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 .
Efficacy and Safety of Canagliflozin in Individuals Aged 75 and Older with Type 2 Diabetes Mellitus: A Pooled Analysis
Objectives To compare the efficacy and safety of canagliflozin , a sodium glucose co‐transporter 2 inhibitor developed to treat type 2 diabetes mellitus ( T2DM ) , in individuals younger than 75 and those aged 75 and older . Design R and omized Phase 3 studies . Setting International study centers . Participants Adults with T2DM . Measurements Changes from baseline in glycosylated hemoglobin ( HbA1c ) , fasting plasma glucose ( FPG ) , blood pressure ( BP ) , and body weight were measured . Efficacy was evaluated using pooled data from six r and omized , double‐blind , placebo‐controlled studies ( N = 4,158 ; n = 3,975 aged < 75 , n = 183 aged ≥75 ) . Safety was assessed based on adverse event ( AE ) reports from eight r and omized , double‐blind , placebo‐ and active‐controlled studies ( N = 9,439 ; n = 8,949 aged < 75 , n = 490 aged ≥75 ) . Results Canagliflozin 100 and 300 mg were associated with placebo‐subtracted mean reductions in HbA1c in participants younger than 75 ( −0.69 % and −0.85 % , respectively ) and aged 75 and older ( −0.65 % and −0.55 % , respectively ) . Dose‐related reductions in FPG , body weight , and BP were seen with canagliflozin 100 and 300 mg in participants in both age groups . Overall AE incidence was 67.1 % with canagliflozin 100 mg , 68.6 % with canagliflozin 300 mg , and 65.9 % with non‐canagliflozin ( pooled group of comparators in all studies ) in participants younger than 75 , and 72.4 % , 79.1 % , and 72.3 % , respectively , in those aged 75 and older , with a similar safety profile in both groups . The incidence of volume depletion – related AEs was 2.2 % , 3.1 % , and 1.4 % in participants younger than 75 with canagliflozin 100 and 300 mg and non‐canagliflozin , respectively , and 4.9 % , 8.7 % , and 2.6 % , respectively , in those aged 75 and older .  Conclusion Canagliflozin improved glycemic control , body weight , and BP in participants aged 75 and older . The overall incidence of AEs was high across treatment groups in participants aged 75 and older and higher than in those younger than 75 . The safety profile of canagliflozin was generally similar in both age groups , with a higher incidence of AEs related to volume depletion observed with canagliflozin in participants aged 75 and older than in those younger than 75 . These findings support canagliflozin , starting with the 100‐mg dose , as an effective therapeutic option for older adults with T2DM
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 .