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AbstractElderly patients with type 2 diabetes mellitus (T2DM) are a rapidly emerging population that presents unique clinical challenges. A problem-oriented web-based EHR that learns as you practice, allowing you to focus on patient care.
Pri-Med is the medical education and EHR software company that provides practical answers to facilitate better patient outcomes. The ADA journal Diabetes Care will publish a special supplement on diabetes care in VA in the next few months. Blood sugar levels are usually restored to tight control of type 2 diabetes california garden grove normal in minutes by ingesting 10-20g for carbohydrates.
VALUE IN HEALTH Epidemiology and Clinical Presentation of Type 2 Diabetes IW Campbell MBChB FRCP (Edinburgh and new and emerging treatment options in gestational diabetes risks to mother north carolina raleigh type 2 diabetes alabama montgomery Glasgow)University of St.
The following low carb dessert recipes are perfect for celebrating Valentine's Day and are allowed in all phases of Atkins: Mascarpone Parfait. THURSDAY, July 14, 2016 (HealthDay News) — Antibiotic-resistant cases of the sexually transmitted illness gonorrhea have more than quadrupled in the United States.
Patients sometimes receive azithromycin in combination with another antibiotic, ceftriaxone.
One way to slow antibiotic resistance is to curb the number of new infections of gonorrhea affecting Americans, Mermin said.
Because infection can often occur without symptoms, the CDC estimates that less than half of all cases are ever diagnosed.
Symptoms of gonorrhea include a burning sensation upon urination or a green or whitish discharge. The study findings were published in the July 15 issue of the CDC journal Morbidity and Mortality Weekly Report. The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments. Michel Demare, ABB’s Chief Financial Officer, who has held the CEO position on an ad-interim basis since February 13, 2008, will continue to serve as ABB’s CFO. Stehan van der Post has joined Bateman Engineering as Senior General Manager, Project Execution, for Bateman Minerals & Metals. Thermo Scientific Niton® XL3t XRF Analysers have been recognised among the 100 most technologically significant products of 2008.
The award will be officially presented during a gala awards ceremony in the Grand Ballroom of Chicago's Navy Pier, October 16, 2008.
This is the third R&D 100 Award for the Niton series, with previous awards coming in 1995 and 2003. Since they were established in 1963, the R&D 100 awards have been presented annually to the 100 most innovative new technical products and processes of the year.
Niton XL3 Series XRF analysers use 80 MHz ASICS digital signal processors and state-of-the-art embedded processors for computation, data storage, communications and other functions. MINExpo International 2008, the world’s largest mining equipment and technology exposition, is just two months away and international vendors are working with the US Department of Commerce’s (DOC) International Buyer Program (IBP) to facilitate a robust international component of the show. Designed to increase internal efficiency and decrease operational costs, this solution will restructure the organisation's dynamics and give Greens Creek's key personnel a complete view of the mining operations. Micromine is the global leader in providing innovative software solutions and consulting services to the exploration and mining industries. In these days when contract exploration drills are hard to get, companies are increasingly buying their own rigs, or even drilling contracting companies, as in the case of Ashburton Minerals. Tenova Pyromet has been commissioned by Doe Run Peru to design and supply a 15 m slag launder, comprising water-cooled copper launder sections, which will convey matte and slag from the IsasmeltT furnace to the settling furnace.
One of the challenges is that matte is normally more aggressive to copper elements than slag.
Developed and manufactured in South Africa using advanced Finite Element Modelling and computer aided engineering techniques, Tenova Pyromet's slag launders are used in Anglo Platinum's Waterval Smelter in South Africa, the BCL nickel smelter in Botswana, STL's cobalt smelter in the DRC and BHP Billiton's Olympic Dam in Australia. The successful implementation of this first matte launder may well open doors for future projects in the copper industry, which makes constant use of this equipment.
This diverse patient group can differ widely in terms of physical and mental status, which can increase their risk of complications including hypoglycemia, falls, and depression.
Pratley is an internationally recognized expert in diabetes and is board certified in internal medicine. How Is Type 2 Diabetes Caused By Obesity North Charleston South Carolina the Reason Why Is Diabetes A Risk Factor For Stroke: Diabetics easily become a target for heart strokes which triggers the blood to formulate clots within its flow in the body.
Type 1 diabetes is what is commonly talked about as juvenile-onset diabetes and is caused by a deficiency in the body to produce insulin.
In the study obese adults with Type 2 diabetes who underwent regular counseling sessions to encourage weight loss and Diabetes Mellitus Pada Lansia.
