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 .
Linagliptin for patients aged 70 years or older with type 2 diabetes inadequately controlled with common antidiabetes treatments: a randomised, double-blind, placebo-controlled trial
BACKGROUND A substantial proportion of patients with type 2 diabetes are elderly ( ≥65 years ) but this group has been largely excluded from clinical studies of glucose-lowering drugs . We aim ed to assess the effectiveness of linagliptin , a dipeptidyl peptidase-4 inhibitor , in elderly patients with type 2 diabetes . METHODS In this r and omised , double-blind , parallel-group , multinational phase 3 study , patients aged 70 years or older with type 2 diabetes , glycated haemoglobin A1c ( HbA1c ) of 7·0 % or more , receiving metformin , sulfonylureas , or basal insulin , or combinations of these drugs  , were r and omised ( by computer-generated r and omisation sequence , concealed with a voice-response system , stratified by HbA1c level [ < 8·5 % vs ≥8·5 % ] and insulin use [ yes vs no ] , block size four ) in a 2:1 ratio to once-daily oral treatment with linagliptin 5 mg or matching placebo for 24 weeks . Investigators and participants were masked to assignment throughout the study . The primary endpoint was change in HbA1c from baseline to week 24 . This trial is registered with Clinical Trials.gov , number NCT01084005 . FINDINGS 241 community-living out patients were r and omised ( 162 linagliptin , 79 placebo ) . Mean age was 74·9 years ( SD 4·3 ) . Mean HbA1c was 7·8 % ( SD 0·8 ) . At week 24 , placebo-adjusted mean change in HbA1c with linagliptin was -0·64 % ( 95 % CI -0·81 to -0·48 , p<0·0001 ) . Overall safety and tolerability were much the same between the linagliptin and placebo groups ; 75·9 % of patients in both groups had an adverse event ( linagliptin n=123 , placebo n=60 ) . No deaths occurred . Serious adverse events occurred in 8·6 % ( 14 ) of patients in the linagliptin group and 6·3 % ( five ) patients in the placebo group ; none were deemed related to study drug . Hypoglycaemia was the most common adverse event in both groups , but did not differ between groups ( 24·1 % [ 39 ] in the linagliptin group , 16·5 % [ 13 ] in the placebo group ; odds ratio 1·58 , 95 % CI 0·78 - 3·78 , p=0·2083 ) . INTERPRETATION In elderly patients with type 2 diabetes linagliptin was efficacious in lowering glucose with a safety profile similar to placebo . These findings could inform treatment decisions for achieving individualised glycaemic goals with minimal risk in this important population of patients . FUNDING Boehringer Ingelheim
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 .