J Korean Diabetes.  2019 Dec;20(4):220-224. 10.4093/jkd.2019.20.4.220.

Treatment Goals for Glycemia in Older Patients with Diabetes Mellitus

Affiliations
  • 1Division of Endocrinology and Metabolism, Department of Internal Medicine, National Medical Center, Seoul, Korea. drjalim@nmc.or.kr

Abstract

More than 25% of Korean population aged ≥ 65 years has diabetes, and elderly diabetic patients show higher mortality, reduced functional activity, and increased risk of hospitalization. The care of elderly diabetic patients is complicated by their clinical, cognitive, and functional heterogeneity. Healthy patients with good functional status can be treated using therapeutic interventions and goals similar those for younger adults with diabetes. For patients with complications and reduced functionality, intensive glycemic control should be avoided. Glycemic goals for older patients might be individualized so that treatment can achieve the appropriate balance between glycemic control and risk of hypoglycemia.

Keyword

Aged; Diabetes mellitus; Therapeutics

MeSH Terms

Adult
Aged
Diabetes Mellitus*
Hospitalization
Humans
Hypoglycemia
Mortality
Population Characteristics

Reference

1. Kim DJ, Won JC, Kim BY, Kim HS, Park JH. Diabetes fact sheet in Korea 2018. Seoul: Korean Diabetes Association;2018.
2. Sinclair A, Dunning T, Rodriguez Mañas L, Munshi MN. Diabetes in old age. Chichester, West Sussex: Wiley-Blackwell;2017.
3. Yoo HJ. Comprehensive approach for managing the older person with diabetes mellitus. Diabetes Metab J. 2017; 41:155–159.
Article
4. Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008; 359:1577–1589.
Article
5. Action to Control Cardiovascular Risk in Diabetes Study Group. Gerstein HC, Miller ME, Byington RP, Goff DC Jr, Bigger JT, Buse JB, Cushman WC, Genuth S, Ismail-Beigi F, Grimm RH Jr, Probstfield JL, Simons-Morton DG, Friedewald WT. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008; 358:2545–2559.
Article
6. Miller ME, Bonds DE, Gerstein HC, Seaquist ER, Bergenstal RM, Calles-Escandon J, Childress RD, Craven TE, Cuddihy RM, Dailey G, Feinglos MN, Ismail-Beigi F, Largay JF, O'Connor PJ, Paul T, Savage PJ, Schubart UK, Sood A, Genuth S. ACCORD Investigators. The effects of baseline characteristics, glycaemia treatment approach, and glycated haemoglobin concentration on the risk of severe hypoglycaemia: post hoc epidemiological analysis of the ACCORD study. BMJ. 2010; 340:b5444.
Article
7. ADVANCE Collaborative Group. Patel A, MacMahon S, Chalmers J, Neal B, Billot L, Woodward M, Marre M, Cooper M, Glasziou P, Grobbee D, Hamet P, Harrap S, Heller S, Liu L, Mancia G, Mogensen CE, Pan C, Poulter N, Rodgers A, Williams B, Bompoint S, de Galan BE, Joshi R, Travert F. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008; 358:2560–2572.
8. Duckworth W, Abraira C, Moritz T, Reda D, Emanuele N, Reaven PD, Zieve FJ, Marks J, Davis SN, Hayward R, Warren SR, Goldman S, McCarren M, Vitek ME, Henderson WG, Huang GD. VADT Investigators. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2009; 360:129–139.
Article
9. Skyler JS, Bergenstal R, Bonow RO, Buse J, Deedwania P, Gale EA, Howard BV, Kirkman MS, Kosiborod M, Reaven P, Sherwin RS. American Diabetes Association. American College of Cardiology Foundation. American Heart Association. Intensive glycemic control and the prevention of cardiovascular events: implications of the ACCORD, ADVANCE, and VA diabetes trials: a position statement of the American Diabetes Association and a scientific statement of the American College of Cardiology Foundation and the American Heart Association. Diabetes Care. 2009; 32:187–192.
Article
10. Araki A, Iimuro S, Sakurai T, Umegaki H, Iijima K, Nakano H, Oba K, Yokono K, Sone H, Yamada N, Ako J, Kozaki K, Miura H, Kashiwagi A, Kikkawa R, Yoshimura Y, Nakano T, Ohashi Y, Ito H. Japanese Elderly Diabetes Intervention Trial Study Group. Long-term multiple risk factor interventions in Japanese elderly diabetic patients: the Japanese Elderly Diabetes Intervention Trial--study design, baseline characteristics and effects of intervention. Geriatr Gerontol Int. 2012; 12 Suppl 1:7–17.
11. Currie CJ, Peters JR, Tynan A, Evans M, Heine RJ, Bracco OL, Zagar T, Poole CD. Survival as a function of HbA(1c) in people with type 2 diabetes: a retrospective cohort study. Lancet. 2010; 375:481–489.
Article
12. Huang ES, Liu JY, Moffet HH, John PM, Karter AJ. Glycemic control, complications, and death in older diabetic patients: the diabetes and aging study. Diabetes Care. 2011; 34:1329–1336.
13. Laiteerapong N, Huang ES, Chin MH. Prioritization of care in adults with diabetes and comorbidity. Ann N Y Acad Sci. 2011; 1243:69–87.
Article
14. Piette JD, Kerr EA. The impact of comorbid chronic conditions on diabetes care. Diabetes Care. 2006; 29:725–731.
Article
15. Greenfield S, Billimek J, Pellegrini F, Franciosi M, De Berardis G, Nicolucci A, Kaplan SH. Comorbidity affects the relationship between glycemic control and cardiovascular outcomes in diabetes: a cohort study. Ann Intern Med. 2009; 151:854–860.
Article
16. American Diabetes Association. 12. Older adults: Standards of Medical Care in Diabetes-2019. Diabetes Care. 2019; 42(Suppl 1):S139–S147.
17. American Geriatrics Society Expert Panel on Care of Older Adults with Diabetes Mellitus. Moreno G, Mangione CM, Kimbro L, Vaisberg E. Guidelines abstracted from the American Geriatrics Society Guidelines for improving the care of older adults with diabetes mellitus: 2013 update. J Am Geriatr Soc. 2013; 61:2020–2026.
Article
18. Young-Hyman D, de Groot M, Hill-Briggs F, Gonzalez JS, Hood K, Peyrot M. Psychosocial care for people with diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2016; 39:2126–2140.
Article
Full Text Links
  • JKD
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr