Evidence-Based Management of Diabetes in Older Adults

  • Arshag D. Mooradian
Review Article


The number of older adults with diabetes is rapidly increasing worldwide. A variety of factors contribute to the age-related increase in the incidence of diabetes. The lack of empiric evidence in the field has limited the management guidelines to mostly expert opinion. Given uncertainty over the rate at which to lower blood glucose levels and the optimal method of doing so, the goals of diabetes control in older people must be individualized. If the patient requires insulin therapy, the newer insulins, with their improved pharmacodynamic consistency and reduced risk of hypoglycemia, should be preferred. Several oral agents are preferable for people with sufficient endogenous insulin because they do not cause hypoglycemia when used as monotherapy. Some of these oral agents have been found to have cardioprotective effects. Older people with diabetes also require management of the other risk factors for cardiovascular disease, with antihypertensive drugs, cholesterol-lowering agents and low-dose aspirin. However, the precise targets for blood pressure control and low-density lipoprotein (LDL) cholesterol levels continue to evolve as more data become available. Diabetes care in older adults should focus on enhancing the individual’s quality of life rather than trying to normalize blood glucose levels or reach predetermined blood pressure and LDL cholesterol targets.


Compliance with Ethical Standards


No sources of funding were used to conduct this study or prepare this manuscript.

Conflict of interest

Arshag D. Mooradian has no conflicts of interest that are directly relevant to the content of this article.


  1. 1.
    National Center for Chronic Disease Prevention and Health Promotion; Division of Diabetes Translation. National Diabetes Statistics Report, 2017. Accessed 9 Nov 2018.
  2. 2.
    Paolisso G. Pathophysiology of diabetes in elderly people. Acta Biomed. 2010;81(Suppl 1):47–53.PubMedGoogle Scholar
  3. 3.
    Mooradian AD. Mechanisms of age-related endocrine alterations. Part II. Drugs Aging. 1993;3:131–46.CrossRefPubMedGoogle Scholar
  4. 4.
    Giddings SJ, Carnaghi LR, Mooradian AD. Age-related changes in pancreatic islet cell gene expression. Metabolism. 1995;44:320–4.CrossRefPubMedGoogle Scholar
  5. 5.
    Brown AF, Mangione CM, Saliba D, et al. Guidelines for improving the care of the older person with diabetes mellitus, California Healthcare Foundation/American Geriatrics Society Panel on Improving Care for Elders with Diabetes. J Am Geriatr Soc. 2003;51(5 supplement):S265–80.PubMedGoogle Scholar
  6. 6.
    Olson DE, Norris SL. Diabetes in older adults. Overview of AGS guidelines for the treatment of diabetes mellitus in geriatric populations. Geriatrics. 2004;59:18–24.PubMedGoogle Scholar
  7. 7.
    Sinclair AJ, Paolisso G, Castro M, Bourdel-Marchasson I, Gadsby R, Rodriguez Mañas L, European Diabetes Working Party for Older People. European Diabetes Working Party for Older People 2011 clinical guidelines for type 2 diabetes mellitus. Executive summary. Diabetes Metab. 2011;37(Suppl 3):S27–38.CrossRefPubMedGoogle Scholar
  8. 8.
    Durso SC. Using clinical guidelines for older adult patients with diabetes mellitus and complex health status. JAMA. 2006;295:1935–40.CrossRefPubMedGoogle Scholar
  9. 9.
    Maty SC, Fried LP, Volpato S, et al. Patterns of disability related to diabetes mellitus in older women. J Gerontol A Biol Sci Med Sci. 2004;59:148–53.CrossRefPubMedGoogle Scholar
  10. 10.
    Wray LA, Ofstedal MB, Langa KM, et al. The effect of diabetes on disability in middle-aged and older adults. J Gerontol A Biol Sci Med Sci. 2005;60:1206–11.CrossRefPubMedGoogle Scholar
  11. 11.
    Volpato S, Leveille SG, Blaum C, Fried LP, Guralnik JM. Risk factors for falls in older disabled women with diabetes: the women’s health and aging study. J Gerontol A Biol Sci Med Sci. 2005;60:1539–45.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Mooradian AD. Psychosocial aspects of diabetes in the elderly. Diabetes Spectr. 1989;2:170–2.Google Scholar
  13. 13.
    Feldman SM, Rosen R, De Stasio J. Status of diabetes management in the nursing home setting in 2008: a retrospective chart review and epidemiology study of diabetic nursing home residents and nursing home initiatives in diabetes management. J Am Med Dir Assoc. 2009;10:354–60.CrossRefPubMedGoogle Scholar
  14. 14.
    Mooradian AD. Diabetes as a model of premature aging. In: Cohn M, editor. Handbook of models for human aging. Burlington, MA: Elsevier Academic Press; 2006. p. 687–95.CrossRefGoogle Scholar
  15. 15.
    Mooradian AD. Tissue specificity of premature aging in diabetes mellitus: the role of cellular replicative capacity. J Am Geriatr Soc. 1988;36:831–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Morisaki N, Watanabe S, Kobayashi J, Kanzaki T, Takahashi K, Yokote K, Tezuka M, Tashiro J, Inadera H, Saito Y, et al. Diabetic control and progression of retinopathy in elderly patients: five-year follow-up study. J Am Geriatr Soc. 1994;42:142–5.CrossRefPubMedGoogle Scholar
  17. 17.
    Barnett KN, McMurdo ME, Ogston SA, Morris AD, Evans JM. Mortality in people diagnosed with type 2 diabetes at an older age: a systematic review. Age Ageing. 2006;35:463–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Tancredi M, Rosengren A, Svensson AM, Kosiborod M, Pivodic A, Gudbjörnsdottir S, Wedel H, Clements M, Dahlqvist S, Lind M. Excess mortality among persons with type 2 diabetes. N Engl J Med. 2015;373:1720–32.CrossRefPubMedGoogle Scholar
  19. 19.
    Huo L, Magliano DJ, Rancière F, Harding JL, Nanayakkara N, Shaw JE, Carstensen B. Impact of age at diagnosis and duration of type 2 diabetes on mortality in Australia 1997–2011. Diabetologia. 2018;61:1055–63.PubMedGoogle Scholar
  20. 20.
    Zoungas S, Woodward M, Li Q, Cooper ME, Hamet P, Harrap S, Heller S, Marre M, Patel A, Poulter N, Williams B, Chalmers J, ADVANCE Collaborative group. Impact of age, age at diagnosis and duration of diabetes on the risk of macrovascular and microvascular complications and death in type 2 diabetes. Diabetologia. 2014;57:2465–74.CrossRefPubMedGoogle Scholar
  21. 21.
    Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM, Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393–403.CrossRefPubMedGoogle Scholar
  22. 22.
    Leske MC, Sperduto RD. The epidemiology of senile cataracts: a review. Am J Epidemiol. 1983;118:152–65.CrossRefPubMedGoogle Scholar
  23. 23.
    Leske MC. The epidemiology of open-angle glaucoma: a review. Am J Epidemiol. 1983;118:166–91.CrossRefPubMedGoogle Scholar
  24. 24.
    Morley JE, Mooradian AD, Rosenthal MH, Kaiser FE. Diabetes mellitus in the elderly: is it different? Am J Med. 1987;83:533–44.CrossRefPubMedGoogle Scholar
  25. 25.
    Evans SL, Nixon BP, Lee I, Yee D, Mooradian AD. The prevalence and nature of podiatric problems in elderly diabetic patients. J Am Geriatr Soc. 1991;39:241–5.CrossRefPubMedGoogle Scholar
  26. 26.
    Mooradian AD, Korenman SG. Management of the cardinal features of andropause. Am J Ther. 2006;13:145–60.CrossRefPubMedGoogle Scholar
  27. 27.
    Wachtel TJ. The diabetic-hyperosmolar state. Clin Geriatr Med. 1990;6:797–806.CrossRefPubMedGoogle Scholar
  28. 28.
