Management of Glucose-Lowering Therapy in Older Adults with Type 2 Diabetes: Challenges and Opportunities

References

• Orimo H, Ito H, Suzuki T, Araki A, Hosoi T, Sawabe M. Reviewing the definition of “elderly”. Geriatr Gerontol Int. 2006;6(3):149–158. doi:10.1111/j.1447-0594.2006.00341.x
   Google Scholar
• Singh S, Bajorek B. Defining ‘elderly’ in clinical practice guidelines for pharmacotherapy. Pharm Pract. 2014;12(4):489. doi:10.4321/s1886-36552014000400007
   PubMedGoogle Scholar
• Ouchi Y, Rakugi H, Arai H, et al. Redefining the elderly as aged 75 years and older: proposal from the joint committee of Japan gerontological Society and the Japan Geriatrics Society. Geriatr Gerontol Int. 2017;17(7):1045–1047. doi:10.1111/ggi.13118
   PubMed Web of Science ®Google Scholar
• Lee SB, Oh JH, Park JH, Choi SP, Wee JH. Differences in youngest-old, middle-old, and oldest-old patients who visit the emergency department. Clin Exp Emerg Med. 2018;5(4):249–255. doi:10.15441/ceem.17.261
   PubMed Web of Science ®Google Scholar
• ElSayed NA, Aleppo G, Aroda VR, et al. 13. Older adults: standards of care in diabetes-2023. Diabetes Care. 2023;46(Suppl 1):S216–229. doi:10.2337/dc23-S013
   PubMedGoogle Scholar
• Khan MAB, Hashim MJ, King JK, Govender RD, Mustafa H, Al Kaabi J. Epidemiology of type 2 diabetes - Global burden of disease and forecasted trends. J Epidemiol Glob Health. 2020;10(1):107–111. doi:10.2991/jegh.k.191028.001
   PubMed Web of Science ®Google Scholar
• Cortez BN, Bahour N, Aguayo-Mazzucato C. Biological age in diabetes and precision medicine. Aging. 2022;14(11):4622–4623. doi:10.18632/aging.204123
   PubMedGoogle Scholar
• Bradley D, Hsueh W. Type 2 diabetes in the elderly: challenges in a unique patient population. J Geriatr Med Gerontol. 2016;2(2):14. doi:10.23937/2469-5858/1510014
   PubMedGoogle Scholar
• Lowsky DJ, Olshansky SJ, Bhattacharya J, Goldman DP. Heterogeneity in healthy aging. J Gerontol a Biol Sci Med Sci. 2014;69(6):640–649. doi:10.1093/gerona/glt162
   PubMed Web of Science ®Google Scholar
• Longo M, Bellastella G, Maiorino MI, Meier JJ, Esposito K, Giugliano D. Diabetes and aging: from treatment goals to pharmacologic therapy. Front Endocrinol. 2019;10:45. doi:10.3389/fendo.2019.00045
   PubMed Web of Science ®Google Scholar
• Ahlqvist E, Storm P, Käräjämäki A, et al. Novel subgroups of adult-onset diabetes and their association with outcomes: a data-driven cluster analysis of six variables. Lancet Diabetes Endocrinol. 2018;6(5):361–369. doi:10.1016/S2213-8587(18)30051-2
   PubMed Web of Science ®Google Scholar
• Sanz-Cánovas J, López-Sampalo A, Cobos-Palacios L, et al. Management of type 2 diabetes mellitus in elderly patients with frailty and/or sarcopenia. Int J Environ Res Public Health. 2022;19(14):8677. doi:10.3390/ijerph19148677
   PubMed Web of Science ®Google Scholar
• Menassa M, Stronks K, Khatmi F, et al. Concepts and definitions of healthy ageing: a systematic review and synthesis of theoretical models. EClinicalMedicine. 2023;56:101821. doi:10.1016/j.eclinm.2022.101821
   PubMedGoogle Scholar
• International Diabetes Federation (IDF). IDF global guideline for managing older people with type 2 diabetes; 2017. Available from: https://www.idf.org/e-library/guidelines/78-global-guideline-for-managing-older-people-with-type-2-diabetes.html. Accessed March 28, 2023.
