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Optimal Glycaemic Control in Elderly People with Type 2 Diabetes: What Does the Evidence Say?

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Abstract

The global prevalence of type 2 diabetes mellitus (T2DM) is rising in an ageing population through a combination of lifestyle changes and greater longevity. However, by excluding participants aged over 70 years, most major interventional trials on which current diabetes therapeutic guidelines are based have failed to provide specific evidence to support the prescribed management of diabetes in elderly people. While diabetes per se has a significant impact on the elderly person, the side effects of medications, particularly hypoglycaemia, prevent optimisation of diabetes treatment. Hypoglycaemia is associated with significant morbidity, to which elderly people are often more vulnerable because of factors such as the effects of ageing, progressive renal impairment, frailty, polypharmacy and cognitive decline. T2DM is associated with accelerated cognitive decline in some individuals, and recurrent severe hypoglycaemia has been implicated as a potential contributory factor. Although the evidence for selection of appropriate glycaemic targets in elderly patients is sparse, it is now acknowledged that prevention of hypoglycaemia must influence individualisation of treatment goals in this vulnerable group. This should also be reflected by the choice of anti-diabetes agents that are initiated when diet and lifestyle advice is ineffective. Recently developed international guidelines, which have specifically addressed the management of diabetes in elderly people, highlight the importance of a pragmatic management approach rather than attempting to achieve a generic glycated haemoglobin goal and are summarised in this article.

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References

  1. Danaei G, Finucane MM, Lu Y, Singh GM, Cowan MJ, Paciorek CJ, et al. National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants. Lancet. 2011;378(9785):31–40.

    CAS  PubMed  Google Scholar 

  2. Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010;87(1):4–14.

    CAS  PubMed  Google Scholar 

  3. Selvin E, Parrinello CM, Sacks DB, Coresh J. Trends in prevalence and control of diabetes in the United States, 1988–1994 and 1999–2010. Ann Intern Med. 2014;160(8):517–25.

    PubMed  Google Scholar 

  4. Pw W, Km A, Wb K. Epidemiology of diabetes mellitus in the elderly. The Framingham Study. Am J Med. 1986;80(5A):3–9.

    Google Scholar 

  5. Fagot-Campagna A, Bourdel-Marchasson I, Simon D. Burden of diabetes in an aging population: prevalence, incidence, mortality, characteristics and quality of care. Diabetes Metab. 2005;31(Spec No. 2):5S35–52.

    PubMed  Google Scholar 

  6. Selvin E, Coresh J, Brancati FL. The burden and treatment of diabetes in elderly individuals in the US Diabetes Care. 2006;29(11):2415–9.

    PubMed  Google Scholar 

  7. Group DS. Age- and sex-specific prevalences of diabetes and impaired glucose regulation in 13 European cohorts. Diabetes Care. 2003;26(1):61–9.

    Google Scholar 

  8. Qiao Q, Hu G, Tuomilehto J, Nakagami T, Balkau B, Borch-Johnsen K, et al. Age- and sex-specific prevalence of diabetes and impaired glucose regulation in 11 Asian cohorts. Diabetes Care. 2003;26(6):1770–80.

    PubMed  Google Scholar 

  9. Rockwood K, Awalt E, MacKnight C, McDowell I. Incidence and outcomes of diabetes mellitus in elderly people: report from the Canadian Study of Health and Aging. CMAJ. 2000;162(6):769–72.

    CAS  PubMed Central  PubMed  Google Scholar 

  10. Lakey WC, Barnard K, Batch BC, Chiswell K, Tasneem A, Green JB. Are current clinical trials in diabetes addressing important issues in diabetes care? Diabetologia. 2013;56(6):1226–35.

    CAS  PubMed  Google Scholar 

  11. Mitchell BD, Vietri J, Zagar A, Curtis B, Reaney M. Hypoglycaemic events in patients with type 2 diabetes in the United Kingdom: associations with patient-reported outcomes and self-reported HbA1c. BMC Endocr Disord. 2013;13(1):59.

    PubMed Central  PubMed  Google Scholar 

  12. Cryer PE. Hypoglycaemia: the limiting factor in the glycaemic management of type I and type II diabetes. Diabetologia. 2002;45(7):937–48.

