Journal List > J Korean Diabetes > v.12(4) > 1054797

Mok: Drug Therapy of Elderly Diabetic Patients

Abstract

The elderly population has recently increased significantly, and therefore the number of elderly patients with diabetes is also rapidly increasing. There are many physical, mental, and societal differences among elderly diabetic patients. Therefore, before initiating any form of glucose-lowering therapy in the elderly, it is necessary to assess overall patient health status, coexisting illnesses, the social environment, and degree of cognitive function. The elderly may also be at increased risk of adverse events, particularly hypoglycemia, during drug therapy for glucose control. Glucose control should remain an individualized target while minimizing the risk of hypoglycemia in elderly diabetic patients. This article summarizes treatment options with respect to oral glucose-lowering agents and insulins that are effective in elderly patients.

REFERENCES

1. Korean Diabetes Association, Elderly Diabetes Investigation Team. Elderly diabetes mellitus. 2nd ed.Seoul: Korea medical book;2010.
02. Baik SH, Choi KM, Cho YJ, Kim KO, Kim DR, Kim NH, Kim SG, Shin DH, Park IB, Choi DS. Prevalence of diabetes mellitus in elderly Korean in Southwest Seoul (SWS Study): comparision of 1997 ADA and 1985 WHO criteria in elderly Korean. J Korean Diabetes Assoc. 2001; 25:125–32.
3. Yu SH, Kwon MK, Lee YH, Kim HJ, Lee JJ, Park JH, Choi SH, Lim S, Park YJ, Kim KW, Jang HC. Effects of eating behaviors on health-related parameters in the elderly living in Seongnam city (Korean longitudinal study on health and aging study). J Korean Geriatr Soc. 2008; 12:138–45.
4. American Diabetes Association. Standards of medical care in diabetes-2010. Diabetes Care. 2010; 33(Suppl 1):S11–61.
5. Halter JB, Ouslander JG, Tinetti ME, Studenski S, High KP, Asthana S. Hazzard's geriatric medicine and gerontology. 6th ed.New York: McGraw-Hill;2009.
6. Brown AF, Mangione CM, Saliba D, Sarkisian CA. California Healthcare Foundation/American Geriatrics Society Panel on Improving Care for Elders with Diabetes. Guidelines for improving the care of the older person with diabetes mellitus. J Am Geriatr Soc. 2003; 51(5 Suppl Guidelines):S265–80.
7. Fravel MA, McDanel DL, Ross MB, Moores KG, Starry MJ. Special considerations for treatment of type 2 diabetes mellitus in the elderly. Am J Health Syst Pharm. 2011; 68:500–9.
crossref
8. Bosi E. Metformin-the gold standard in type 2 diabetes: what does the evidence tell us? Diabetes Obes Metab. 2009; 11(Suppl 2):3–8.
9. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998; 352:854–65.
10. Bodmer M, Meier C, Krahenbuhl S, Jick SS, Meier CR. Longterm metformin use is associated with decreased risk of breast cancer. Diabetes Care. 2010; 33:1304–8.
crossref
11. Nyenwe EA, Jerkins TW, Umpierrez GE, Kitabchi AE. Management of type 2 diabetes: evolving strategies for the treatment of patients with type 2 diabetes. Metabolism. 2011; 60:1–23.
crossref
12. Nattrass M, Lauritzen T. Review of prandial glucose regulation with repaglinide: a solution to the problem of hypoglycaemia in the treatment of type 2 diabetes? Int J Obes Relat Metab Disord. 2000; 24(Suppl 3):S21–31.
crossref
13. Dormandy JA, Charbonnel B, Eckland DJ, Erdmann E, Massi-Benedetti M, Moules IK, Skene AM, Tan MH, Lefebvre PJ, Murray GD, Standl E, Wilcox RG, Wilhelmsen L, Betteridge J, Birkeland K, Golay A, Heine RJ, Koranyi L, Laakso M, Mokan M, Norkus A, Pirags V, Podar T, Scheen A, Scherbaum W, Schernthaner G, Schmitz O, Skrha J, Smith U, Taton J. PROactive investigators. Secondary prevention of macrovascular events in patients with type 2 diabetes in the PROactive Study (PROspective pioglitAzone Clinical Trial In macroVascular Events): a randomised controlled trial. Lancet. 2005; 366:1279–89.
crossref
14. Meier C, Kraenzlin ME, Bodmer M, Jick SS, Jick H, Meier CR. Use of thiazolidinediones and fracture risk. Arch Intern Med. 2008; 168:820–5.
crossref
15. van de Laar FA, Lucassen PL, Akkermans RP, van de Lisdonk EH, Rutten GE, van Weel C. Alpha-glucosidase inhibitors for patients with type 2 diabetes: results from a Cochrane systematic review and meta-analysis. Diabetes Care. 2005; 28:154–63.
16. Drucker DJ, Nauck MA. The incretin system: glucagonlike peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors in type 2 diabetes. Lancet. 2006; 368:1696–705.
crossref
17. Schwartz SL. Treatment of elderly patients with type 2 diabetes mellitus: a systematic review of the benefits and risks of dipeptidyl peptidase-4 inhibitors. Am J Geriatr Pharmacother. 2010; 8:405–18.
crossref
18. Eng J, Kleinman WA, Singh L, Singh G, Raufman JP. Isolation and characterization of exendin-4, an exendin-3 analogue, from Heloderma suspectum venom. Further evidence for an exendin receptor on dispersed acini from guinea pig pancreas. J Biol Chem. 1992; 267:7402–5.
crossref
19. Nelson P, Poon T, Guan X, Schnabel C, Wintle M, Fineman M. The incretin mimetic exenatide as a monotherapy in patients with type 2 diabetes. Diabetes Technol Ther. 2007; 9:317–26.
crossref
20. Yki-Jarvinen H, Dressler A, Ziemen M. HOE 901/300s Study Group. Less nocturnal hypoglycemia and better post-dinner glucose control with bedtime insulin glargine compared with bedtime NPH insulin during insulin combination therapy in type 2 diabetes. HOE 901/3002 Study Group. Diabetes Care. 2000; 23:1130–6.
21. Riddle MC. Glycemic management of type 2 diabetes: an emerging strategy with oral agents, insulins, and combinations. Endocrinol Metab Clin North Am. 2005; 34:77–98.
crossref
TOOLS
Similar articles