   Google Scholar
• LeRoith D, Biessels GJ, Braithwaite SS, et al. Treatment of diabetes in older adults: an Endocrine Society* clinical practice guideline. J Clin Endocrinol Metab. 2019;104(5):1520–1574. doi:10.1210/jc.2019-00198
   PubMed Web of Science ®Google Scholar
• Huang ES. Management of diabetes mellitus in older people with comorbidities. BMJ. 2016;353:i2200. doi:10.1136/bmj.i2200
   PubMedGoogle Scholar
• Corriere M, Rooparinesingh N, Kalyani RR. Epidemiology of diabetes and diabetes complications in the elderly: an emerging public health burden. Curr Diab Rep. 2013;13(6):805–813. doi:10.1007/s11892-013-0425-5
   PubMed Web of Science ®Google Scholar
• An J, Nichols GA, Qian L, et al. Prevalence and incidence of microvascular and macrovascular complications over 15 years among patients with incident type 2 diabetes. BMJ Open Diabetes Res Care. 2021;9(1):e001847. doi:10.1136/bmjdrc-2020-001847
   PubMed Web of Science ®Google Scholar
• Doucet J, Verny C, Balkau B, Scheen AJ, Bauduceau B. Haemoglobin A1c and 5-year all-cause mortality in French type 2 diabetic patients aged 70 years and older: the GERODIAB observational cohort. Diabetes Metab. 2018;44(6):465–472. doi:10.1016/j.diabet.2018.05.003
   PubMed Web of Science ®Google Scholar
• Anyanwagu U, Mamza J, Donnelly R, Idris I. Relationship between HbA1c and all-cause mortality in older patients with insulin-treated type 2 diabetes: results of a large UK Cohort Study. Age Ageing. 2019;48(2):235–240. doi:10.1093/ageing/afy178
   PubMed Web of Science ®Google Scholar
• Idrees T, Castro-Revoredo IA, Migdal AL, Moreno EM, Umpierrez GE. Update on the management of diabetes in long-term care facilities. BMJ Open Diabetes Res Care. 2022;10(4):e002705. doi:10.1136/bmjdrc-2021-002705
   PubMed Web of Science ®Google Scholar
• Pilla SJ, Jalalzai R, Tang O, et al. A national physician survey of deintensifying diabetes medications for older adults with type 2 diabetes. Diabetes Care. 2023;46(6):1164–1168. doi:10.2337/dc22-2146
   PubMed Web of Science ®Google Scholar
• Lipska KJ, Ross JS, Miao Y, Shah ND, Lee SJ, Steinman MA. Potential overtreatment of diabetes mellitus in older adults with tight glycemic control. JAMA Intern Med. 2015;175(3):356–362. doi:10.1001/jamainternmed.2014.7345
   PubMed Web of Science ®Google Scholar
• Verma M, Paneri S, Badi P, Raman PG. Effect of increasing duration of diabetes mellitus type 2 on glycated hemoglobin and insulin sensitivity. Indian J Clin Biochem. 2006;21(1):142–146. doi:10.1007/BF02913083
   PubMedGoogle Scholar
• Yotsapon T, Sirinate K, Ekgaluck W, et al. Clinical characteristics and outcomes of the oldest old people with type 2 diabetes - perspective from a tertiary diabetes center in Thailand. BMC Endocr Disord. 2016;16(1):30. doi:10.1186/s12902-016-0115-9
   PubMedGoogle Scholar
• Wing RR, Bolin P. Look AHEAD Research Group. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med. 2013;369(2):145–154.