    CAS  PubMed  Google Scholar 

  13. Cryer PE. The barrier of hypoglycemia in diabetes. Diabetes. 2008;57(12):3169–76.

    CAS  PubMed Central  PubMed  Google Scholar 

  14. McCoy RG, Van Houten HK, Ziegenfuss JY, Shah ND, Wermers RA, Smith SA. Increased mortality of patients with diabetes reporting severe hypoglycemia. Diabetes Care. 2012;35(9):1897–901.

    PubMed Central  PubMed  Google Scholar 

  15. Kirkman MS, Briscoe VJ, Clark N, Florez H, Haas LB, Halter JB, et al. Diabetes in older adults. Diabetes Care. 2012;35(12):2650–64.

    PubMed Central  PubMed  Google Scholar 

  16. Greco D, Pisciotta M, Gambina F, Maggio F. Severe hypoglycaemia leading to hospital admission in type 2 diabetic patients aged 80 years or older. Exp Clin Endocrinol Diabetes. 2010;118(4):215–9.

    CAS  PubMed  Google Scholar 

  17. Geller AI, Shehab N, Lovegrove MC, Kegler SR, Weidenbach KN, Ryan GJ, et al. National estimates of insulin-related hypoglycemia and errors leading to emergency department visits and hospitalizations. JAMA Intern Med. 2014;174(5):678–86.

    CAS  PubMed  Google Scholar 

  18. Biessels GJ, Staekenborg S, Brunner E, Brayne C, Scheltens P. Risk of dementia in diabetes mellitus: a systematic review. Lancet Neurol. 2006;5(1):64–74.

    PubMed  Google Scholar 

  19. Strachan MW, Reynolds RM, Marioni RE, Price JF. Cognitive function, dementia and type 2 diabetes mellitus in the elderly. Nat Rev Endocrinol. 2011;7(2):108–14.

    CAS  PubMed  Google Scholar 

  20. Deary IJ, Frier BM. Severe hypoglycaemia and cognitive impairment in diabetes. BMJ. 1996;313(7060):767–8.

    CAS  PubMed Central  PubMed  Google Scholar 

  21. Feinkohl I, Aung PP, Keller M, Robertson CM, Morling JR, McLachlan S, et al. Severe hypoglycemia and cognitive decline in older people with type 2 diabetes: the Edinburgh Type 2 Diabetes Study. Diabetes Care. 2014;37(2):507–15.

    CAS  PubMed  Google Scholar 

  22. Marioni RE, Strachan MW, Reynolds RM, Lowe GD, Mitchell RJ, Fowkes FG, et al. Association between raised inflammatory markers and cognitive decline in elderly people with type 2 diabetes: the Edinburgh Type 2 Diabetes Study. Diabetes. 2010;59(3):710–3.

    CAS  PubMed Central  PubMed  Google Scholar 

  23. Marioni RE, Deary IJ, Strachan MW, Lowe GD, Rumley A, Murray GD, et al. Blood rheology and cognition in the Edinburgh Type 2 Diabetes Study. Age Ageing. 2010;39(3):354–9.

    PubMed  Google Scholar 

  24. Aung PP, Strachan MW, Frier BM, Butcher I, Deary IJ, Price JF, et al. Severe hypoglycaemia and late-life cognitive ability in older people with Type 2 diabetes: the Edinburgh Type 2 Diabetes Study. Diabet Med. 2012;29(3):328–36.

    CAS  PubMed  Google Scholar 

  25. Yaffe K, Falvey C, Hamilton N, Schwartz AV, Simonsick EM, Satterfield S, et al. Diabetes, glucose control, and 9-year cognitive decline among older adults without dementia. Arch Neurol. 2012;69(9):1170–5.

    PubMed Central  PubMed  Google Scholar 

  26. Punthakee Z, Miller ME, Launer LJ, Williamson JD, Lazar RM, Cukierman-Yaffee T, et al. Poor cognitive function and risk of severe hypoglycemia in type 2 diabetes: post hoc epidemiologic analysis of the ACCORD trial. Diabetes Care. 2012;35(4):787–93.

    PubMed Central  PubMed  Google Scholar 

  27. Hewitt J, Smeeth L, Chaturvedi N, Bulpitt CJ, Fletcher AE. Self management and patient understanding of diabetes in the older person. Diabet Med. 2011;28(1):117–22.

    CAS  PubMed Central  PubMed  Google Scholar 

  28. de Galan BE, Zoungas S, Chalmers J, Anderson C, Dufouil C, Pillai A, et al. Cognitive function and risks of cardiovascular disease and hypoglycaemia in patients with type 2 diabetes: the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. Diabetologia. 2009;52(11):2328–36.

