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 Saxagliptin in Older Participants in the SAVOR-TIMI 53 Trial
OBJECTIVE To examine the safety and cardiovascular ( CV ) effects of saxagliptin in the predefined elderly ( ≥65 years ) and very elderly ( ≥75 years ) sub population s of the Saxagliptin Assessment of Vascular Outcomes Recorded in Patients with Diabetes Mellitus – Thrombolysis in Myocardial Infa rct ion 53 ( SAVOR-TIMI 53 ) trial . RESEARCH DESIGN AND METHODS Individuals ≥40 years ( n = 16,492 ; elderly , n = 8,561 ; very elderly , n = 2,330 ) with HbA1c ≥6.5 % ( 47.5 mmol/mol ) and ≤12.0 % ( 107.7 mmol/mol ) were r and omized ( 1:1 ) to saxagliptin  ( 5 or 2.5 mg daily ) or placebo in a double-blind trial for a median follow-up of 2.1 years . RESULTS The hazard ratio ( HR ) for the comparison of saxagliptin versus placebo for the primary end point ( composite of CV mortality , myocardial infa rct ion , or ischemic stroke ) was 0.92 for elderly patients vs. 1.15 for patients < 65 years ( P = 0.06 ) and 0.95 for very elderly patients . The HRs for the secondary composite end points in the entire cohort , elderly cohort , and very elderly cohort were similar . Although saxagliptin increased the risk of hospitalization for heart failure in the overall saxagliptin population , there was no age-based treatment interaction ( P = 0.76 for elderly patients vs. those < 65 years ; P = 0.34 for very elderly patients vs. those < 75 years ) . Among saxagliptin-treated individuals with baseline HbA1c ≥7.6 % ( 59.6 mmol/mol ) , the mean change from baseline HbA1c at 2 years was −0.69 % , −0.64 % , −0.66 % , and −0.66 % for those ≥65 , < 65 , ≥75 , and < 75 years old , respectively . The incidence of overall adverse events ( AEs ) and serious AEs was similar between saxagliptin and placebo in all cohorts ; however , hypoglycemic events were higher for saxagliptin versus placebo regardless of age . CONCLUSIONS The SAVOR-TIMI 53 trial supports the overall CV safety of saxagliptin in a robust number of elderly and very elderly participants , although the risk of heart failure hospitalization was increased irrespective of age category . AEs and serious AEs as well as glycemic efficacy of saxagliptin in elderly patients are similar to those found in younger patients
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 .