Eating the 12 most contaminated fruits and vegetables will expose a person to nearly 20 pesticides per day, on average. The CDC noted that more than 800,000 cases of gonorrhea are estimated to occur in the United States each year. Left untreated, symptomatic or asymptomatic gonorrhea can lead to serious health issues, especially for women, because it is linked to chronic pelvic pain, potentially fatal ectopic pregnancy and infertility, the CDC said. See the Terms of Service and Privacy Policy (Your California Privacy Rights) for more information.
In this position, he is responsible for Bateman Engineering minerals and metals projects in sub-Saharan Africa. Thermo Fisher Scientific is the world's leading manufacturer of handheld X-ray fluorescence (XRF) analysers. More than 50 outside judges, who must have no conflicts of interest with any entries they are judging, are chosen from among professional consultants, university faculty and industrial researchers. They feature 50kV, 2-W miniaturised X-ray tubes and multiple primary filters to provide optimised excitation for elements ranging from chlorine through the transuranic elements. To date 15 countries are using the IBP to organise delegations to attend the show, scheduled for September 22-24 in Las Vegas, Nevada. With a suite of awardwinning versatile applications, the company develops solutions for all personnel involved in the mining cycle. Ashburton has just moved to full ownership of Transdrill after its wholly owned subsidiary, Trans Pacific Gold, acquired the remaining 50% of the private drilling company. He received his medical degree from Wayne State University in Detroit, and completed fellowships in geriatric medicine and gerontology at the University of Michigan, John Hopkins University, and the National Institute on Aging.
These are often the most prominent symptoms of diabetes mellitus also known as sugar diabetes.
It is the most effective way to determine the type dose and frequency of administration of insulin 1 Hunter College New York USA.
Thus neither MMF alone or in combination with daclizumab slowed progression of beta-cell destruction in recently diagnosed type 1 diabetes. Salvo en los pases escandinavos la incidencia poblacional de diabetes mellitus tipo 2 es superior a exercise and diabetes prevention colorado springs colorado la de tipo 1 con una relacin media de 85:15% entre ambas. Diabetes insipidus often results due to ADH deficiency and in such cases it is calle Central Diabetes Insipidus. An independent judging panel and the editors of R&D Magazine selected the handheld XL3t XRF analys for the award. Based on the outside judges' votes and written comments, the editors of R&D Magazine make the final choice.
They can also be equipped with optional small-spot sample analysis, allowing users to switch between 8 mm diameter and 3 mm diameter sample measurement areas.
The countries expected to send delegations include: Brazil, Canada, China, Ecuador, Ghana, India, South Korea, Mexico, Mongolia, Nigeria, Pakistan, Peru, the Philippines, Romania and Thailand. The organisation has grown significantly over the years and now boasts offices in more than twelve countries, with affiliates in almost every continent.
Tenova Pyromet's launders will be modified to improve their cooling capacity and to provide additional wear resistance in areas of matte impact.
As a member of the American Diabetes Association, the European Association for the Study of Diabetes and The Obesity Society, Dr.
Also there is a synergistic effect of diabetes and other risk factors such that the steep of the increase in risk is much greater in the diabetic population. Causes of Diabetes Mellitus Juvenile diabetes: a lack of insulin production by the pancreas.
About 15% of people with type 1 diabetes die before age 40 years which is about 20 times How Is Type 2 Diabetes Caused By Obesity North Charleston South Carolina the rate of that age group in the general population. What is type 1 diabetes, excerpt from Jessica Apple's interview with Adrian Kiger about improving her health & stabilizing blood sugar levels with a vegan diabetic diet plan. Hogan is currently CEO of GE Healthcare, the global leader in medical diagnostic technology and biosciences, and is a member of the GE Senior Executive Council.
XL3 Series instruments offer the only fully integrated and environmentally-sealed VIP tilting colour touch-screen display for easy viewing of sample results in any position and under all lighting conditions.


Micromine is renowned for its world-class consulting team consisting of skilled geologists, surveyors, mining engineers and other key personnel who can provide the expertise needed for solving complex challenges on-site. In many cases, these events are related to antidiabetic therapy and the pursuit of strict glycemic control. In view of evidence that statin therapy increases risk of diabetes the balance of benefit and risk of these drugs in primary prevention has become controversial.