    PubMed  Google Scholar 

  29. Cheng C, Lin CH, Tsai CJ, Chou PH, Lan TH. Type 2 diabetes and antidiabetic medications in relation to dementia diagnosis. J Gerontol A Biol Sci Med Sci. 2014;69(10):1299–305.

    PubMed  Google Scholar 

  30. Sinclair AJ, Conroy SP, Bayer AJ. Impact of diabetes on physical function in older people. Diabetes Care. 2008;31(2):233–5.

    PubMed  Google Scholar 

  31. Dhamoon MS, Moon YP, Paik MC, Sacco RL, Elkind MS. Diabetes predicts long-term disability in an elderly urban cohort: the Northern Manhattan Study. Ann Epidemiol. 2014 May;24(5):362-8.e1.

  32. Chou KL, Chi I. Functional disability related to diabetes mellitus in older Hong Kong Chinese adults. Gerontology. 2005;51(5):334–9.

  33. Lipscombe LL, Jamal SA, Booth GL, Hawker GA. The risk of hip fractures in older individuals with diabetes: a population-based study. Diabetes Care. 2007;30(4):835–41.

    PubMed  Google Scholar 

  34. Signorovitch JE, Macaulay D, Diener M, Yan Y, Wu EQ, Gruenberger JB, et al. Hypoglycaemia and accident risk in people with type 2 diabetes mellitus treated with non-insulin antidiabetes drugs. Diabetes Obes Metab. 2013;15(4):335–41.

    CAS  PubMed Central  PubMed  Google Scholar 

  35. Johnston SS, Conner C, Aagren M, Ruiz K, Bouchard J. Association between hypoglycaemic events and fall-related fractures in Medicare-covered patients with type 2 diabetes. Diabetes Obes Metab. 2012;14(7):634–43.

    CAS  PubMed  Google Scholar 

  36. Schwartz AV, Vittinghoff E, Sellmeyer DE, Feingold KR, de Rekeneire N, Strotmeyer ES, et al. Diabetes-related complications, glycemic control, and falls in older adults. Diabetes Care. 2008;31(3):391–6.

    PubMed Central  PubMed  Google Scholar 

  37. Matyka K, Evans M, Lomas J, Cranston I, Macdonald I, Amiel SA. Altered hierarchy of protective responses against severe hypoglycemia in normal aging in healthy men. Diabetes Care. 1997;20(2):135–41.

    CAS  PubMed  Google Scholar 

  38. Zammitt NN, Frier BM. Hypoglycaemia in type 2 diabetes and in elderly people. In: Frier BM, Heller SR, McCrimmon RR, editors. Hypoglycaemia in clinical diabetes. 3rd ed. London: Wiley; 2014. p. 230–62.

  39. Marker JC, Cryer PE, Clutter WE. Attenuated glucose recovery from hypoglycemia in the elderly. Diabetes. 1992;41(6):671–8.

    CAS  PubMed  Google Scholar 

  40. Meneilly GS, Elahi D. Physiological importance of first-phase insulin release in elderly patients with diabetes. Diabetes Care. 1998;21(8):1326–9.

    CAS  PubMed  Google Scholar 

  41. Deary IJ, Hepburn DA, MacLeod KM, Frier BM. Partitioning the symptoms of hypoglycaemia using multi-sample confirmatory factor analysis. Diabetologia. 1993;36(8):771–7.

    CAS  PubMed  Google Scholar 

  42. McCrimmon RJ, Deary IJ, Gold AE, Hepburn DA, MacLeod KM, Ewing FM, et al. Symptoms reported during experimental hypoglycaemia: effect of method of induction of hypoglycaemia and of diabetes per se. Diabet Med. 2003;20(6):507–9.

    CAS  PubMed  Google Scholar 

  43. Meneilly GS, Cheung E, Tuokko H. Altered responses to hypoglycemia of healthy elderly people. J Clin Endocrinol Metab. 1994;78(6):1341–8.

    CAS  PubMed  Google Scholar 

  44. Jaap AJ, Jones GC, McCrimmon RJ, Deary IJ, Frier BM. Perceived symptoms of hypoglycaemia in elderly type 2 diabetic patients treated with insulin. Diabet Med. 1998;15(5):398–401.

    CAS  PubMed  Google Scholar 

  45. Pegg A, Fitzgerald F, Wise D, Singh BM, Wise PH. A community-based study of diabetes-related skills and knowledge in elderly people with insulin-requiring diabetes. Diabet Med. 1991;8(8):778–81.