   PubMed Web of Science ®Google Scholar
• Pahor M, Guralnik JM, Ambrosius WT, et al. Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE study randomized clinical trial. JAMA. 2014;311(23):2387–2396. doi:10.1001/jama.2014.5616
   PubMed Web of Science ®Google Scholar
• Dziegielewska-Gesiak S. Metabolic syndrome in an aging society - role of oxidant-antioxidant imbalance and inflammation markers in disentangling atherosclerosis. Clin Interv Aging. 2021;16:1057–1070. doi:10.2147/CIA.S306982
   PubMed Web of Science ®Google Scholar
• Tamura Y, Omura T, Toyoshima K, Araki A. Nutrition management in older adults with diabetes: a review on the importance of shifting prevention strategies from metabolic syndrome to frailty. Nutrients. 2020;12(11):3367. doi:10.3390/nu12113367
   PubMed Web of Science ®Google Scholar
• Farabi SS, Carley DW, Smith D, Quinn L. Impact of exercise on diurnal and nocturnal markers of glycaemic variability and oxidative stress in obese individuals with type 2 diabetes or impaired glucose tolerance. Diab Vasc Dis Res. 2015;12(5):381–385. doi:10.1177/1479164115579003
   PubMed Web of Science ®Google Scholar
• Yakaryılmaz FD, Öztürk ZA. Treatment of type 2 diabetes mellitus in the elderly. World J Diabetes. 2017;8(6):278–285. doi:10.4239/wjd.v8.i6.278
   PubMed Web of Science ®Google Scholar
• Strain WD, Hope SV, Green A, Kar P, Valabhji J, Sinclair AJ. Type 2 diabetes mellitus in older people: a brief statement of key principles of modern day management including the assessment of frailty. A national collaborative stakeholder initiative. Diabet Med. 2018;35(7):838–845. doi:10.1111/dme.13644
   PubMed Web of Science ®Google Scholar
• Bellary S, Kyrou I, Brown JE, Bailey CJ. Type 2 diabetes mellitus in older adults: clinical considerations and management. Nat Rev Endocrinol. 2021;17(9):534–548. doi:10.1038/s41574-021-00512-2
   PubMed Web of Science ®Google Scholar
• Seidu S, Kunutsor SK, Topsever P, Hambling CE, Cos FX, Khunti K. Deintensification in older patients with type 2 diabetes: a systematic review of approaches, rates and outcomes. Diabetes Obes Metab. 2019;21(7):1668–1679. doi:10.1111/dom.13724
   PubMed Web of Science ®Google Scholar
• Munshi MN, Slyne C, Segal AR, Saul N, Lyons C, Weinger K. Simplification of insulin regimen in older adults and risk of hypoglycemia. JAMA Intern Med. 2016;176(7):1023–1025. doi:10.1001/jamainternmed.2016.2288
   PubMed Web of Science ®Google Scholar
• Jude EB, Malecki MT, Gomez Huelgas R, et al. Expert panel guidance and narrative review of treatment simplification of complex insulin regimens to improve outcomes in type 2 diabetes. Diabetes Ther. 2022;13(4):619–634. doi:10.1007/s13300-022-01222-2
   PubMed Web of Science ®Google Scholar
• Karagiannis T, Tsapas A, Athanasiadou E, et al. GLP-1 receptor agonists and SGLT2 inhibitors for older people with type 2 diabetes: a systematic review and meta-analysis. Diabetes Res Clin Pract. 2021;174:108737. doi:10.1016/j.diabres.2021.108737
   PubMed Web of Science ®Google Scholar
• Cheng D, Yang S, Zhao X, Wang G. The role of glucagon-like peptide-1 receptor agonists (GLP-1 RA) in diabetes-related neurodegenerative diseases. Drug Des Devel Ther. 2022;16:665–684. doi:10.2147/DDDT.S348055
   PubMed Web of Science ®Google Scholar
• Seidu S, Cos X, Brunton S, et al. 2022 update to the position statement by primary care diabetes Europe: a disease state approach to the pharmacological management of type 2 diabetes in primary care. Prim Care Diabetes. 2022;16(2):223–244. doi:10.1016/j.pcd.2022.02.002
   PubMed Web of Science ®Google Scholar
• Sinclair AJ, Girling AJ, Bayer AJ. Cognitive dysfunction in older subjects with diabetes mellitus: impact on diabetes self-management and use of care services. All Wales Research into Elderly (AWARE) Study. Diabetes Res Clin Pract. 2000;50(3):203–212. doi:10.1016/S0168-8227(00)00195-9
   PubMed Web of Science ®Google Scholar