    Schwartz AV, Vittinghoff E, Sellmeyer DE, Feingold KR, de Rekeneire N, Strotmeyer ES, Shorr RI, Vinik AI, Odden MC, Park SW, Faulkner KA, Harris TB, Health, Aging, and Body Composition Study. Diabetes-related complications, glycemic control, and falls in older adults. Diabetes Care. 2008;31:391–6.CrossRefPubMedGoogle Scholar
  29. 29.
    Blaum CS, Ofstedal MB, Langa KM, et al. Functional status and health outcomes in older Americans with diabetes mellitus. J Am Geriatr Soc. 2003;51:745–53.CrossRefPubMedGoogle Scholar
  30. 30.
    Blaum CS, Xue QL, Tian J, Semba RD, Fried LP, Walston J. Is hyperglycemia associated with frailty status in older women? J Am Geriatr Soc. 2009;57:840–7.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Mooradian AD, Perryman K, Fitten J, Kavonian G, Morley JE. Cortical function in elderly non-insulin dependent diabetic patients: behavioral and electrophysiological studies. Arch Int Med. 1988;148:2369–72.CrossRefGoogle Scholar
  32. 32.
    Mooradian AD. Diabetic complications of the central nervous system. Endocr Rev. 1988;9:346–56.CrossRefPubMedGoogle Scholar
  33. 33.
    Mooradian AD, Siverly FD. Qualitative differences in the visual retention test performance of older non-insulin dependent diabetic patients. Age. 1993;16:67–9.CrossRefGoogle Scholar
  34. 34.
    Ray KK, Seshasai SR, Wijesuriya S, et al. Effect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus: a meta-analysis of randomised controlled trials. Lancet. 2009;373:1765–72.CrossRefPubMedGoogle Scholar
  35. 35.
    Action to Control Cardiovascular Risk in Diabetes Study Group, Gerstein HC, Miller ME, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358:2545–59.CrossRefGoogle Scholar
  36. 36.
    American Diabetes Association. 6. Glycemic targets: standards of medical care in diabetes-2018. Diabetes Care. 2018;41(Suppl 1):S55–64.CrossRefGoogle Scholar
  37. 37.
    Chung SC, Hlatky MA, Faxon D, Ramanathan K, Adler D, Mooradian A, Rihal C, Stone RA, Bromberger JT, Kelsey SF, Brooks MM, BARI 2D Study Group. The effect of age on clinical outcomes and health status BARI 2D (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes). J Am Coll Cardiol. 2011;58:810–9.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Damluji AA, Cohen ER, Moscucci M, Myerburg RJ, Cohen MG, Brooks MM, Rich MW, Forman DE. Insulin provision therapy and mortality in older adults with diabetes mellitus and stable ischemic heart disease: Insights from BARI-2D trial. Int J Cardiol. 2017;241:35–40.CrossRefPubMedGoogle Scholar
  39. 39.
    Mooradian AD, Chehade JM. Diabetes mellitus in older adults. Am J Ther. 2012;19:145–59.CrossRefPubMedGoogle Scholar
  40. 40.
    Holvey SM. Psychosocial aspects in the care of elderly diabetic patients. Am J Med. 1986;8(suppl 5A):61–3.CrossRefGoogle Scholar
  41. 41.
    Mooradian AD. Behavioral effects if noninsulin-dependent diabetes mellitus in the elderly. Neurobiol Aging. 1994;15:565–7.CrossRefPubMedGoogle Scholar
  42. 42.
    Katon WJ, Von Korff M, Lin EH, Simon G, Ludman E, Russo J, Ciechanowski P, Walker E, Bush T. The pathways study: a randomized trial of collaborative care in patients with diabetes and depression. Arch Gen Psychiatry. 2004;61:1042–9.CrossRefPubMedGoogle Scholar
  43. 43.
    American Diabetes Association. 2. Diagnosis and classification of diabetes: standards of medical care in diabetes-2018. Diabetes Care. 2018;41(Suppl 1):S13–27.CrossRefGoogle Scholar
  44. 44.
    Ziemer DC, Kolm P, Weintraub WS, Vaccarino V, Rhee MK, Twombly JG, Narayan KM, Koch DD, Phillips LS. Glucose-independent, black-white differences in hemoglobin A1c levels: a cross-sectional analysis of 2 studies. Ann Intern Med. 2010;152:770–7.CrossRefPubMedGoogle Scholar
  45. 45.
