These episodes may have especially severe consequences in older adults, such as falls and traumatic fractures, exacerbation of comorbidities with adverse cardiovascular events, 13 impaired cognition 14 and function. On the other hand, elderly patients are at increased risk of hypoglycemia with intensive glycemic control. 11, 12 Moreover, hyperglycemia in itself has negative physiologic consequences: osmotic diuresis leading to dehydration, impaired vision, and decreased cognition. The mean age was 62.2 years and a subgroup analysis suggested that the risk for cardiovascular mortality was disproportionally high among patients under 65 years of age.įinally, the Veteran’s Affairs Diabetes Trial, 10 found that intensive glucose control in patients with poorly controlled DM2 and a mean age of 60 years had no significant effect on the rates of major cardiovascular events, death, or microvascular complications, with the exception of progression of albuminuria over a follow-up of 5 years.Īlthough indisputable evidence on the impact of glycemic control in diabetic macrovascular complications is lacking, several observational studies have verified a correlation between high A 1c levels (>8%) and increased mortality and cardiovascular events in older adults. The Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial 9 demonstrated a decrease only in diabetic nephropathy with intensive glycemic control even though patients on this arm of the study were transitioned to standard therapy after a median follow-up of 3.7 years due to an increase in total and cardiovascular mortality. The trial only enrolled patients 55 years and older and included a subgroup analysis of patients over 65 with no statistical difference in the outcomes. In accordance with the results of the UKPDS, the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) trial 8 showed a reduction of diabetic nephropathy with intensive glycemic control, but failed to demonstrate a cardiovascular benefit after a median follow-up of 5 years. 6, 7 Since then, studies that were designed to study patients with long-standing DM2 have examined an older population, with mixed results. The UK Prospective Diabetes Study (UKPDS) was the first large randomized controlled trial to provide concrete evidence of the value of glycemic control on diabetic microvascular complications, but it excluded patients aged 65 and older at the time of enrollment to the study. Hence, the purpose of this article is to review the current literature on particularities of DM2 treatment in the age group of 65 years and older.Įvidence that supports treatment and individualized glycemic targetĭespite years of diabetes research, specific data about the benefits of diabetes treatment on older adults are scarce. 4 Therapeutic goals and the selection of drugs may not be the same for elderly and younger patients. The treatment of DM2 is especially challenging in this population due to cognitive disorders, physical disabilities, higher risk of hypoglycemia, and the high rate of comorbidities leading to polypharmacy. The elderly also take a bigger toll for this disease since DM2 in older adults is linked to increased mortality and complication rates when compared to young diabetics 4 and to people in the same age group without DM2. 2, 3 In the population over 65 years of age, the estimate is even more alarming: 10.9 million people or 26.9% of all people in this age group suffered from diabetes in 2010. Data available from multiple sources in the US 1 show that approximately 8.6% of the US population is diabetic and that this number has been steadily increasing in the last few decades. Diabetes mellitus type 2 (DM2) and its complications remain major causes of morbidity and mortality worldwide.
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