Optimal Glycaemic Control in Elderly People with Type 2 Diabetes: What Does the Evidence Say?

• Published in: Drug safety Vol. 38; no. 1; pp. 17 - 32
• Main Authors: Mathur, Supriya, Zammitt, Nicola N., Frier, Brian M.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.01.2015; Springer Nature B.V
• Subjects: Age; Age Factors; Aged; Aging; Alzheimer's disease; Blood Glucose - drug effects; Confidence intervals; Diabetes; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - physiopathology; Drug Safety and Pharmacovigilance; Global Health; Glycated Hemoglobin A - metabolism; Heart attacks; Humans; Hypoglycemia - chemically induced; Hypoglycemia - epidemiology; Hypoglycemic Agents - adverse effects; Hypoglycemic Agents - therapeutic use; Insulin; Insulin resistance; Leading Article; Life Style; Medicine; Medicine & Public Health; Mens health; Mortality; Older people; Patients; Pharmacology/Toxicology; Population; Practice Guidelines as Topic; Glycaemic Control; Metformin; Insulin Glargine; Sulfonylurea; Severe Hypoglycaemia
• ISSN: 0114-5916; 1179-1942
• DOI: 10.1007/s40264-014-0247-7

The global prevalence of type 2 diabetes mellitus (T2DM) is rising in an ageing population through a combination of lifestyle changes and greater longevity. However, by excluding participants aged over 70 years, most major interventional trials on which current diabetes therapeutic guidelines are based have failed to provide specific evidence to support the prescribed management of diabetes in elderly people. While diabetes per se has a significant impact on the elderly person, the side effects of medications, particularly hypoglycaemia, prevent optimisation of diabetes treatment. Hypoglycaemia is associated with significant morbidity, to which elderly people are often more vulnerable because of factors such as the effects of ageing, progressive renal impairment, frailty, polypharmacy and cognitive decline. T2DM is associated with accelerated cognitive decline in some individuals, and recurrent severe hypoglycaemia has been implicated as a potential contributory factor. Although the evidence for selection of appropriate glycaemic targets in elderly patients is sparse, it is now acknowledged that prevention of hypoglycaemia must influence individualisation of treatment goals in this vulnerable group. This should also be reflected by the choice of anti-diabetes agents that are initiated when diet and lifestyle advice is ineffective. Recently developed international guidelines, which have specifically addressed the management of diabetes in elderly people, highlight the importance of a pragmatic management approach rather than attempting to achieve a generic glycated haemoglobin goal and are summarised in this article.