• Papa G, Fedele V, Chiavetta A, et al. Therapeutic options for elderly diabetic subjects: open label, randomized clinical trial of insulin glargine added to oral antidiabetic drugs versus increased dosage of oral antidiabetic drugs. Acta Diabetol. 2008;45(1):53–59. doi:10.1007/s00592-007-0023-6
   PubMed Web of Science ®Google Scholar
• Abd.Ghafar MZA, O’Donovan M, Sezgin D, et al. Frailty and diabetes in older adults: overview of current controversies and challenges in clinical practice. Front Clin Diabetes Healthc. 2022;3:895313. doi:10.3389/fcdhc.2022.895313
   PubMedGoogle Scholar
• Abdelhafiz AH, Pennells D, Sinclair AJ. A modern approach to glucose-lowering therapy in frail older people with type 2 diabetes mellitus. Expert Rev Endocrinol Metab. 2022;17(2):95–98. doi:10.1080/17446651.2022.2044304
   PubMed Web of Science ®Google Scholar
• Bradley MC, Chillarige Y, Lee H, et al. Severe hypoglycemia risk with long-acting insulin analogs vs neutral protamine Hagedorn insulin. JAMA Intern Med. 2021;181(5):598–607. doi:10.1001/jamainternmed.2020.9176
   PubMed Web of Science ®Google Scholar
• Munshi MN, Pandya N, Umpierrez GE, DiGenio A, Zhou R, Riddle MC. Contributions of basal and prandial hyperglycemia to total hyperglycemia in older and younger adults with type 2 diabetes mellitus. J Am Geriatr Soc. 2013;61(4):535–541. doi:10.1111/jgs.12167
   PubMed Web of Science ®Google Scholar
• Rosenstock J, Bajaj HS, Janež A, et al. Once-weekly insulin for type 2 diabetes without previous insulin treatment. N Engl J Med. 2020;383(22):2107–2116. doi:10.1056/NEJMoa2022474
   PubMed Web of Science ®Google Scholar
• Toschi E, Munshi MN. Benefits and challenges of diabetes technology use in older adults. Endocrinol Metab Clin North Am. 2020;49(1):57–67. doi:10.1016/j.ecl.2019.10.001
   PubMed Web of Science ®Google Scholar
• Munshi MN, Meneilly GS, Rodríguez-Mañas L, et al. Diabetes in ageing: pathways for developing the evidence base for clinical guidance. Lancet Diabetes Endocrinol. 2020;8(10):855–867. doi:10.1016/S2213-8587(20)30230-8
   PubMed Web of Science ®Google Scholar
• Munshi MN, Slyne C, Greenberg JM, et al. Nonadherence to insulin therapy detected by bluetooth-enabled pen cap is associated with poor glycemic control. Diabetes Care. 2019;42(6):1129–1131. doi:10.2337/dc18-1631
   PubMed Web of Science ®Google Scholar
• Reznik Y, Cohen O, Aronson R, et al. Insulin pump treatment compared with multiple daily injections for treatment of type 2 diabetes (OpT2mise): a randomised open-label controlled trial. Lancet. 2014;384(9950):1265–1272. doi:10.1016/S0140-6736(14)61037-0
   PubMed Web of Science ®Google Scholar
• Abdelhafiz AH, Sinclair AJ. Metabolic phenotypes explain the relationship between dysglycaemia and frailty in older people with type 2 diabetes. J Diabetes Complications. 2022;36(4):108144. doi:10.1016/j.jdiacomp.2022.108144
   PubMed Web of Science ®Google Scholar
• Heinemann L. Continuous glucose monitoring (CGM) or blood glucose monitoring (BGM): interactions and implications. J Diabetes Sci Technol. 2018;12(4):873–879. doi:10.1177/1932296818768834
   PubMedGoogle Scholar
• Pratley RE, Kanapka LG, Rickels MR, et al. Effect of continuous glucose monitoring on hypoglycemia in older adults with type 1 diabetes: a randomized clinical trial. JAMA. 2020;323(23):2397–2406. doi:10.1001/jama.2020.6928
   PubMed Web of Science ®Google Scholar
• Pratley RE, Rosenstock J, Heller SR, et al. Reduced glucose variability with glucose-dependent versus glucose-independent therapies despite similar glucose control and hypoglycemia rates in a randomized, controlled study of older patients with type 2 diabetes mellitus. J Diabetes Sci Technol. 2018;12(6):1184–1191. doi:10.1177/1932296818776993
   PubMedGoogle Scholar
• Bao S, Bailey R, Calhoun P, Beck RW. Effectiveness of continuous glucose monitoring in older adults with type 2 diabetes treated with basal insulin. Diabetes Technol Ther. 2022;24(5):299–306. doi:10.1089/dia.2021.0494
   PubMed Web of Science ®Google Scholar
