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Aim to normalize glucose levels and reduce cardiovascular mortality when managing type 2 diabetes in the elderly

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Abstract

The prevalence of type 2 diabetes (T2D) in older adults is rapidly increasing worldwide. The management of T2D involves normalizing hyperglycaemia and reducing cardiovascular risks, thereby improving mortality. In general, the use of antidiabetics shown to reduce the incidence of major adverse cardiovascular events and cardiovascular mortality is preferred. Despite emergence of newer class of antidiabetics, metformin remains to be a first-line treatment in patients with T2D, including those with established cardiovascular disease.

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References

  1. Mooradian AD. Evidence-based management of diabetes in older adults. Drugs Aging. 2018;35(12):1065–78.

    Article  CAS  PubMed  Google Scholar 

  2. Manolis AA, Manolis TA, Manolis AS. Cardiovascular safety of antihyperglycemic agents: “do good or do no harm”. Drugs. 2018;78(15):1567–92.

    Article  CAS  PubMed  Google Scholar 

  3. Johnson JA, Majumdar SR, Simpson SH, et al. Decreased mortality associated with the use of metformin compared with sulfonylurea monotherapy in type 2 diabetes. Diabetes Care. 2002;25(12):2244–8.

    Article  CAS  PubMed  Google Scholar 

  4. Kosiborod M, Lam CSP, Kohsaka S, et al. Cardiovascular events associated with SGLT-2 inhibitors versus other glucose-lowering drugs: the CVD-REAL 2 study. J Am Coll Cardiol. 2018;71(23):2628–39.

    Article  CAS  PubMed  Google Scholar 

  5. Birkeland KI, Jorgensen ME, Carstensen B, et al. Cardiovascular mortality and morbidity in patients with type 2 diabetes following initiation of sodium-glucose co-transporter-2 inhibitors versus other glucose-lowering drugs (CVD-REAL Nordic): a multinational observational analysis. Lancet Diabetes Endocrinol. 2017;5(9):709–17.

    Article  CAS  PubMed  Google Scholar 

  6. Ekstrom N, Svensson AM, Miftaraj M, et al. Cardiovascular safety of glucose-lowering agents as add-on medication to metformin treatment in type 2 diabetes: report from the Swedish national diabetes register. Diabetes Obes Metab. 2016;18(10):990–8.

    Article  CAS  PubMed  Google Scholar 

  7. 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(11):877–86.

    Article  CAS  PubMed  Google Scholar 

  8. Chiasson JL, Josse RG, Gomis R, et al. Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial. Lancet. 2002;359(9323):2072–7.

    Article  CAS  PubMed  Google Scholar 

  9. 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, multicentre trial. Lancet Diabetes Endocrinol. 2017;5(11):887–97.

    Article  PubMed  Google Scholar 

  10. Pratley R, Nauck M, Bailey T, et al. One year of liraglutide treatment offers sustained and more effective glycaemic control and weight reduction compared with sitagliptin, both in combination with metformin, in patients with type 2 diabetes: a randomised, parallel-group, open-label trial. Int J Clin Pract. 2011;65(4):397–407.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Bergenstal RM, Wysham C, Macconell L, et al. Efficacy and safety of exenatide once weekly versus sitagliptin or pioglitazone as an adjunct to metformin for treatment of type 2 diabetes (DURATION-2): a randomised trial. Lancet. 2010;376(9739):431–9.

    Article  PubMed  Google Scholar 

  12. 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(9493):1279–89.

    Article  CAS  PubMed  Google Scholar 

  13. Zannad F, Cannon CP, Cushman WC, et al. Heart failure and mortality outcomes in patients with type 2 diabetes taking alogliptin versus placebo in EXAMINE: a multicentre, randomised, double-blind trial. Lancet. 2015;385(9982):2067–76.

    Article  CAS  PubMed  Google Scholar 

  14. Ghotbi AA, Kober L, Finer N, et al. Association of hypoglycemic treatment regimens with cardiovascular outcomes in overweight and obese subjects with type 2 diabetes: a substudy of the SCOUT trial. Diabetes Care. 2013;36(11):3746–53.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Holman RR, Haffner SM, McMurray JJ, et al. Effect of nateglinide on the incidence of diabetes and cardiovascular events. N Engl J Med. 2010;362(16):1463–76.

    Article  PubMed  Google Scholar 

  16. Kernan WN, Viscoli CM, Furie KL, et al. Pioglitazone after ischemic stroke or transient ischemic attack. N Engl J Med. 2016;374(14):1321–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Jorsal A, Kistorp C, Holmager P, et al. Effect of liraglutide, a glucagon-like peptide-1 analogue, on left ventricular function in stable chronic heart failure patients with and without diabetes (LIVE)-a multicentre, double-blind, randomised, placebo-controlled trial. Eur J Heart Fail. 2017;19(1):69–77.

    Article  CAS  PubMed  Google Scholar 

  18. 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(14):1327–35.

    Article  CAS  PubMed  Google Scholar 

  19. 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):232–42.

    Article  CAS  PubMed  Google Scholar 

  20. 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):1317–26.