    CAS  PubMed  Google Scholar 

  46. Thomson FJ, Masson EA, Leeming JT, Boulton AJ. Lack of knowledge of symptoms of hypoglycaemia by elderly diabetic patients. Age Ageing. 1991;20(6):404–6.

    CAS  PubMed  Google Scholar 

  47. Abellan van Kan G, Rolland Y, Houles M, Gillette-Guyonnet S, Soto M, Vellas B. The assessment of frailty in older adults. Clin Geriatr Med. 2010;26(2):275–86.

    PubMed  Google Scholar 

  48. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–56.

    CAS  PubMed  Google Scholar 

  49. Chen LK, Chen YM, Lin MH, Peng LN, Hwang SJ. Care of elderly patients with diabetes mellitus: a focus on frailty. Ageing Res Rev. 2010;9(Suppl 1):S18–22.

    PubMed  Google Scholar 

  50. Sinclair AJ, Paolisso G, Castro M, Bourdel-Marchasson I, Gadsby R, Rodriguez Mañas L, et al. 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.

  51. Nordin C. The case for hypoglycaemia as a proarrhythmic event: basic and clinical evidence. Diabetologia. 2010;53(8):1552–61.

    CAS  PubMed  Google Scholar 

  52. Desouza C, Salazar H, Cheong B, Murgo J, Fonseca V. Association of hypoglycemia and cardiac ischemia: a study based on continuous monitoring. Diabetes Care. 2003;26(5):1485–9.

    PubMed  Google Scholar 

  53. Zoungas S, Patel A, Chalmers J, de Galan BE, Li Q, Billot L, et al. Severe hypoglycemia and risks of vascular events and death. N Engl J Med. 2010;363(15):1410–8.

    CAS  PubMed  Google Scholar 

  54. Bremer JP, Jauch-Chara K, Hallschmid M, Schmid S, Schultes B. Hypoglycemia unawareness in older compared with middle-aged patients with type 2 diabetes. Diabetes Care. 2009;32(8):1513–7.

    CAS  PubMed Central  PubMed  Google Scholar 

  55. Segel SA, Paramore DS, Cryer PE. Hypoglycemia-associated autonomic failure in advanced type 2 diabetes. Diabetes. 2002;51(3):724–33.

    CAS  PubMed  Google Scholar 

  56. Group UHS. Risk of hypoglycaemia in types 1 and 2 diabetes: effects of treatment modalities and their duration. Diabetologia. 2007;50(6):1140–7.

    Google Scholar 

  57. Middleton RJ, Foley RN, Hegarty J, Cheung CM, McElduff P, Gibson JM, et al. The unrecognized prevalence of chronic kidney disease in diabetes. Nephrol Dial Transplant. 2006;21(1):88–92.

    PubMed  Google Scholar 

  58. Solini A, Penno G, Bonora E, Fondelli C, Orsi E, Trevisan R, et al. Age, renal dysfunction, cardiovascular disease, and antihyperglycemic treatment in type 2 diabetes mellitus: findings from the Renal Insufficiency and Cardiovascular Events Italian Multicenter Study. J Am Geriatr Soc. 2013;61(8):1253–61.

    PubMed  Google Scholar 

  59. Tseng CL, Soroka O, Maney M, Aron DC, Pogach LM. Assessing potential glycemic overtreatment in persons at hypoglycemic risk. JAMA Intern Med. 2014;174(2):259–68.

    PubMed  Google Scholar 

  60. Aljasem LI, Peyrot M, Wissow L, Rubin RR. The impact of barriers and self-efficacy on self-care behaviors in type 2 diabetes. Diabetes Educ. 2001 2001 May-Jun;27(3):393-404.

  61. Sinclair AJ, Gadsby R, Penfold S, Croxson SC, Bayer AJ. Prevalence of diabetes in care home residents. Diabetes Care. 2001;24(6):1066–8.

    CAS  PubMed  Google Scholar 

  62. Chen LK, Lin MH, Lai HY, Hwang SJ. Care of patients with diabetes mellitus in long-term care facilities in Taiwan: diagnosis, glycemic control, hypoglycemia, and functional status. J Am Geriatr Soc. 2008;56(10):1975–6.

