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 .
Canagliflozin for Primary and Secondary Prevention of Cardiovascular Events
Background : Canagliflozin is a sodium glucose cotransporter 2 inhibitor that significantly reduces the composite of cardiovascular death , nonfatal myocardial infa rct ion , or nonfatal stroke in patients with type 2 diabetes mellitus and elevated cardiovascular risk . The comparative effects among participants with and without a history of cardiovascular disease ( secondary versus primary prevention ) were prespecified for evaluation . Methods : The CANVAS Program ( Canagliflozin Cardiovascular Assessment Study ) r and omly assigned 10 142 participants with type 2 diabetes mellitus to canagliflozin or placebo . The primary prevention cohort comprised individuals ≥50 years of age with ≥2 risk factors for cardiovascular events but with no prior cardiovascular event , and the secondary prevention cohort comprised individuals ≥30 years of age with a prior cardiovascular event . The primary end point was a composite of cardiovascular death , nonfatal myocardial infa rct ion , or nonfatal stroke . Secondary outcomes included heart failure hospitalization and a renal composite ( 40 % reduction in estimated glomerular filtration rate , renal replacement therapy , or renal death ) . Results : Primary prevention participants ( N=3486 ; 34 % ) were younger ( 63 versus 64 years of age ) , were more often female ( 45 % versus 31 % ) , and had a longer duration of diabetes mellitus ( 14 versus 13 years ) compared with secondary prevention participants ( N=6656 ; 66 % ) . The primary end point event rate was higher in the secondary prevention group compared with the primary prevention group ( 36.9 versus 15.7/1000 patient-years , P<0.001 ) . In the total cohort , the primary end point was reduced with canagliflozin compared with placebo ( 26.9 versus 31.5/1000 patient-years ; hazard ratio [ HR ] , 0.86 ; 95 % confidence interval [ CI ] , 0.75–0.97 ; P<0.001 for noninferiority , P=0.02 for superiority ) with no statistical evidence of heterogeneity ( interaction P value=0.18 ) between the primary ( HR , 0.98 ; 95 % CI , 0.74–1.30 ) and secondary prevention ( HR , 0.82 ; 95 % CI , 0.72–0.95 ) cohorts . Renal outcomes ( HR , 0.59 ; 95 % CI , 0.44–0.79 versus HR , 0.63 ; 95 % CI , 0.39–1.02 ; interaction P value=0.73 ) and heart failure hospitalization ( HR , 0.68 ; 95 % CI , 0.51–0.90 versus HR , 0.64 ; 95 % CI , 0.35–1.15 ; interaction P value=0.91 ) were similarly reduced in the secondary and primary prevention cohorts , respectively . Lower extremity amputations were similarly increased in the secondary and primary prevention cohorts ( HR , 2.07 ; 95 % CI , 1.43–3.00 versus HR , 1.52 ; 95 % CI , 0.70–3.29 ; interaction P value=0.63 ) . Conclusions : Patients with type 2 diabetes mellitus and prior cardiovascular events had higher rates of cardiovascular outcomes compared with the primary prevention patients .  Canagliflozin reduced cardiovascular and renal outcomes with no statistical evidence of heterogeneity of the treatment effect across the primary and secondary prevention groups . Additional studies will provide further insights into the effects of canagliflozin in these patient population s. Clinical Trial Registration : URL : https://www . clinical trials.gov . Unique identifiers : NCT01032629 and NCT01989754
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 .