Management of type 2 diabetes mellitus in older adults: eight case studies with focus SGLT-2 inhibitors and metformin
| Autor: | Nezahat Muge Catikkas, Mirko Petrovic, Gulistan Bahat, Mehmet Akif Karan |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Blood Glucose
medicine.medical_specialty Anorexia Type 2 diabetes Diabetes Therapy Weight loss Diabetes mellitus Internal medicine Weight Loss medicine Humans Hypoglycemic Agents Sodium-Glucose Transporter 2 Inhibitors Aged Aged 80 and over Polypharmacy Frailty business.industry Malnutrition Type 2 Diabetes Mellitus General Medicine medicine.disease Metformin Diabetes Mellitus Type 2 medicine.symptom business medicine.drug |
| Zdroj: | Acta Clinica Belgica. 77:727-734 |
| ISSN: | 2295-3337 1784-3286 |
| Popis: | Objectives: Sodium-glucose co-transporter-2 (SGLT-2) inhibitors have been recently introduced for type 2 diabetes treatment with significant cardiovascular, renal benefits. Yet, they have frequently been refrained in older adults. Metformin is regarded the first-line diabetes therapy for all ages; still it is associated with weight loss and frailty in older adults. We aimed to outline our experience with three oldest-old patients with high cardiovascular risk managed with SGLT-2 inhibitors, and five patients with anorexia/weight loss managed by metformin cessation. Methods: We outlined demographics, comorbidities, geriatric syndromes, functional status, and diabetes duration, and presented the changes in frailty by noting pre-intervention and post-intervention frailty scores. We outlined benefits and side effects related to SGLT-2 inhibitors, and the deprescription reasons and represcription practices of metformin therapy. We gave details on baseline and current diabetes treatment, overall medication regimen, and current status of the patients. Results: Among the case studies with SGLT-2 inhibitors, two patients were frail and reversed to pre-frailty status after SGLT-2 intervention, while the third patient was and remained robust. All patients had clinical improvements with better blood pressure and glucose control. Among the case studies treated with metformin, all were frail before the cessation of metformin. Four reversed to pre-frailty and one became robust after intervention. Conclusion: The findings of our case studies suggest considering SGLT-2 inhibitors in patients with accompanying heart failure/high cardiovascular risk factors and cessation of metformin in those with malnutrition/malnutrition risk. These approaches have potential to improve frailty and inappropriate medication use in diabetic older adults. |
| Databáze: | OpenAIRE |
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