Management of Type 2 Diabetes Mellitus in the Very Elderly: One Practice's Experience.
| Autor: | Grajower MM; Albert Einstein College of Medicine, Bronx, New York. Electronic address: grajower@msn.com., LeRoith D; Icahn School of Medicine at Mount Sinai, NY, New York. |
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| Jazyk: | angličtina |
| Zdroj: | Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists [Endocr Pract] 2023 Jul; Vol. 29 (7), pp. 560-565. Date of Electronic Publication: 2023 Mar 24. |
| DOI: | 10.1016/j.eprac.2023.03.271 |
| Abstrakt: | Objective: Type 2 diabetes mellitus (T2DM) affects 25% of adults over age 65. Nevertheless, few clinical trials include patients over age 75. Methods: This case series reports retrospective data on a cohort of 85 patients aged 80 and over (mean 88.1, range 80-104) with T2DM, managed by a single endocrinologist. The practice's computerized data base was searched for all patients 80 years of age and older with a diagnosis of T2DM. Results: The major observations were the significant decrease in the use of agents associated with hypoglycemia (sulfonylureas and insulin), and the beneficial and well-tolerated use of glucagon like peptide-1 receptor analogues (GLP-1 RA). The mean A1c in the entire cohort dropped from 7.6% to 6.6% over a mean of 9 months. Nearly one-half of the cohort were treated with GLP1-RA, reflecting studies demonstrating the safety and efficacy of this class of drugs in less elderly patients. At presentation, 75% were on sulfonylurea and/or insulin; this number was reduced to 27%. Furthermore, none of the patients required short-acting (bolus) insulin to achieve the individualized A1c target. Conclusion: Patients with T2DM aged 80 and over respond well to GLP1-RA drugs, drastically reducing the need for agents associated with hypoglycemia. The important question, which will require larger and prospective studies, is whether the lowering of A1c, as shown in this paper, and the use of GLP-1 RA specifically, are associated with improved morbidity and mortality in the very elderly. (Copyright © 2023 AACE. Published by Elsevier Inc. All rights reserved.) |
| Databáze: | MEDLINE |
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