    Mooradian AD, Morin A, Clip L, Haspel H. Glucose transport is reduced in the blood–brain barrier of aged rats. Brain Res. 1991;551:145–9.CrossRefPubMedGoogle Scholar
  46. 46.
    Mooradian AD, Scarpace PJ. β-Adrenergic receptor activity of cerebral microvessels is reduced in aged rats. Neurochem Res. 1991;16:447–51.CrossRefPubMedGoogle Scholar
  47. 47.
    Mooradian AD. Central nervous system complications of diabetes mellitus. A perspective from the blood–brain barrier. Brain Res Rev. 1997;23:210–8.CrossRefPubMedGoogle Scholar
  48. 48.
    Mooradian AD. Pathophysiology of central nervous system disorders in diabetes. Clin Neurosci. 1997;4:322–6.PubMedGoogle Scholar
  49. 49.
    Wolff JL, Starfield B, Anderson G. Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Arch Intern Med. 2002;162:2269–76.CrossRefPubMedGoogle Scholar
  50. 50.
    Niefeld MR, Braunstein JB, Wu AW, Saudek CD, Weller WE, Anderson GF. Hospitalization among elderly medicare beneficiaries with type 2 diabetes. Diabetes Care. 2003;26:1344–9.CrossRefPubMedGoogle Scholar
  51. 51.
    Druss BG, Marcus SC, Olfson M, Tanielian T, Elinson L, Pincus HA. Comparing the national economic burden of five chronic conditions. Health Aff (Millwood). 2001;20:233–41.CrossRefGoogle Scholar
  52. 52.
    Piette JD, Kerr EA. The impact of comorbid chronic conditions on diabetes care. Diabetes Care. 2006;29:725–31.CrossRefPubMedGoogle Scholar
  53. 53.
    Reed RL, Mooradian AD. Nutritional status and dietary management of elderly diabetic patients. Clin Geriatr Med. 1990;6:883–902.CrossRefPubMedGoogle Scholar
  54. 54.
    Mooradian AD, Osterweil D, Petrasek D, Morley JE. Diabetes mellitus in the elderly nursing home patients: a survey of clinical characteristics and management. J Am Geriatr Soc. 1988;36:391–6.CrossRefPubMedGoogle Scholar
  55. 55.
    Mooradian AD, Kalis J, Nugent CA. The nutritional status of ambulatory elderly type II diabetic patients. Age. 1990;13:87–9.CrossRefGoogle Scholar
  56. 56.
    Thurman JE. Mooradian AD Vitamin supplementation therapy in the elderly. Drugs Aging. 1997;11:433–49.CrossRefPubMedGoogle Scholar
  57. 57.
    Binder EF, Yarasheski KE, Steger-May K, Sinacore DR, Brown M, Schechtman KB, Holloszy JO. Effects of progressive resistance training on body composition in frail older adults: results of a randomized, controlled trial. J Gerontol A Biol Sci Med Sci. 2005;60:1425–31.CrossRefPubMedGoogle Scholar
  58. 58.
    Fiatarone MA, O’Neill EF, Ryan ND, Clements KM, Solares GR, Nelson ME, Roberts SB, Kehayias JJ, Lipsitz LA, Evans WJ. Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med. 1994;330:1769–75.CrossRefPubMedGoogle Scholar
  59. 59.
    Mooradian AD. Drug therapy of non-insulin-dependent diabetes mellitus in the elderly. Drugs. 1996;6:931–41.CrossRefGoogle Scholar
  60. 60.
    Chehade JM, Mooradian AD. A rational approach to drug therapy of type 2 diabetes mellitus. Drugs. 2000;60:95–113.CrossRefPubMedGoogle Scholar
  61. 61.
    Oiknine R, Mooradian AD. Drug therapy of diabetes in the elderly. Biomed Pharmacother. 2003;57:231–9.CrossRefPubMedGoogle Scholar
  62. 62.
