Specifics of choosing antidiabetic treatment for elderly patients with type 2 diabetes mellitus

Czech version

Authors: Zbynek Schroner ¹; Vladimír Uličiansky ²
Authors‘ workplace: SchronerMED s. r. o., Košice ¹; Via medica, s. r. o., Košice ²
Published in: Diab Obez 2021; 21(41): 29-32
Category:

Overview

336 968 patients with type 2 diabetes mellitus (T2DM) were registered in Slovakia in 2019, almost 151 000 were older than 65 years. Suitable antidiabetic drug for older patient should be: cardiovascular safe (protective), associated with low risk of hypoglycaemia, renal safe (protective), oncologic safe, should have simple method of administration and anticipating general safety profile. Important is also possibility in its using in more serious renal dysfunctions, combination with other drugs, weight neutrality. Metformin is first line therapy also in older patients with T2DM unless contraindicated or presence of side effects. DPP-4 inhibitors are good and safe option for the therapy of older patients with type 2 diabetes. Using of SU derivatives or thiazolidinediones (pioglitazone) is not optimal in older patients with type 2 diabetes. SGLT2 inhibitors and agonists of GLP-1 receptors are recommended also in older type 2 diabetics, of course with specifications in their using for that age. Many older patients with type T2DM need treatment with insulin.

Keywords:

antidiabetic therapy – older patient – specifications of selection – type 2 diabetes mellitus

Sources

Činnosť diabetologických ambulancií v SR 2019. NCZI: Bratislava 2021. Dostupné z WWW: <http://www.nczisk.sk/Aktuality/Pages/Cinnost-diabetologickych-ambulancii-v-Slovenskej-republike-2019.aspx>.
[American Diabetes Association]. 12. Older Adults: Standards of Medical Care in Diabetes-2021. Diabetes Care 2021; 44(Suppl 1): S168-S179. Dostupné z DOI: <http://dx.doi.org/10.2337/dc21-S012>.
Schroner Z, Uličiansky V. Manažment antidiabetickej liečby u staršieho fragilného pacient s diabetes mellitus. Diab Obez 2020; 20(39): 7–11.
Uličiansky V, Schroner Z, Galajda P et al. Diabetes v zrelom veku. Quick Print: Martin 2013. ISBN 978–80–971417–1-4.
Buse JB, Wexler DJ, Tsapas A et al. 2019 Update to: Management of hyperglycemia in type 2 diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2020; 43(2): 487–493. Dostupné z DOI: <http://dx.doi.org/10.2337/dci19–0066>.
Davies MJ, D Alessio DA, Fradkin J et al. Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia 2018; 61(12): 2461–2498. Dostupné z DOI: <http://dx.doi.org/10.1007/s00125–018–4729–5>.
[Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group]. KDIGO 2020 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease. Kidney Int 2020; 98(4S): S1–S115. Dostupné z DOI: <http://dx.doi.org/10.1016/j.kint.2020.06.019>.
Pelikánová T. Diabetes ve stáří. In: Pelikánová T, Bartoš V. Praktická diabetologie. 6. vyd. Maxdorf: Praha 2018. ISBN 978–80–7345–559–0.
White WB, Cannon CP, Heller SR et al. Alogliptin after acute coronary syndromes in patients with type 2 diabetes. N Engl J Med 2013; 369(14): 1327–1335. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1305889>.
Scirica BM, Bhatt DL, Braunwald E et al. Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus. N Engl J Med 2013; 369(14): 1317–1326. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1307684>.
Green JB, Bethel MA, Armstrong PW et al. Effect of Sitagliptin on Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med 2015; 373(3): 232–242. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1501352>.
Rosenstock J, Perkovic V, Johansen OE et al. Effect of linagliptin vs placebo on major cardiovascular events in adults with type 2 diabetes and high cardiovascular and renal risk. The CARMELINA randomized clinical trial. JAMA 2019; 321(1): 69–79. Dostupné z DOI: <http://dx.doi.org/10.1001/jama.2018.18269>.
Marso SP, Daniels GH, Brown-Frandsen K et al. Liraglutide an cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med 2016; 375(4): 311–322. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1603827>.
Marso SP, Stephen C Bain SC, Consoli A et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med 2016; 375(19); 1834–1844. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1607141>.
Hernandez AF, Green JB, Janmohamed S et al. Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial. Lancet 2018; 392(10157): 1519–1529. Dostupné z DOI: <http://dx.doi.org/10.1016/S0140–6736(18)32261-X>.
Gerstein HC, Colhoun HM, Dagenais GR et al. Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind,randomised placebo-controlled trial. Lancet 2019; 394(10193): 121–130. Dostupné Dostupné z DOI: z DOI: <http://dx.doi.org/10.1016/S0140–6736(19)31149–3>.
Zinman B, Wanner C, Lachin JM et al. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med 2015; 373(22): 2117–2128. <http://dx.doi.org/10.1056/NEJMoa1504720>.
Neal B, Perkovic V, Mahaffey KW et al. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med 2017; 377(7): 644–657. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1611925>.
Wiviott SD, Raz I, Bonaca P et al. Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Eng J Med 2019; 380(4): 347–357. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1812389>.