    PubMed  Google Scholar 

  63. Hope SV, Strain WD. Hypoglycaemia in the elderly. Diabetic Hypoglycaemia. 2013;6(1):3–10.

    Google Scholar 

  64. Sinclair AJ. Diabetes, disability and frailty—a need for greater recognition and focused research. Br J Diabetes Vasc Dis. 2012;12:109.

  65. Bourdel-Marchasson I, Dugaret E, Regueme S. Disability in older people with diabetes: issues for the clinician. Br J Diabetes Vasc Dis. 2012;12(3):135–40.

    Google Scholar 

  66. Hager KK, Loprinzi P, Stone D. Implementing diabetes care guidelines in long term care. J Am Med Dir Assoc. 2013;14(11):851.e7–15.

  67. NICE. CG66 Type 2 diabetes: full guideline. 2008 [cited 12 June 2014]. http://guidance.nice.org.uk/CG66/Guidance/pdf/English.

  68. SIGN. 116: management of diabetes. 2010 [cited 12 June 2014]. http://www.sign.ac.uk/guidelines/fulltext/116/index.html.

  69. Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008;359(15):1577–89.

    CAS  PubMed  Google Scholar 

  70. Gerstein HC, Miller ME, Byington RP, Goff DC, Bigger JT, Buse JB, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358(24):2545–59.

    CAS  PubMed  Google Scholar 

  71. Miller ME, Williamson JD, Gerstein HC, Byington RP, Cushman WC, Ginsberg HN, et al. Effects of randomization to intensive glucose control on adverse events, cardiovascular disease, and mortality in older versus younger adults in the ACCORD Trial. Diabetes Care. 2014;37(3):634–43.

    PubMed  Google Scholar 

  72. Patel A, MacMahon S, Chalmers J, Neal B, Billot L, Woodward M, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358(24):2560–72.

    CAS  PubMed  Google Scholar 

  73. Duckworth W, Abraira C, Moritz T, Reda D, Emanuele N, Reaven PD, et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2009;360(2):129–39.

    CAS  PubMed  Google Scholar 

  74. Skyler JS, Bergenstal R, Bonow RO, Buse J, Deedwania P, Gale EA, et al. Intensive glycemic control and the prevention of cardiovascular events: implications of the ACCORD, ADVANCE, and VA diabetes trials: a position statement of the American Diabetes Association and a scientific statement of the American College of Cardiology Foundation and the American Heart Association. Diabetes Care. 2009;32(1):187–92.

    PubMed Central  PubMed  Google Scholar 

  75. International Diabetes Federation. IDF global guidelines for managing older people with type 2 diabetes. 2012 [cited 12 June 2014]. http://www.idf.org/guidelines/managing-older-people-type-2-diabetes.

  76. Sinclair A, Morley JE, Rodriguez-Mañas L, Paolisso G, Bayer T, Zeyfang A, et al. Diabetes mellitus in older people: position statement on behalf of the International Association of Gerontology and Geriatrics (IAGG), the European Diabetes Working Party for Older People (EDWPOP), and the International Task Force of Experts in Diabetes. J Am Med Dir Assoc. 2012;13(6):497–502.

    PubMed  Google Scholar 

  77. Currie CJ, Peters JR, Tynan A, Evans M, Heine RJ, Bracco OL, et al. Survival as a function of HbA(1c) in people with type 2 diabetes: a retrospective cohort study. Lancet. 2010;375(9713):481–9.

    CAS  PubMed  Google Scholar 

  78. Huang ES, Liu JY, Moffet HH, John PM, Karter AJ. Glycemic control, complications, and death in older diabetic patients: the diabetes and aging study. Diabetes Care. 2011;34(6):1329–36.

    PubMed Central  PubMed  Google Scholar 

  79. Munshi MN, Segal AR, Suhl E, Staum E, Desrochers L, Sternthal A, et al. Frequent hypoglycemia among elderly patients with poor glycemic control. Arch Intern Med. 2011;171(4):362–4.

    PubMed Central  PubMed  Google Scholar 

  80. Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, et al. Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2012;35(6):1364–79.

    CAS  PubMed Central  PubMed  Google Scholar 

  81. Nathan DM, Buse JB, Davidson MB, Ferrannini E, Holman RR, Sherwin R, et al. Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2009;32(1):193–203.

    CAS  PubMed Central  PubMed  Google Scholar 

  82. Bailey CJ, Turner RC. Metformin. N Engl J Med. 1996;334(9):574–9.

    CAS  PubMed  Google Scholar 

  83. Holstein A, Plaschke A, Egberts EH. Clinical characterisation of severe hypoglycaemia—a prospective population-based study. Exp Clin Endocrinol Diabetes. 2003;111(6):364–9.