    Chehade J, Mooradian AD. Drug therapy: current and emerging agents for hyperglycemia. In: Sinclair AJ, editor. Diabetes in old age. 3rd ed. Hoboken: Wiley; 2009. p. 245–64.CrossRefGoogle Scholar
  63. 63.
    Nissen SE, Wolski K. Effect of rosiglitazone on the risk of myocardial infarction and death from cardiovascular causes. N Engl J Med. 2007;356:2457–71.CrossRefPubMedGoogle Scholar
  64. 64.
    ORIGIN Trial Investigators, Gerstein HC, Bosch J, et al. Basal insulin and cardiovascular and other outcomes in dysglycemia. N Engl J Med. 2012;367:319–28.CrossRefGoogle Scholar
  65. 65.
    Marso SP, McGuire DK, Zinman B, et al. Efficacy and safety of degludec versus glargine in type 2 diabetes. N Engl J Med. 2017;377:723–32.CrossRefPubMedPubMedCentralGoogle Scholar
  66. 66.
    Oiknine R, Bernbaum M, Mooradian AD. A critical appraisal of the role of insulin analogues in the management of diabetes. Drugs. 2005;65:325–40.CrossRefPubMedGoogle Scholar
  67. 67.
    Mooradian AD, Bernbaum M, Albert SG. A narrative review: a rational approach to starting insulin therapy. Ann Intern Med. 2006;145:125–34.CrossRefPubMedGoogle Scholar
  68. 68.
    Janka HU, Plewe G, Busch K. Combination of oral antidiabetic agents with basal insulin versus premixed insulin alone in randomized elderly patients with type 2 diabetes mellitus. J Am Geriatr Soc. 2007;55:182–8.CrossRefPubMedGoogle Scholar
  69. 69.
    Herman WH, Ilag LL, Johnson SL, Martin CL, Sinding J, Al Harthi A, Plunkett CD, LaPorte FB, Burke R, Brown MB, Halter JB, Raskin P. A clinical trial of continuous subcutaneous insulin infusion versus multiple daily injections in older adults with type 2 diabetes. Diabetes Care. 2005;28:1568–73.CrossRefPubMedGoogle Scholar
  70. 70.
    Schwartz TB, Meinert CL. The UGDP controversy: 34 years of contentious ambiguity laid to rest. Perspect Biol Med. 2004;47:564–74.CrossRefPubMedGoogle Scholar
  71. 71.
    UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837–53.CrossRefGoogle Scholar
  72. 72.
    Vaccaro O, Masulli M, Nicolucci A, et al. Effects on the incidence of cardiovascular events of the addition of pioglitazone versus sulfonylureas in patients with type 2 diabetes inadequately controlled with metformin (TOSCA.IT): a randomised, multicenter trial. Lancet Diabetes Endocrinol. 2017;5:887–97.CrossRefPubMedGoogle Scholar
  73. 73.
    Shorr RI, Ray WA, Daugherty JR, et al. Incidence and risk factors for serious hypoglycemia in older persons using insulin or sulfonylureas. Arch Intern Med. 1997;157:1681–6.CrossRefPubMedGoogle Scholar
  74. 74.
    UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet. 1998;352:854–65.CrossRefGoogle Scholar
  75. 75.
    Home PD, Pocock SJ, Beck-Nielsen H, et al. Rosiglitazone evaluated for cardiovascular outcomes in oral agent combination therapy for type 2 diabetes (RECORD): a multicentre, randomised, open-label trial. Lancet Lond Engl. 2009;373:2125–35.CrossRefGoogle Scholar
  76. 76.
    Kernan WN, Viscoli CM, Furie KL, et al. Pioglitazone after ischemic stroke or transient ischemic attack. N Engl J Med. 2016;374:1321–31.CrossRefPubMedPubMedCentralGoogle Scholar
  77. 77.
    Dormandy JA, Charbonnel B, Eckland DJ, et al. 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.CrossRefPubMedGoogle Scholar
  78. 78.
    Chiasson J-L, Josse RG, Gomis R, et al. Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance: the STOP-NIDDM trial. JAMA. 2003;290:486–94.CrossRefPubMedGoogle Scholar
  79. 79.
