Clinical management of elderly patients with type 2 diabetes mellitus.
ABSTRACT With an increase in life expectancy of the general population comes an increase in the number of elderly patients with type 2 diabetes mellitus (T2DM). Although the pharmacologic treatment options for elderly patients with T2DM are the same as for younger adults, management of this growing group poses unique challenges. Changes in renal and hepatic function and an increased prevalence of multiple comorbidities mandate an individually tailored treatment strategy that balances treatment benefits with the patient's functional status and risk for hypoglycemia and polypharmacy. This approach is hampered by the relative paucity of data regarding the pharmacotherapy of T2DM in older adults, necessitating clinical guidance based on data extrapolated from a younger population. Most current guidelines are disease-focused and do not include specific instructions on how to prioritize the treatment of hyperglycemia relative to that of other comorbidities and the functional status of patients. This article reviews the epidemiology, pathophysiology, comorbidities, pharmacokinetic considerations, treatment goals, guidelines, and treatment options for the elderly population, and highlights the current knowledge gaps complicating the management of T2DM in this population.
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ABSTRACT: Aim S.AGES is a multicenter prospective cohort study of non-institutionalized patients aged 65 and over with atrial fibrillation, type 2 diabetes or chronic pain. Its objective is to describe the medical management in primary care. This article presents the baseline characteristics of subjects in the diabetes subcohort and compares the results to those from cohorts of older diabetic patients. Methods From April 2009 to June 2011, 983 patients were included in the diabetes subcohort by 213 primary care providers. Demographic data, geriatric parameters and the history, characteristics and treatment of the diabetes were recorded at baseline. Results The mean age was 76.7 ± 5.9 years. Most patients were living independently, with no cognitive impairment and in relatively good health. The duration of diabetes was 11.3 ± 8.7 years with average HbA1c of 6.9 ± 1.0%. 20% of patients had macrovascular disease, 33% renal failure, 14.6% ocular complication and 7.1% neuropathy. The first-line antidiabetic treatment was metformin (61.2%) and 18% of patients had used insulin. Treatment intensified with the worsening of diabetic symptoms. When compared to those from French and North American cohorts, the results showed increased complications and use of insulin with age, disease duration and severity. Conclusion Due to the method of recruitment, S.AGES patients were generally healthy with well-controlled diabetes. However, the results were consistent with those from other cohorts. Three-year follow-up is expected to study the management of diabetic patients aged 65 and over in primary care.Primary Care Diabetes 07/2014; · 1.29 Impact Factor
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ABSTRACT: Impaired glucose tolerance (IGT) is a pre-diabetic metabolic state involving heterogeneous and dynamic changes between the normal and diabetic state. The present study aimed to investigate the endocrine regulation of endothelium-dependent dysfunction in middle-aged patients with IGT and in patients with a normal glucose tolerance (NGT). An oral glucose tolerance test was performed to determine the NGT and IGT states. Physiological and biochemical analyses were performed. The carotid artery structure and function were investigated with Doppler supersonic diagnostic equipment. The functioning of the vascular endothelium was analyzed with physiological and biochemical indices in the IGT group. The results showed a significant reduction in endothelium-dependent vasodilation, but not in endothelium-independent vasodilation in the IGT group compared with those of the NGT group. It was identified that the intima-media thickness of the carotid artery and expression levels of endothelin-1 were significantly higher, whereas the endothelium-derived factor C-type natriuretic peptide levels were significantly lower in the IGT group compared with those in the NGT group. Notably, significant correlations were identified between endocrinological changes and body composition, including fat and glucose metabolism, in the IGT group. Our data indicate that vascular endothelial functions may be impaired by fat and glucose metabolism and body composition in IGT patients during prediabetes mellitusare.Experimental and therapeutic medicine 03/2014; 7(3):697-702. · 0.94 Impact Factor
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ABSTRACT: To assess the efficacy of dapagliflozin, a sodium-glucose cotransporter 2 inhibitor, for the treatment of individuals with type 2 diabetes mellitus (T2DM) and preexisting cardiovascular disease (CVD).Journal of the American Geriatrics Society 06/2014; · 4.22 Impact Factor