Diabetes mellitus in complex older patients

Česká verzia

Authors: Alena Šmahelová
Authors place of work: III. interní gerontometabolická klinika LF UK a FN Hradec Králové
Published in the journal: Vnitř Lék 2018; 64(11): 1005-1008
Category:

Summary

Care of the elderly diabetic patients requires a special approach. What must be considered is not only individualization, and in more fragile elderly patients easing the targets for long-term compensation of diabetes, but also appropriate antidiabetic therapy needs to be chosen. Most patients suffer from polymorbidity and are at a greater risk for occurrence and consequences of hypoglycemia and cognitive impairment. The treatment procedure for sturdy elderly patients with diabetes is not any different from younger patients, while appropriate drugs for fragile patients are gliptins, possibly in combination with a long-term insulin analogue.

Key words:

antidiabetic therapy – complications – diabetes mellitus – level of robustness – old age

Zdroje

Abdelhafiz AH, Sinclair AJ. Management of Type 2 diabetes in Older People. Diabetes Ther 2013; 4(1): 13–26. Dostupné z DOI: <http://dx.doi.org/10.1007/s13300–013–0020–4>.
Nobili A, Garatttini S, Mannucci PM. Multiple diseases and polypharmacy in the elderly: challenges for the internist of the third millennium. J Comorbid 2011; 1: 28–44.
Tschöpe D, Hanefeld M et al. The role of co-morbidity in the selection of antidiabetic pharmacotherapy in type-2 diabetes. Cardiovasc Diabetol 2013; 12:62. Dostupné z DOI: <http://dx.doi.org/10.1186/1475–2840–12–62>.
Nair KS. Aging muscle. Am J Clin Nutr 2005; 81(5): 953–963. Dostupné z DOI: <http://dx.doi.org/10.1093/ajcn/81.5.953>.
Halter JB, Musi N, Horne FM et al. Diabetes and Cardiovascular Disease in Older Adults: Current Status and Future Directions. Diabetes 2014; 63(8): 2578–2589. Dostupné z DOI: <http://dx.doi.org/10.2337/db14–0020>.
Knowler WC, Fowler SE, Hamman RF et al. Diabetes Prevention Program Research Group. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet 2009; 374(9702): 1677–1686. Dostupné z DOI: <http://dx.doi.org/10.1016/S0140–6736(09)61457–4>. Erratum in Lancet 2009; 374(9707): 2054.
Rejeski WJ, Ip EH, Bertoni AG et al. Look AHEAD Research Group. Lifestyle change and mobility in obese adults with type 2 diabetes. N Engl J Med 2012; 366(13): 1209–1217. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1110294>.
De Pablos-Velasco P, Bradley C, de Pablos-Velasco E et al. The PANORAMA pan-European Survey: impact of severe and non-severe hypoglycaemia on quality of life and other patient reported outcomes in patients with type 2 diabetes [Abstract 580]. Diabetologia 2010; 53(Suppl 1): S234-S235.
Inzucchi S, Bergenstal R , Buse J. Management of Hyperglycemia in Type 2 Diabetes, 2015: A Patient-Centered Approach: Update to a Position Statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2015; 38(1): 140–149. Dostupné z DOI: <http://dx.doi.org/10.2337/dc14–2441>.
Whitmer RA, Karter AJ, Yaffe KF et al. Hypoglycemic Episodes and Risk of Dementia in Older Patients With Type 2 Diabetes Mellitus. JAMA 2009; 301(15): 1565–1572.<http://dx.doi.org/10.1001/jama.2009.460>.
Blaum C, Cigolle CT, Boyd C et al. Clinical complexity in middle-aged and older adults with diabetes: the Health and Retirement Study. Med Care 2010; 48(4): 327–334.
Svačina Š, Jurašková B, Karen Igor. Diabetes mellitus. Léčba u starších pacientů v ČR. Doporučené diagnostické a terapeutické postupy pro všeobecné praktické lékaře. Centrum doporučených postupů pro praktické lékaře. Společnost všeobecného lékařství, Praha 2014. Dostupné z WWW: <https://docplayer.cz/7799976-Diabetes-mellitus-lecba-u-starsich-pacientu-v-cr-prvni-vydani-2014-doporucene-diagnosticke-a-terapeuticke-postupy-pro-vseobecne-prakticke-lekare.html>.
[American Diabetes Association]. Older Adults: Standards of Medical Care in Diabetes – 2018. Diabetes Care 2018; 41(Suppl 1): S119-S125. Dostupné z DOI: <http://dx.doi.org/10.2337/dc18-S011>.
Mostafa SA, Coleman RL, Agbaje OF et al. Modelling incremental benefits on complications rates when targeting lower HbA1c levels in people with Type 2 diabetes and cardiovascular disease. Diabet Med 2018; 35(1): 72–77. Dostupné z DOI: <http://dx.doi.org/10.1111/dme.13533>.
Scott R, Morgan J, Zimmer Z et al. A Randomized Clinical Trial of the Efficacy and Safety of Sitagliptin Compared with Dapagliflozin in Patients with Type 2 Diabetes Mellitus and Mild Renal Insufficiency: The CompoSIT-R Study. Diabetes Obes Metab 2018; Dostupné z DOI: <http://dx.doi.org/10.1111/dom.13473>.
Fioretto P, Stefansson BV, Johnsson E et al. Dapagliflozin reduces albuminuria over 2 years in patients with type 2 diabetes mellitus and renal impairment. Diabetologia 2016; 59(9): 2036–2039. Dostupné z DOI: <http://dx.doi.org/10.1007/s00125–016–4017–1>.
Roussel R, Duran-Garcia S, Zhang Y et al. Efficacy and Safety of Continuing Sitagliptin When Initiating Insulin Therapy in Subjects With Type 2 Diabetes Mellitus. Poster presented at: ADA 2018; June 22–26, 2018; Orlando, Florida. Diabetes 2018; 67(Supplement 1). Dostupné z DOI: <https://doi.org/10.2337/db18–112-LB>.
Halter JB, Musi N, McFarland Horne F. Diabetes and cardiovascular disease in older adults: current status and future directions. Diabetes 2014 ; 63(8):2578–2589. Dostupné z DOI: <http://doi: 10.2337/db14–0020>.