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IDIS Index Record 653134

Title:
SPECIAL CONSIDERATIONS FOR TREATMENT OF TYPE 2 DIABETES MELLITUS IN THE
ELDERLY

Authors:
FRAVEL M A; MCDANEL D L; ROSS M B; MOORES K G; STARRY M J

Source:
AM J HEALTH-SYST PHARM, vol 68, iss 6, p 500-509, yr 2011

Drugs:
INSULINS & ANTIDIABETIC AGTS 68200000; SULFONYLUREAS 68200600; METFORMIN 68200407; ROSIGLITAZONE 68200418; PIOGLITAZONE 68200417; NATEGLINIDE 68200413; REPAGLINIDE 68200402; ACARBOSE 68200411; INSULINS 68200800; PRAMLINTIDE 68200011; SITAGLIPTIN 68200002; SAXAGLIPTIN 68200015

Diseases:
GERIATRIC V86.; DIABETES MELLITUS 250.

Descriptors:
REVIEW GERIATRIC 23; SIDE EF ADVERSE REACTION 46

Abstract:
Purpose. The intensity and selection of therapy for the treatment of type 2 diabetes mellitus in elderly patients are discussed.
Summary. Glycemic control is fundamental in diabetes care; however, as glycemic goals are approached, the risk of hypoglycemia increases. This risk is even greater in the elderly due to many predisposing factors, including renal insufficiency, polypharmacy, drug-drug interactions, comorbidities, irregular meal patterns, and infrequent self-monitoring of blood glucose. When deciding on the desired intensity of diabetes treatment, the risk of hypoglycemic complications must be weighed against the potential benefit of reducing microvascular and macrovascular complications. Three large-scale, randomized controlled trials examining the effects of intensive versus standard glycemic control on microvascular and macrovascular outcomes in patients with type 2 diabetes have been published in recent years. In general, a glycosylated hemoglobin (HbA1c) goal of <7% is reasonable for most patients. A less-aggressive goal may be considered for patients at high risk of hypoglycemia or high risk of complications from hypoglycemia, as long as acutely symptomatic hyperglycemia is avoided. Chlorpropamide, glyburide, and rosiglitazone, which pose a great risk for hypoglycemia, should be avoided in the elderly.
Conclusion. In the absence of clear evidence advocating strict glycemic targets goal of <7% is for elderly patients, an HbA1c reasonable for most patients; however, the risk of hypoglycemic complications must be weighed against the potential benefit of reducing microvascular and macrovascular disease. Metformin may be used as first-line therapy, but chlorpropamide and glyburide, which pose a great risk for hypoglycemia, should be avoided in the elderly. Due to increased cardiovascular risk, use of rosiglitazone in the elderly should also be avoided.


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