    CAS  PubMed  Google Scholar 

  84. 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.

  85. Stevens LA, Viswanathan G, Weiner DE. Chronic kidney disease and end-stage renal disease in the elderly population: current prevalence, future projections, and clinical significance. Adv Chronic Kidney Dis. 2010;17(4):293–301.

    PubMed Central  PubMed  Google Scholar 

  86. Yki-Järvinen H. Thiazolidinediones. N Engl J Med. 2004;351(11):1106–18.

    PubMed  Google Scholar 

  87. Kahn SE, Haffner SM, Heise MA, Herman WH, Holman RR, Jones NP, et al. Glycemic durability of rosiglitazone, metformin, or glyburide monotherapy. N Engl J Med. 2006;355(23):2427–43.

    CAS  PubMed  Google Scholar 

  88. Singh S, Loke YK, Furberg CD. Thiazolidinediones and heart failure: a teleo-analysis. Diabetes Care. 2007;30(8):2148–53.

    CAS  PubMed  Google Scholar 

  89. Lago RM, Singh PP, Nesto RW. Congestive heart failure and cardiovascular death in patients with prediabetes and type 2 diabetes given thiazolidinediones: a meta-analysis of randomised clinical trials. Lancet. 2007;370(9593):1129–36.

    CAS  PubMed  Google Scholar 

  90. Lincoff AM, Wolski K, Nicholls SJ, Nissen SE. Pioglitazone and risk of cardiovascular events in patients with type 2 diabetes mellitus: a meta-analysis of randomized trials. JAMA. 2007;298(10):1180–8.

    CAS  PubMed  Google Scholar 

  91. Chaggar PS, Shaw SM, Williams SG. Review article: thiazolidinediones and heart failure. Diab Vasc Dis Res. 2009;6(3):146–52.

    PubMed  Google Scholar 

  92. Loke YK, Singh S, Furberg CD. Long-term use of thiazolidinediones and fractures in type 2 diabetes: a meta-analysis. CMAJ. 2009;180(1):32–9.

    PubMed Central  PubMed  Google Scholar 

  93. Jones SG, Momin SR, Good MW, Shea TK, Patric K. Distal upper and lower limb fractures associated with thiazolidinedione use. Am J Manag Care. 2009;15(8):491–6.

    PubMed  Google Scholar 

  94. Meier C, Kraenzlin ME, Bodmer M, Jick SS, Jick H, Meier CR. Use of thiazolidinediones and fracture risk. Arch Intern Med. 2008;168(8):820–5.

    CAS  PubMed  Google Scholar 

  95. Barnett AH. Avoiding hypoglycaemia while achieving good glycaemic control in type 2 diabetes through optimal use of oral agent therapy. Curr Med Res Opin. 2010;26(6):1333–42.

    CAS  PubMed  Google Scholar 

  96. Shorr RI, Ray WA, Daugherty JR, Griffin MR. Incidence and risk factors for serious hypoglycemia in older persons using insulin or sulfonylureas. Arch Intern Med. 1997;157(15):1681–6.

  97. Gangji AS, Cukierman T, Gerstein HC, Goldsmith CH, Clase CM. A systematic review and meta-analysis of hypoglycemia and cardiovascular events: a comparison of glyburide with other secretagogues and with insulin. Diabetes Care. 2007;30(2):389–94.

    PubMed  Google Scholar 

  98. Becker ML, Visser LE, Trienekens PH, Hofman A, van Schaik RH, Stricker BH. Cytochrome P450 2C9 *2 and *3 polymorphisms and the dose and effect of sulfonylurea in type II diabetes mellitus. Clin Pharmacol Ther. 2008;83(2):288–92.

    CAS  PubMed  Google Scholar 

  99. Buse JB, Henry RR, Han J, Kim DD, Fineman MS, Baron AD, et al. Effects of exenatide (exendin-4) on glycemic control over 30 weeks in sulfonylurea-treated patients with type 2 diabetes. Diabetes Care. 2004;27(11):2628–35.

    CAS  PubMed  Google Scholar 

  100. Amori RE, Lau J, Pittas AG. Efficacy and safety of incretin therapy in type 2 diabetes: systematic review and meta-analysis. JAMA. 2007;298(2):194–206.