    Article  CAS  PubMed  Google Scholar 

  21. 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(8):723–32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Lee G, Oh SW, Hwang SS, et al. Comparative effectiveness of oral antidiabetic drugs in preventing cardiovascular mortality and morbidity: a network meta-analysis. PLoS One. 2017;12(5):e0177646.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. 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(1):10–6.

    Article  CAS  PubMed  Google Scholar 

  24. Gu S, Shi J, Tang Z, et al. Comparison of glucose lowering effect of metformin and acarbose in type 2 diabetes mellitus: a meta-analysis. PLoS One. 2015;10(5):e0126704.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Bundhun PK, Janoo G, Teeluck AR, et al. Adverse drug effects observed with vildagliptin versus pioglitazone or rosiglitazone in the treatment of patients with type 2 diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials. BMC Pharmacol Toxicol. 2017;18(1):66.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Varvaki Rados D, Catani Pinto L, Reck Remonti L, et al. The association between sulfonylurea use and all-cause and cardiovascular mortality: a meta-analysis with trial sequential analysis of randomized clinical trials. PLoS Med. 2016;13(4):e1001992.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Lee M, Saver JL, Liao HW, et al. Pioglitazone for secondary stroke prevention: a systematic review and meta-analysis. Stroke. 2017;48(2):388–93.

    Article  CAS  PubMed  Google Scholar 

  28. Zhou X, Chen S, Zhu M, et al. Different effects of thiazolidinediones on in-stent restenosis and target lesion revascularization after PCI: a meta-analysis of randomized controlled trials. Sci Rep. 2017;7(1):14464.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Bethel MA, Patel RA, Merrill P, et al. Cardiovascular outcomes with glucagon-like peptide-1 receptor agonists in patients with type 2 diabetes: a meta-analysis. Lancet Diabetes Endocrinol. 2018;6(2):105–13.

    Article  PubMed  Google Scholar 

  30. Simpson SH, Lee J, Choi S, et al. Mortality risk among sulfonylureas: a systematic review and network meta-analysis. Lancet Diabetes Endocrinol. 2015;3(1):43–51.

    Article  CAS  PubMed  Google Scholar 

  31. Chan CW, Yu CL, Lin JC, et al. Glitazones and alpha-glucosidase inhibitors as the second-line oral anti-diabetic agents added to metformin reduce cardiovascular risk in type 2 diabetes patients: a nationwide cohort observational study. Cardiovasc Diabetol. 2018;17(1):20.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Asakura M, Kim J, Asanuma H, et al. Does treatment of impaired glucose tolerance improve cardiovascular outcomes in patients with previous myocardial infarction? Cardiovasc Drugs Ther. 2017;31(4):401–11.

    Article  CAS  PubMed  Google Scholar 

  33. Gerstein HC, Bosch J, Dagenais GR, et al. Basal insulin and cardiovascular and other outcomes in dysglycemia. N Engl J Med. 2012;367(4):319–28.

    Article  CAS  PubMed  Google Scholar 

  34. Damluji AA, Cohen ER, Moscucci M, et al. 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.

    Article  PubMed  Google Scholar 

  35. Morgan CL, Mukherjee J, Jenkins-Jones S, et al. Association between first-line monotherapy with sulphonylurea versus metformin and risk of all-cause mortality and cardiovascular events: a retrospective, observational study. Diabetes Obes Metab. 2014;16(10):957–62.

    Article  CAS  PubMed  Google Scholar 

  36. Sun F, Wu S, Guo S, et al. Impact of GLP-1 receptor agonists on blood pressure, heart rate and hypertension among patients with type 2 diabetes: a systematic review and network meta-analysis. Diabetes Res Clin Pract. 2015;110(1):26–37.

    Article  CAS  PubMed  Google Scholar 

  37. 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(9131):854–65.

    Article  Google Scholar 

  38. Brunton S. GLP-1 receptor agonists vs. DPP-4 inhibitors for type 2 diabetes: is one approach more successful or preferable than the other? Int J Clin Pract. 2014;68(5):557–67.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. 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(5):922–44.

    Article  CAS  PubMed  Google Scholar 

  40. 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(25 Suppl 2):S1–45.

    Article  PubMed  Google Scholar 

  41. 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(14):1785–822.

    Article  PubMed  Google Scholar 

  42. American Diabetes Association. 9. Cardiovascular disease and risk management: standards of medical care in diabetes-2018. Diabetes Care. 2018;41(Suppl 1):S86–104.

    Article  Google Scholar 

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The article was adapted from Drugs & Aging 2018;35(12):1065–78 [1] and Drugs 2018;78(15):1567–92 [2] by employees of Adis/Springer, who are responsible for the article content and declare no conflicts of interest.

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The preparation of this review was not supported by any external funding.

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Adis Medical Writers. Aim to normalize glucose levels and reduce cardiovascular mortality when managing type 2 diabetes in the elderly. Drugs Ther Perspect 35, 271–277 (2019). https://doi.org/10.1007/s40267-019-00619-7

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  • DOI: https://doi.org/10.1007/s40267-019-00619-7

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