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 .
Durability of glycemic control with insulin lispro mix 75/25 versus insulin glargine for older patients with type 2 diabetes
Background and Aims Few studies have evaluated long-term durability of glycemic control in older patients . The aim of this study was to compare durability of glycemic control of twice-daily insulin lispro mix 75/25 ( LM75/25 ; 75 % insulin lispro protamine suspension , 25 % insulin lispro ) and once-daily insulin glargine ( GL ) added to oral antihyperglycemic medications in older patients ( ≥65 years of age ) . Methods Patients were participants in the maintenance phase of the DURABLE trial . During the initiation phase , patients with type 2 diabetes were r and omized to LM75/25 or GL . After 6 months , patients with hemoglobin A1c ( HbA1c ) ≤7.0 % advanced to the 24-month maintenance phase . The primary objective was between-group comparison of duration of maintaining the HbA1c goal in older patients ( ≥65 years of age ) . A similar analysis was conducted for older patients achieving HbA1c ≤6.5 % in the initiation phase .  Results Median time of maintaining HbA1c goal was longer in LM75/25 versus GL ( 19.6 versus 15.4 months , p = 0.007 ) and more LM75/25 patients maintained goal versus GL ( 49.2 versus 30.4 % ; p = 0.003 ) . HbA1c reduction from baseline was greater in LM75/25 versus GL ( −1.56 ± 0.10 versus −1.24 ± 0.11 % ; p = 0.003 ) . Post-meal glucose was significantly lower in LM75/25 versus GL ( 158.86 ± 3.42 versus 171.67 ± 4.51 mg/dL ; p = 0.017 ) . No differences were observed in overall and severe hypoglycemia . LM75/25 patients had higher daily insulin doses ( 0.41 ± 0.02 versus 0.32 ± 0.02 units/kg/day ; p < 0.001 ) and more weight gain ( 5.47 ± 0.49 versus 3.10 ± 0.53 kg ; p = 0.001 ) . Similar results were generally obtained in older patients with HbA1c ≤6.5 % . Conclusions In our evaluation of older patients from a larger trial , LM75/25 appeared to provide longer durability of glycemic control , as well as a greater number of patients maintaining HbA1c goal versus GL
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 .