    CAS  PubMed  Google Scholar 

  101. Strain WD, Lukashevich V, Kothny W, Hoellinger MJ, Paldánius PM. Individualised treatment targets for elderly patients with type 2 diabetes using vildagliptin add-on or lone therapy (INTERVAL): a 24 week, randomised, double-blind, placebo-controlled study. Lancet. 2013;382(9890):409–16.

    CAS  PubMed  Google Scholar 

  102. Seaquist ER, Anderson J, Childs B, Cryer P, Dagogo-Jack S, Fish L, et al. Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society. Diabetes Care. 2013;36(5):1384–95.

    CAS  PubMed Central  PubMed  Google Scholar 

  103. Schwartz SL. Treatment of elderly patients with type 2 diabetes mellitus: a systematic review of the benefits and risks of dipeptidyl peptidase-4 inhibitors. Am J Geriatr Pharmacother. 2010;8(5):405–18.

    CAS  PubMed  Google Scholar 

  104. Barnett AH, Huisman H, Jones R, von Eynatten M, Patel S, Woerle HJ. Linagliptin for patients aged 70 years or older with type 2 diabetes inadequately controlled with common antidiabetes treatments: a randomised, double-blind, placebo-controlled trial. Lancet. 2013;382(9902):1413–23.

    CAS  PubMed  Google Scholar 

  105. Scirica BM, Bhatt DL, Braunwald E, Steg PG, Davidson J, Hirshberg B, et al. Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus. N Engl J Med. 2013;369(14):1317–26.

    CAS  PubMed  Google Scholar 

  106. Levy CJ, Kinsley BT, Bajaj M, Simonson DC. Effect of glycemic control on glucose counterregulation during hypoglycemia in NIDDM. Diabetes Care. 1998;21(8):1330–8.

    CAS  PubMed  Google Scholar 

  107. Spyer G, Hattersley AT, MacDonald IA, Amiel S, MacLeod KM. Hypoglycaemic counter-regulation at normal blood glucose concentrations in patients with well controlled type-2 diabetes. Lancet. 2000;356(9246):1970–4.

    CAS  PubMed  Google Scholar 

  108. Davis TM, Brown SG, Jacobs IG, Bulsara M, Bruce DG, Davis WA. Determinants of severe hypoglycemia complicating type 2 diabetes: the Fremantle Diabetes Study. J Clin Endocrinol Metab. 2010;95(5):2240–7.

    CAS  PubMed  Google Scholar 

  109. Henderson JN, Allen KV, Deary IJ, Frier BM. Hypoglycaemia in insulin-treated type 2 diabetes: frequency, symptoms and impaired awareness. Diabet Med. 2003;20(12):1016–21.

    CAS  PubMed  Google Scholar 

  110. Reaven GM, Greenfield MS, Mondon CE, Rosenthal M, Wright D, Reaven EP. Does insulin removal rate from plasma decline with age? Diabetes. 1982;31(8 Pt 1):670–3.

    CAS  PubMed  Google Scholar 

  111. Minaker KL, Rowe JW, Tonino R, Pallotta JA. Influence of age on clearance of insulin in man. Diabetes. 1982;31(10):851–5.

    CAS  PubMed  Google Scholar 

  112. Fink RI, Revers RR, Kolterman OG, Olefsky JM. The metabolic clearance of insulin and the feedback inhibition of insulin secretion are altered with aging. Diabetes. 1985;34(3):275–80.

    CAS  PubMed  Google Scholar 

  113. Reza M, Taylor CD, Towse K, Ward JD, Hendra TJ. Insulin improves well-being for selected elderly type 2 diabetic subjects. Diabetes Res Clin Pract. 2002;55(3):201–7.

    CAS  PubMed  Google Scholar 

  114. Zafon C, Creus C. A comparison on insulin regimen treatment of elderly (>70 years) and younger (<70 years) type 2 diabetic patients in actual clinical practice. Acta Diabetol. 2013;50(1):33–7.

    CAS  PubMed  Google Scholar 

  115. Rodbard HW, Jellinger PS, Davidson JA, Einhorn D, Garber AJ, Grunberger G, et al. Statement by an American Association of Clinical Endocrinologists/American College of Endocrinology consensus panel on type 2 diabetes mellitus: an algorithm for glycemic control. Endocr Pract. 2009;15(6):540–59.