    Hanefeld M, Cagatay M, Petrowitsch T, et al. Acarbose reduces the risk for myocardial infarction in type 2 diabetic patients: meta-analysis of seven long-term studies. Eur Heart J. 2004;25:10–6.CrossRefPubMedGoogle Scholar
  80. 80.
    Holman RR, Coleman RL, Chan JCN, et al. Effects of acarbose on cardiovascular and diabetes outcomes in patients with coronary heart disease and impaired glucose tolerance (ACE): a randomised, double-blind, placebo-controlled trial. Lancet Diabetes Endocrinol. 2017;5:877–86.CrossRefPubMedGoogle Scholar
  81. 81.
    Johnston PS, Lebovitz HE, Coniff RF, Simonson DC, Raskin P, Munera CL. Advantages of alpha glucosidase inhibition as monotherapy in elderly type 2 diabetic patients. J Clin Endocrinol Metab. 1998;83:1515–22.PubMedGoogle Scholar
  82. 82.
    Deleon MJ, Chandurkar V, Albert SG, Mooradian AD. Glucagon-like peptide-1 (GLP-1) response to acarbose in elderly type 2 diabetic subjects. Diabetes Res Clin Pract. 2002;56:101–6.CrossRefPubMedGoogle Scholar
  83. 83.
    Mooradian AD, Albert SG, Wittry S, Chehade J, Kim J, Bellrichard B. Dose-response profile of acarbose in older subjects with Type 2 diabetes. Am J Med Sci. 2000;319:334–7.CrossRefPubMedGoogle Scholar
  84. 84.
    Scirica BM, Braunwald E, Raz I, et al. Heart failure, saxagliptin, and diabetes mellitus: observations from the SAVOR-TIMI 53 randomized trial. Circulation. 2014;130:1579–88.CrossRefPubMedGoogle Scholar
  85. 85.
    Green JB, Bethel MA, Armstrong PW, et al. Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2015;373:232–42.CrossRefPubMedGoogle Scholar
  86. 86.
    White WB, Cannon CP, Heller SR, et al. Alogliptin after acute coronary syndrome in patients with type 2 diabetes. N Engl J Med. 2013;369:1327–35.CrossRefPubMedGoogle Scholar
  87. 87.
    Umpierrez GE, Cardona S, Chachkhiani D, et al. A randomized controlled study comparing a DPP4 inhibitor (linagliptin) and basal insulin (glargine) in patients with type 2 diabetes in long-term care and skilled nursing facilities: Linagliptin-LTC Trial. J Am Med Dir Assoc. 2018;19:399–404.CrossRefPubMedGoogle Scholar
  88. 88.
    Marso SP, Daniels GH, Brown-Frandsen K, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2016;375:311–22.CrossRefPubMedPubMedCentralGoogle Scholar
  89. 89.
    Marso SP, Bain SC, Consoli A, et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2016;375:1834–44.CrossRefPubMedGoogle Scholar
  90. 90.
    Pfeffer MA, Claggett B, Diaz R, et al. Lixisenatide in patients with type 2 diabetes and acute coronary syndrome. N Engl J Med. 2015;373:2247–57.CrossRefGoogle Scholar
  91. 91.
    Holman RR, Bethel MA, Mentz RJ, et al. Effects of once-weekly exenatide on cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2017;377:1228–39.CrossRefPubMedGoogle Scholar
  92. 92.
    Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015;373:2117–28.CrossRefPubMedGoogle Scholar
  93. 93.
    Neal B, Perkovic V, Mahaffey KW, et al. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med. 2017;377:644–57.CrossRefPubMedGoogle Scholar
  94. 94.
    Mortensen MB, Falk E. Primary prevention with statins in the elderly. J Am Coll Cardiol. 2018;71:85–94.CrossRefPubMedGoogle Scholar
  95. 95.
    Colhoun HM, Betteridge DJ, Durrington PN, et al. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial. Lancet. 2004;364:685–96.CrossRefPubMedGoogle Scholar
  96. 96.
    ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The antihypertensive and lipid-lowering treatment to prevent heart attack trial. Major outcomes in moderately hypercholesterolemic, hypertensive patients randomized to pravastatin vs usual care: the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT-LLT). JAMA. 2002;288:2998–3007.Google Scholar
  97. 97.
    Knopp RH, d’Emden M, Smilde JG, Pocock SJ. Efficacy and safety of atorvastatin in the prevention of cardiovascular end points in subjects with type 2 diabetes: the Atorvastatin Study for Prevention of Coronary Heart Disease Endpoints in non-insulin-dependent diabetes mellitus (ASPEN). Diabetes Care. 2006;29:1478–85.CrossRefPubMedGoogle Scholar
  98. 98.
    Sever PS, Dahlöf B, Poulter NR, Wedel H, Beevers G, Caulfield M, Collins R, Kjeldsen SE, Kristinsson A, McInnes GT, Mehlsen J, Nieminen M, O’Brien E, Ostergren J, ASCOT investigators. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial. Lancet. 2003;361(9364):1149–58.CrossRefPubMedGoogle Scholar
  99. 99.
    Cholesterol Treatment Trialists’ (CTT) Collaboration, Baigent C, Blackwell L, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet Lond Engl. 2010;376:1670–81.CrossRefGoogle Scholar
  100. 100.
    Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129:S1–45.CrossRefPubMedGoogle Scholar
  101. 101.
    HPS Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet Lond Engl. 2002;360:7–22.CrossRefGoogle Scholar
  102. 102.
    Cannon CP, Blazing MA, Giugliano RP, et al. Ezetimibe added to statin therapy after acute coronary syndromes. N Engl J Med. 2015;372:2387–97.CrossRefPubMedGoogle Scholar
  103. 103.
    Sabatine MS, Giugliano RP, Keech AC, et al. Evolocumab and clinical outcomes in patients with cardiovascular disease. N Engl J Med. 2017;376:1713–22.CrossRefPubMedGoogle Scholar
  104. 104.
  105. 105.
    Lloyd-Jones DM, Morris PB, Ballantyne CM, et al. 2017 Focused update of the 2016 ACC expert consensus decision pathway on the role of non-statin therapies for LDL-cholesterol lowering in the management of atherosclerotic cardiovascular disease risk: a Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. J Am Coll Cardiol. 2017;70:1785–822.CrossRefPubMedGoogle Scholar
  106. 106.
    Mooradian AD. Dyslipidemia of type 2 diabetes mellitus. Nat Clin Pract Endocrinol Metab. 2009;5:150–9.PubMedGoogle Scholar
  107. 107.
    Wright JT Jr, Williamson JD, Whelton PK, et al. A randomized trial of intensive versus standard blood pressure control (SPRINT). N Engl J Med. 2015;373:2103–16.CrossRefGoogle Scholar
  108. 108.
    Cushman WC, Evans GW, Byington RP, et al. Effects of intensive blood pressure control in type 2 diabetes mellitus. The ACCORD study group. N Engl J Med. 2010;362:1575–85.CrossRefPubMedGoogle Scholar
  109. 109.
    Thomopoulos C, Parati G, Zanchetti A. Effects of blood-pressure lowering treatment on outcome incidence in hypertension: 10—should blood pressure management differ in hypertensive patients with and without diabetes mellitus? Overview and meta-analyses of randomized trials. J Hypertens. 2017;35:922–44.CrossRefPubMedGoogle Scholar
  110. 110.
    Bangalore S, Kumar S, Lobach I, et al. Blood pressure targets in subjects with type 2 diabetes mellitus/impaired fasting glucose: observations from traditional and Bayesian random-effects metaanalyses of randomized trials. Circulation. 2011;123:2799–810.CrossRefPubMedGoogle Scholar
  111. 111.
    Ettehad D, Emdin CA, Kiran A, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet Lond Engl. 2016;387:957–67.CrossRefGoogle Scholar
  112. 112.
    Whelton PK, Carey RM, Aronow WSD, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. A report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. JACC. 2018;71:e127–248.CrossRefPubMedGoogle Scholar
  113. 113.
