increased history of heart failure . Within the older cohort , the IP and IS subgroups were similar in respect to baseline cardiovascular risk factors , medications , and coronary artery disease severity . During follow-up , the older subjects receiving IP therapy had higher cardiovascular mortality compared to those receiving IS therapy ( 16 % vs. 11 % , p=0.040 ) . Using Cox proportional hazards analysis , the older IP subjects were at increased risk for all-cause-mortality ( hazard ratio 1.89 , CI 1.1 - 3.2 , p=0.020 ) . No mortality difference  between IP and IS was observed in those < 75years of age . CONCLUSION AND RELEVANCE Among adults with diabetes and SIHD aged ≥75years  , IP therapy may be associated with increased mortality  compared to IS therapy . Additional studies are needed to further refine optimal treatment strategies for diabetes and SIHD in old age
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 .