• Davis GM, Spanakis EK, Migdal AL, et al. Accuracy of Dexcom G6 continuous glucose monitoring in non-critically ill hospitalized patients with diabetes. Diabetes Care. 2021;44(7):1641–1646. doi:10.2337/dc20-2856
   PubMed Web of Science ®Google Scholar
• Klonoff DC, Ahn D, Drincic A. Continuous glucose monitoring: a review of the technology and clinical use. Diabetes Res Clin Pract. 2017;133:178–192. doi:10.1016/j.diabres.2017.08.005
   PubMed Web of Science ®Google Scholar
• Prasad-Reddy L, Godina A, Chetty A, Isaacs D. Use of continuous glucose monitoring in older adults: a review of benefits, challenges and future directions. touchREV Endocrinol. 2022;18(2):116–121. doi:10.17925/EE.2022.18.2.116
   PubMedGoogle Scholar
• Wang R, Foskey R, Barmanray R, Le B, Fourlanos S. End-of-life care requires caution with use of continuous glucose monitoring. J Palliat Med. 2022;25(3):516–518. doi:10.1089/jpm.2021.0271
   PubMed Web of Science ®Google Scholar
• Jackson MA, Ahmann A, Shah VN. Type 2 diabetes and the use of real-time continuous glucose monitoring. Diabetes Technol Ther. 2021;23(S1):S27–34. doi:10.1089/dia.2021.0007
   PubMedGoogle Scholar
• Shehav-Zaltzman G, Segal G, Konvalina N, Tirosh A. Remote glucose monitoring of hospitalized, quarantined patients with diabetes and COVID-19. Diabetes Care. 2020;43(7):e75–76. doi:10.2337/dc20-0696
   PubMed Web of Science ®Google Scholar
• Garcia SP, Madalosso MM, Bottino LG, et al. Optimization of care for adult outpatients with type 2 diabetes through the diabetes self-management multidisciplinary program: a randomized clinical trial. Can J Diabetes. 2022;46(5):449–456.e443. doi:10.1016/j.jcjd.2022.01.006
   PubMed Web of Science ®Google Scholar
• Inouye SK, Studenski S, Tinetti ME, Kuchel GA. Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. J Am Geriatr Soc. 2007;55(5):780–791. doi:10.1111/j.1532-5415.2007.01156.x
   PubMed Web of Science ®Google Scholar
• Bruyère O, Buckinx F, Beaudart C, et al. How clinical practitioners assess frailty in their daily practice: an international survey. Aging Clin Exp Res. 2017;29(5):905–912. doi:10.1007/s40520-017-0806-8
   PubMed Web of Science ®Google Scholar
• Liu X, Le MK, Lim AYC, et al. Perspectives on frailty screening, management and its implementation among acute care providers in Singapore: a qualitative study. BMC Geriatr. 2022;22(1):58. doi:10.1186/s12877-021-02686-w
   PubMed Web of Science ®Google Scholar
• Nan J, Duan Y, Wu S, et al. Perspectives of older adults, caregivers, healthcare providers on frailty screening in primary care: a systematic review and qualitative meta-synthesis. BMC Geriatr. 2022;22(1):482. doi:10.1186/s12877-022-03173-6
   PubMed Web of Science ®Google Scholar
• Choi JY, Lee JY, Shin J, et al. COMPrehensive geriatric Assessment and multidisciplinary team intervention for hospitalised older adults (COMPASS): a protocol of pragmatic trials within a cohort. BMJ Open. 2022;12(8):e060913. doi:10.1136/bmjopen-2022-060913
   PubMed Web of Science ®Google Scholar
• Beverly EA, Wray LA, Chiu CJ, LaCoe CL. Older adults’ perceived challenges with health care providers treating their type 2 diabetes and comorbid conditions. Clin Diabetes. 2014;32(1):12–17. doi:10.2337/diaclin.32.1.12
   PubMedGoogle Scholar
• Wan EYF, Fung CSC, Jiao FF, et al. Five-year effectiveness of the multidisciplinary Risk Assessment and Management Programme-Diabetes Mellitus (RAMP-DM) on diabetes-related complications and health service uses-a population-based and propensity-matched cohort study. Diabetes Care. 2018;41(1):49–59. doi:10.2337/dc17-0426
   PubMed Web of Science ®Google Scholar
• Moorhouse P, Theou O, Fay S, McMillan M, Moffatt H, Rockwood K. Treatment in a geriatric day hospital improve individualized outcome measures using goal attainment scaling. BMC Geriatr. 2017;17(1):9. doi:10.1186/s12877-016-0397-9
   PubMedGoogle Scholar
• Tan HQM, Chin YH, Ng CH, et al. Multidisciplinary team approach to diabetes. An outlook on providers’ and patients’ perspectives. Prim Care Diabetes. 2020;14(5):545–551. doi:10.1016/j.pcd.2020.05.012
   PubMed Web of Science ®Google Scholar