    James PA, Oparil S, Carter BL, et al. 2014 Evidence-based guideline for the management of high blood pressure in adults report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311:507–20.CrossRefGoogle Scholar
  114. 114.
    Aronow WS, Frishman WH. Contemporary drug treatment of hypertension: focus on recent guidelines. Drugs. 2018;78:567–76.CrossRefPubMedGoogle Scholar
  115. 115.
    Chrysant SG. Aggressive systolic blood pressure control in older subjects: benefits and risks. Postgrad Med. 2018;130:159–65.CrossRefPubMedGoogle Scholar
  116. 116.
    Capodanno D, Angiolillo DJ. Aspirin for primary cardiovascular risk prevention and beyond in diabetes mellitus. Circulation. 2016;134:1579–94.CrossRefPubMedGoogle Scholar
  117. 117.
    ASCEND Study Collaborative Group. Effects of aspirin for primary prevention in persons with diabetes mellitus. N Engl J Med. 2018. (Epub ahead of print).
  118. 118.
    American Diabetes Association. 9. Cardiovascular disease and risk management: standards of medical care in diabetes-2018. Diabetes Care. 2018;41(Suppl 1):S86–104.CrossRefGoogle Scholar
  119. 119.
    Levine GN, Bates ER, Bittl JA, et al. 2016 ACC/AHA Guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. An update of the 2011 ACC/AHA/SCAI PCI guideline, 2011 ACC/AHA CABG guideline, 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS SIHD guideline, 2013 ACC/AHA STEMI guideline, 2014 ACC/AHA NSTE-ACS guideline, and 2014 ACC/AHA Perioperative guideline. J Am Coll Cardiol. 2016;68:1082–115.CrossRefGoogle Scholar
  120. 120.
    Bernbaum M, Albert SG, McGinnis J, Brusca S, Mooradian AD. The reliability of self blood glucose monitoring in elderly diabetic patients. J Am Geriatr Soc. 1994;42:779–81.CrossRefPubMedGoogle Scholar
  121. 121.
    Malanda UL, Welschen LM, Riphagen II, Dekker JM, Nijpels G, Bot SD. Self-monitoring of blood glucose in patients with type 2 diabetes mellitus who are not using insulin. Cochrane Database Syst Rev. 2012;1:005060.Google Scholar
  122. 122.
    Mattishent K, Loke YK. Detection of asymptomatic drug-induced hypoglycemia using continuous glucose monitoring in older people—systematic review. J Diabetes Complicat. 2018;32:805–12.CrossRefPubMedGoogle Scholar
  123. 123.
    Reed RL, Mooradian AD. Management of diabetes mellitus in the nursing home. Ann Long Term Care. 1998;6:100–7.Google Scholar
  124. 124.
    Saxon DR, Rasouli N, Eckell RH. Pharmacological prevention of cardiovascular outcomes in diabetes mellitus: established and emerging agents. Drugs. 2018;78:203–14.CrossRefPubMedGoogle Scholar
  125. 125.
    Aubert RE, Herrera V, Chen W, Haffner SM, Pendergrass M. Rosiglitazone and pioglitazone increase fracture risk in women and men with type 2 diabetes. Diabetes Obes Metab. 2010;12:716–21.CrossRefPubMedGoogle Scholar
  126. 126.
    Anderson SL, Trujillo JM. Association of pancreatitis with glucagon-like peptide-1 agonist use. Ann Pharmacother. 2010;44:904–9.CrossRefPubMedGoogle Scholar
  127. 127.
    Garg R, Chen W, Pendergrass M. Acute pancreatitis in type 2 diabetes treated with exenatide or sitagliptin: a retrospective observational pharmacy claims analysis. Diabetes Care. 2010;33:2349–54.CrossRefPubMedPubMedCentralGoogle Scholar
  128. 128.
    Kohler S, Kaspers S, Salsali A, Zeller C, Woerle HJ. Analysis of fractures in patients with type 2 diabetes treated with empagliflozin in pooled data from placebo-controlled trials and a head-to-head study versus glimepiride. Diabetes Care. 2018;41:1809–16.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Department of MedicineUniversity of Florida College of MedicineJacksonvilleUSA

Personalised recommendations