Abstract
Type two diabetes mellitus (T2DM) represents a chronic condition with increasing prevalence worldwide among the older population. The T2DM condition increases the risk of micro and macrovascular complications as well as the risk of geriatric syndromes such as falls, fractures and cognitive impairment. The management of T2DM in the older population represents a challenge for the clinician, and a Comprehensive Geriatric Assessment should always be prioritized, in order to tailor the glycated hemoglobin target according to functional and cognitive status comorbidities, life expectancy and type of therapy. According to the most recent guidelines, older adults with T2DM should be categorized into three groups: healthy patients with good functional status, patients with complications and reduced functionality and patients at the end of life; for each group the target for glycemic control is different, also according to the type of treatment drug. The therapeutic approach should always begin with lifestyle changes; after that, several lines of therapy are available, with different mechanisms of action and potential effects other than glucose level reduction. Particular interest is growing in sodium-glucose cotransporter-2 inhibitors, due to their effect on the cardiovascular system. In this review, we evaluate the therapeutic options available for the treatment of older diabetic patients, to ensure a correct treatment approach.
Highlights
The prevalence of type 2 diabetes mellitus (T2DM) among older people is growing in relation to an ageing global population
In the Participant experiences in the Diabetes REmission Clinical Trial (DiRECT), a cohort of 280 patients from Clinical Practices in UK received either the usual care or a weight management program, including low calories diet replacement, food reintroduction and long term weight loss maintenance, aiming at reducing both weight and HbA1c [35].The results from this study showed that, at 12 months, significant weight loss was achieved in the intervention group [36], with 46% of diabetes remission compared to the 4% in the control group
Glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) are the most important incretins and they are rapidly inactivated by dipeptidyl peptidase-4 (DPP-4) [76,77,78]
Summary
The prevalence of type 2 diabetes mellitus (T2DM) among older people is growing in relation to an ageing global population. The high prevalence of urinary incontinence, chronic pain [2,8], delirium [9,10] and depression [2,8,9] among diabetic older adults negatively affects the quality of life These conditions, along with compliance issues, polypharmacy and, often, inadequate hydration and nutrition, have a negative impact on older adults’ functional status, leading to higher risk of disability and institutionalization [2,8,9,11]. Several recent studies support the hypothesis that hyperinsulinemia is the primary mechanism underlying type 2 diabetes, besides being an important etiological factor for the development of metabolic syndrome, obesity, cardiovascular disease, cancer and premature mortality. According to this new perspective, therapeutic approaches should aim at reducing plasma insulin concentrations.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
