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 and Heart Failure in Type 2 Diabetes Mellitus
Background : Canagliflozin is a sodium glucose cotransporter 2 inhibitor that reduces the risk of cardiovascular events . We report the effects on heart failure ( HF ) and cardiovascular death overall , in those with and without a baseline history of HF , and in other participant subgroups . Methods : The CANVAS Program ( Canagliflozin Cardiovascular Assessment Study ) enrolled 10 142 participants with type 2 diabetes mellitus and high cardiovascular risk . Participants were r and omly assigned to canagliflozin or placebo and followed for a mean of 188 weeks . The primary end point for these analyses was adjudicated cardiovascular death or hospitalized HF . Results : Participants with a history of HF at baseline ( 14.4 % ) were more frequently women , white , and hypertensive and had a history of prior cardiovascular disease  ( all P<0.001 ) . Greater proportions of these patients were using therapies such as blockers of the renin angiotensin aldosterone system , diuretics , and & bgr;-blockers at baseline ( all P<0.001 ) . Overall , cardiovascular death or hospitalized HF was reduced in those treated with canagliflozin compared with placebo ( 16.3 versus 20.8 per 1000 patient-years ; hazard ratio [ HR ] , 0.78 ; 95 % confidence interval [ CI ] , 0.67–0.91 ) , as was fatal or hospitalized HF ( HR , 0.70 ; 95 % CI , 0.55–0.89 ) and hospitalized HF alone ( HR , 0.67 ; 95 % CI , 0.52–0.87 ) . The benefit on cardiovascular death or hospitalized HF may be greater in patients with a prior history of HF ( HR , 0.61 ; 95 % CI , 0.46–0.80 ) compared with those without HF at baseline ( HR , 0.87 ; 95 % CI , 0.72–1.06 ; P interaction = 0.021 ) . The effects of canagliflozin compared with placebo on other cardiovascular outcomes and key safety outcomes were similar in participants with and without HF at baseline ( all interaction P values > 0.130 ) , except for a possibly reduced absolute rate of events attributable to osmotic diuresis among those with a prior history of HF ( P=0.03 ) . Conclusions : In patients with type 2 diabetes mellitus and an elevated risk of cardiovascular disease , canagliflozin reduced the risk of cardiovascular death or hospitalized HF across a broad range of different patient subgroups . Benefits may be greater in those with a history of HF at baseline . 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 .