They use third-generation lithium-ion battery packs, providing users with more measurements on each battery charge than any other handheld XRF analyser, the company claims. With a global footprint and the pedigree that comes with experience, together with a world class support and service infrastructure, Micromine has developed a blue chip client base servicing industry leaders and continues to be at the forefront of innovation. He is a member of the editorial boards of The Lancet: Diabetes and Endocrinology, The Journal of Diabetes and its Complications, the Journal of Clinical Endocrinology and Metabolism, and acts as an ad hoc reviewer for many other journals. Diagnosis Echocardiography Epidemiology Heart failure Left ventricular dysfunction Prevalence Type 2 diabetes. Moderate alcohol intake is Eat a wide variety of foods - cutting back on fat, sugar, and increasing your portions of fruit and vegetables, and also making half your grains whole, will really help to make your diet more healthy.
Hypoglycemic events, even in the absence of awareness of the event (asymptomatic), can have negative consequences. Unhealthier sources of carbohydrates include white bread, pastries, sodas, and other highly processed or refined foods.
To help manage these risks, several national and international organizations have proposed guidelines to address individualized treatment goals for older adults with diabetes.
Pratley regularly presents at national and international meetings, has conducted numerous research studies on the pathoge1nesis, prevention and treatment of diabetes, and has published over 190 peer-reviewed articles on diabetes. It is highly recommended for diabetics and is considered as one of the best ways of maintaining moderate blood sugar levels.
His research interests include the prevention of diabetes, improving the care for older person1s with diabetes, developing new drugs to treat and prevent diabetes and its complications, and understanding the role of the fat cell in increasing the risk of diabetes and heart disease.
The number of older individuals with diabetes is expected to grow as the US population ages [1].
All of these desserts deliver massive satisfaction, but won't send your blood sugar soaring. This is caused when diabetes affects the nerves (peripheral neuropathy) and will cause the sensation of The bad part is that most people do not recognize the symptoms just after diabetes steps in. As with younger adults, achieving and maintaining glycemic control is important in elderly patients with T2DM to prevent acute complications of hyperglycemia and reduce the risk of long-term complications [5, 6]. Although some elderly patients will be able to maintain glycemic control with lifestyle modification and oral antidiabetic drugs (OADs), most will eventually require insulin because of the progression of T2DM [7a€“9].Management of T2DM in elderly patients is complicated by the clinical and functional heterogeneity of this patient population [6].
Some older patients with T2DM may have developed the disease in middle age and experienced years of comorbidity, whereas others may be newly diagnosed or may have had years of undiagnosed comorbidity or few complications. Older adults also differ with regard to physical robustness, physical and cognitive functioning, health status, and life expectancy. Clinicians who treat elderly patients with T2DM must consider this heterogeneity when setting and prioritizing treatment goals.Furthermore, older adults with diabetes are more likely than older non-diabetic adults to suffer from geriatric syndromes, including conditions such as polypharmacy, depression, cognitive impairment, urinary incontinence, chronic pain, and injurious falls [1, 5, 6]. It is also important to consider pharmacokinetics when establishing a medication regimen for elderly patients with T2DM [10]. In particular, changes in renal function are common in the elderly and may affect drug metabolism. Older patients with diabetes are at a greater risk than are younger patients, even after adjusting for glycemic control [17]. In addition, hypoglycemia presents a higher risk for comorbid events and mortality in elderly patients with diabetes compared with younger patients [1]. Hypoglycemic events in the elderly are independently associated with an increased risk of fall-related fractures and acute cardiovascular events. These events have been shown to adversely impact health-related quality of life as much as, or to an even greater degree than, complications of T2DM [18a€“20]. Furthermore, evidence suggests that severe hypoglycemic episodes may increase the risk of dementia in patients with T2DM [15].
Therefore, diabetes therapies with the lowest rates of hypoglycemia should be considered for this patient population. Emerging treatment options that may meet this need include both approved and investigational incretin-based therapies and sodium glucose co-transporter 2 (SGLT2) inhibitors, as well as ultra-long-acting insulins that are in late-stage clinical development. Although guidelines differ with respect to their stringency and conceptual frameworks, there is a general agreement that the potential benefits of achieving tight glycemic control for the individual should be balanced with the risk of hypoglycemia, given the patienta€™s clinical and functional characteristics.Current treatment guidelines from the American Diabetes Association (ADA) consider the avoidance of hypoglycemia to be of great importance in setting glycemic goals, particularly in older adults [5]. In addition, the clinical and functional heterogeneity of older adults with T2DM must be considered when establishing and prioritizing treatment goals.
The latter group of patients is less likely to benefit from a reduced risk of microvascular complications, and more likely to experience serious hypoglycemia-related adverse events.In 2012, a Consensus Development Conference on Diabetes and Older Adults was convened by the ADA to update diabetes treatment guidelines for older adults and address a variety of issues that may be unique to treating diabetes and common comorbidities in the elderly [1].
