Skip to main content
Log in

Take an individualized and multipronged approach when managing older adults with type 2 diabetes

  • Disease Management
  • Published:
Drugs & Therapy Perspectives Aims and scope Submit manuscript

Abstract

The prevalence of diabetes in older adults is increasing worldwide and its management is complicated by the comorbidity, cognitive and psychosocial challenges associated with this population. An individualized and multipronged approach aiming to improve quality of life without intrusive and complicated interventions is recommended in older adults with type 2 diabetes. Medical complexity and functional status should be considered when introducing lifestyle modifications and selecting a pharmacological agent. Metformin remains the recommended first-line option (due to its efficacy, known cardioprotective effects, overall tolerance and affordability).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Gandhi GY, Mooradian AD. Management of hyperglycemia in older adults with type 2 diabetes. Drugs Aging. 2022;39(1):39–58.

    Article  PubMed  Google Scholar 

  2. International Diabetes Federation. IDF Diabetes Atlas 10th Edition. 2021. https://diabetesatlas.org/atlas/tenth-edition/. Accessed 30 Mar 2023.

  3. Pham H, Marathe CS, Phillips LK, et al. Longitudinal changes in fasting and glucose-stimulated GLP-1 and GIP in healthy older subjects. J Clin Endocrinol Metab. 2019;104(12):6201–6.

    Article  PubMed  Google Scholar 

  4. Lee PG, Halter JB. The pathophysiology of hyperglycemia in older adults: clinical considerations. Diabetes Care. 2017;40(4):444–52.

    Article  PubMed  Google Scholar 

  5. DeFronzo RA. Insulin resistance, lipotoxicity, type 2 diabetes and atherosclerosis: the missing links. The Claude Bernard Lecture 2009. Diabetologia. 2010;53(7):1270–87.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Sinclair A, Saeedi P, Kaundal A, et al. Diabetes and global ageing among 65–99-year-old adults: findings from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract. 2020;162:108078.

    Article  PubMed  Google Scholar 

  7. Weinger K, Beverly EA, Smaldone A. Diabetes self-care and the older adult. West J Nurs Res. 2014;36(9):1272–98.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Assar ME, Laosa O, Rodríguez ML. Diabetes and frailty. Curr Opin Clin Nutr Metab Care. 2019;22(1):52–7.

    Article  PubMed  Google Scholar 

  9. Crandall J, Schade D, Ma Y, et al. The influence of age on the effects of lifestyle modification and metformin in prevention of diabetes. J Gerontol A Biol Sci Med Sci. 2006;61(10):1075–8.

    Article  PubMed  Google Scholar 

  10. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998;352(9131):854–65.

  11. O’Hara DV, Parkhill TR, Badve SV, et al. The effects of dipeptidyl peptidase-4 inhibitors on kidney outcomes. Diabetes Obes Metab. 2021;23(3):763–73.

    Article  CAS  PubMed  Google Scholar 

  12. Bae JH, Kim S, Park EG, et al. Effects of dipeptidyl peptidase-4 inhibitors on renal outcomes in patients with type 2 diabetes: a systematic review and meta-analysis. Endocrinol Metab (Seoul). 2019;34:1–80.

    Article  Google Scholar 

  13. Kristensen SL, Rørth R, Jhund PS, et al. Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials. Lancet Diabetes Endocrinol. 2019;7(10):776–8.

    Article  CAS  PubMed  Google Scholar 

  14. Zannad F, Ferreira JP, Pocock SJ, et al. SGLT2 inhibitors in patients with heart failure with reduced ejection fraction: a meta-analysis of the EMPEROR-Reduced and DAPA-HF trials. Lancet. 2020;396(10254):819–29.

    Article  PubMed  Google Scholar 

  15. Shorr RI, Ray WA, Daugherty JR, et al. Individual sulfonylureas and serious hypoglycemia in older people. J Am Geriatr Soc. 1996;44(7):751–5.

    Article  CAS  PubMed  Google Scholar 

  16. Oiknine R, Bernbaum M, Mooradian AD. A critical appraisal of the role of insulin analogues in the management of diabetes mellitus. Drugs. 2005;65(3):325–40.

    Article  CAS  PubMed  Google Scholar 

  17. 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(2):182–8.

    Article  PubMed  Google Scholar 

  18. Hedrington MS, Davis SN. Considerations when using alpha-glucosidase inhibitors in the treatment of type 2 diabetes. Expert Opin Pharmacother. 2019;20(18):2229–35.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sheridan M. Hoy.

Ethics declarations

Funding

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

Authorship and conflict of interest

S. M. Hoy is a salaried employee of Adis International Ltd/Springer Nature and declares no relevant conflicts of interest. All authors contributed to the review and are responsible for the article content.

Ethics approval, Consent to participate, Consent for publication, Availability of data and material, Code availability

Not applicable.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hoy, S.M. Take an individualized and multipronged approach when managing older adults with type 2 diabetes. Drugs Ther Perspect 39, 171–177 (2023). https://doi.org/10.1007/s40267-023-00991-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40267-023-00991-5

Navigation