  116. Papa G, Fedele V, Chiavetta A, Lorenti I, Leotta C, Luca S, et al. Therapeutic options for elderly diabetic subjects: open label, randomized clinical trial of insulin glargine added to oral antidiabetic drugs versus increased dosage of oral antidiabetic drugs. Acta Diabetol. 2008;45(1):53–9.

    CAS  PubMed  Google Scholar 

  117. Garber AJ, Clauson P, Pedersen CB, Kølendorf K. Lower risk of hypoglycemia with insulin detemir than with neutral protamine hagedorn insulin in older persons with type 2 diabetes: a pooled analysis of phase III trials. J Am Geriatr Soc. 2007;55(11):1735–40.

    PubMed  Google Scholar 

  118. Lee P, Chang A, Blaum C, Vlajnic A, Gao L, Halter J. Comparison of safety and efficacy of insulin glargine and neutral protamine hagedorn insulin in older adults with type 2 diabetes mellitus: results from a pooled analysis. J Am Geriatr Soc. 2012;60(1):51–9.

    PubMed  Google Scholar 

  119. Lipska KJ, Ross JS, Van Houten HK, Beran D, Yudkin JS, Shah ND. Use and out-of-pocket costs of insulin for type 2 diabetes mellitus from 2000 through 2010. JAMA. 2014;311(22):2331–3.

    PubMed  Google Scholar 

  120. Lipska KJ, Ross JS, Wang Y, Inzucchi SE, Minges K, Karter AJ, et al. National trends in US hospital admissions for hyperglycemia and hypoglycemia among Medicare beneficiaries, 1999–2011. JAMA Intern Med. 2014;174(7):1116–24.

    PubMed Central  PubMed  Google Scholar 

  121. Haahr H, Heise T. A review of the pharmacological properties of insulin degludec and their clinical relevance. Clin Pharmacokinet. 2014;53(9):787–800.

    CAS  PubMed Central  PubMed  Google Scholar 

  122. Sorli C, Warren M, Oyer D, Mersebach H, Johansen T, Gough SC. Elderly patients with diabetes experience a lower rate of nocturnal hypoglycaemia with insulin degludec than with insulin glargine: a meta-analysis of phase IIIa trials. Drugs Aging. 2013;30(12):1009–18.

    CAS  PubMed Central  PubMed  Google Scholar 

  123. Krentz AJ, Sinclair AJ. Choice of long-acting insulin therapy for type 2 diabetes: how can treatment for older people be optimized? Drugs Aging. 2011;28(12):935–41.

    PubMed  Google Scholar 

  124. Ligthelm RJ, Kaiser M, Vora J, Yale JF. Insulin use in elderly adults: risk of hypoglycemia and strategies for care. J Am Geriatr Soc. 2012;60(8):1564–70.

    PubMed  Google Scholar 

  125. Huang ES, Karter AJ, Danielson KK, Warton EM, Ahmed AT. The association between the number of prescription medications and incident falls in a multi-ethnic population of adult type-2 diabetes patients: the diabetes and aging study. J Gen Intern Med. 2010;25(2):141–6.

    PubMed Central  PubMed  Google Scholar 

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Conflicts of interest

No sources of funding were used to assist in the preparation of this article.

Supriya Mathur has no conflicts of interest relating to this manuscript but has had travel, accommodation and registration for a conference funded by Sanofi. Nicola N. Zammitt has no conflicts of interest relating to this manuscript but has accepted speaker fees from Astra Zeneca and Bristol Myers Squibb and has had travel, accommodation and registration for conferences funded by Sanofi, Aventis, Novo Nordisk, Lilly and Merck Sharpe and Dohme. Brian M. Frier has no conflicts of interest relating to this manuscript but has received honoraria for lecturing and membership of advisory boards for Novo Nordisk, Lilly, MSD, Sanofi, Boehringer Ingelheim and Janssen.

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Authors and Affiliations

  1. Department of Diabetes, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK

    Supriya Mathur, Nicola N. Zammitt & Brian M. Frier

  2. BHF Centre for Cardiovascular Science, The Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, Scotland, UK

    Brian M. Frier

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  1. Supriya Mathur
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  2. Nicola N. Zammitt
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Correspondence to Brian M. Frier.

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Mathur, S., Zammitt, N.N. & Frier, B.M. Optimal Glycaemic Control in Elderly People with Type 2 Diabetes: What Does the Evidence Say?. Drug Saf 38, 17–32 (2015). https://doi.org/10.1007/s40264-014-0247-7

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