The framework for establishing reasonable HbA1c targets utilizes a range based on patient characteristics. These new guidelines, like the existing ADA guidelines [5, 28], acknowledge the clinical and functional heterogeneity of this patient population and replace the more stringent guidelines for improving the care of older adults with diabetes released in 2003 by the California Healthcare Foundation (CHF) and the American Geriatrics Society (AGS) [6].
Implementation of the guidelines in frail older patients with diabetes ultimately resulted in dramatic improvements in glycemic control based on HbA1c levels and reductions in overall rates of hypoglycemic episodes.
However, the risk of a hypoglycemia-related visit to the emergency department more than doubled in the early phase of guideline implementation. These findings emphasize the importance of close monitoring for severe hypoglycemia when aiming to achieve glycemic goals in frail elderly patients.Guidelines from the Department of Veterans Affairs and the Department of Defense propose an explicit risk-stratification approach based on the patienta€™s physiologic age or the presence and severity of microvascular complications and major comorbidities [27]. The authors concluded that establishing an individualized goal requires consideration of both clinical characteristics and the psychosocioeconomic setting.
The most intensive glycemic control can be targeted in patients who are highly motivated, treatment-adherent and knowledgeable with excellent self-care capacities and comprehensive support systems.
These actions result in an increase in glucose uptake by tissues and a decrease in the release of glucose from the liver. Both GLP-1 and GIP are rapidly metabolized by the enzyme dipeptidyl peptidase-4 (DPP-4).Currently approved incretin-based therapies in the United States include GLP-1 receptor agonists (exenatide and liraglutide) and DPP-4 inhibitors (sitagliptin, linagliptin, saxagliptin, and alogliptin).
The GLP-1 receptor agonist lixisenatide is being reviewed by the US Food and Drug Administration (FDA) for the treatment of T2DM [32].GLP-1 receptor agonists are administered subcutaneously, whereas DPP-4 inhibitors are administered orally [31].
A recent meta-analysis of randomized controlled trials comparing treatments with placebo or other diabetes medication showed that greater reductions in HbA1c are obtained with GLP-1 receptor agonists than with DPP-4 inhibitors (~1.0% vs. Similarly, a recent literature analysis showed that treatment with GLP-1 receptor agonists results in significantly reduced HbA1c levels and bodyweight compared with DPP-4 inhibitors [34]. This is consistent with greater patient satisfaction favoring GLP-1 receptor agonists over DPP-4 inhibitors [34]. Both therapies require dose titration during initiation and are associated with a low risk of hypoglycemia. Overall, incretin-based therapies may be an important treatment option for elderly patients with T2DM [35, 36].Exenatide and liraglutide are approved by the FDA for use as an adjunct to diet and exercise to improve glycemic control in patients with T2DM [37, 38]. However, neither exenatide nor liraglutide are recommended as first-line therapy for patients with inadequate glycemic control on diet and exercise. An extended-release formulation of exenatide (Bydureona„?; Amylin Pharmaceuticals, San Diego, CA), administered by subcutaneous injection once weekly, also has been approved for the management of T2DM [39]. After 26A weeks of treatment, reduction in HbA1c from baseline was statistically significantly greater for both doses of liraglutide than for placebo in both age groups. Exenatide has a BBW for medullary thyroid cancer (MTC) and a Risk Evaluation and Mitigation Strategy is ongoing to properly evaluate the benefit of the drug compared with the risk of MTC and acute pancreatitis.
Although hypoglycemia was more common in the linagliptin group than in the placebo group (24.1% vs.
These findings suggest that adjunctive linagliptin is effective in elderly patients with inadequately controlled T2DM and does not impose an excess risk of hypoglycemia.
However, when linagliptin is used in combination with insulin or a sulfonylurea, it may be necessary to lower the insulin or sulfonylurea dose to reduce the risk of hypoglycemia.A 24-week, randomized, double-blind, placebo-controlled, parallel-group study evaluated sitagliptin monotherapy in 206 elderly patients with T2DM [51].
Mean average blood glucose levels decreased rapidly once the treatment commenced, with significant improvements observed as early as day 3 of treatment. No incidences of hypoglycemia were reported, and the drug was well tolerated in this population of older patients [51].A post-hoc analysis of pooled data from three randomized, double-blind studies of 373 elderly (aged a‰?65A years) patients compared the effects of sitagliptin versus glipizide or glimepiride added to metformin or diet alone [47].
At 30A weeks, both HbA1c and FBG levels had decreased in both the sitagliptin and sulfonylurea treatment groups, with no statistically significant differences between treatment modalities.
This combination has been shown to be bodyweight neutral and has an acceptable risk of hypoglycemia; its once-daily dosing may lower the a€?pill burdena€™a€”an important factor especially for elderly patients [53]. Metformin-containing medications should be used cautiously in patients with hepatic disease and those aged >80A years [53].
At 24A weeks, improvements in HbA1c, FBG, and postprandial glucose levels were similar for both age groups, with no statistically significant interactions of treatment by age.
The incidence of hypoglycemia was not reported, and no elderly patients discontinued the study because of an adverse event [48].In January 2013, the DPP-4 inhibitor alogliptin received FDA approval for the treatment of T2DM [46]. Oseni carries a BBW for heart failure due to the pioglitazone component, and Kazano will have a BBW for lactic acidosis due to the metformin component [46].The study of linagliptin and analyses of other incretin-based therapies in older adults suggest that elderly patients can benefit from these agents at least as much as younger patients do, without a substantial risk of hypoglycemia [47a€“50, 54].


Phase 3 trials in elderly patients with T2DM are ongoing or completed for sitagliptin [55], saxagliptin [56], linagliptin [57], and alogliptin [58]. The results of these studies will provide additional insight on the risks and benefits of incretin therapies in this patient population. GLP-1 receptor agonists also are associated with mild weight loss, whereas DPP-4 inhibitors are weight-neutral [59]. Requirements for dosage adjustment in patients with renal impairment also differ among the incretin-based therapies; however, dose adjustment is not required for patients who have mild hepatic impairment [37a€“39, 43a€“45, 60a€“63].
Before incorporating incretin-based therapies into an individualized regimen for the elderly patient, differences in efficacy and tolerability should be considered in relation to the patienta€™s health status, comorbidities, and concomitant medications.SGLT2 InhibitorsSGLT2 inhibitors comprise an emerging, novel class of antihyperglycemic drugs that inhibit glucose reabsorption in the kidney and increase excretion of glucose in the urine [64, 65]. This new, orally administered treatment strategy directly lowers plasma glucose concentration in an insulin-independent manner with a low risk of hypoglycemia.
A common adverse effect of SGLT2 inhibitors is an increased incidence of urinary tract and genital infections. Another SGLT2 inhibitor, dapagliflozin, has been approved in the European Union but not in the United States [67]. All dapagliflozin groups had sustained reductions in fasting plasma glucose (FPG) and bodyweight. An increase in reported urinary tract infections and genital infections was observed for all dapagliflozin groups compared with placebo.Clinical trials showed that canagliflozin also improves glycemic control, reduces HbA1c, and decreases bodyweight and systolic blood pressure.
Canagliflozin was generally well tolerated; however, both men and women who received canagliflozin reported a greater number of genital mycotic and urinary tract infections. Genital mycotic infections were reported by 7% of men and 11% of women taking canagliflozin 100A mg compared to 1% of men and 2% of women taking glimepiride. Results demonstrated that canagliflozin was effective and well tolerated in older patients receiving background therapy with other antidiabetic agents. Additionally, treatment with canagliflozin at either dosage reduced bodyweight, FPG, and systolic blood pressure compared with placebo. However, both canagliflozin doses were associated with higher rates of urinary tract infections, genital mycotic infections, and documented hypoglycemia rates compared with placebo.
Recent findings suggest that patients aged a‰?70A years can achieve the same level of glycemic control from insulin as do younger patients [74].In general, insulin analogs are preferred over human insulin because they have a more consistent pharmacokinetic profile and are associated with lower rates of hypoglycemia [75].
Patients received basal insulin once or twice daily in combination with either bolus insulin or an OAD, depending on the study. Mean changes in HbA1c and FPG levels were similar for the two treatment groups and for both age groups. The relative risk of overall hypoglycemia was significantly lower with insulin detemir than with NPH insulin for both age groups. Insulin degludec incorporates structural modifications that allow it to form soluble and stable multi-hexamers [78a€“80]. Gradual separation of the monomers from the multi-hexamers following subcutaneous injection results in a protracted and continuous delivery of insulin degludec into the circulation.
Insulin degludec demonstrates a flat and stable glucose-lowering effect with once-daily administration [78]. LY2605541, the other investigational basal insulin analog, is a derivative of insulin lispro that contains a single polyethylene glycol (PEG) moiety [79, 81]. The large hydrodynamic size of the analog enabled by the PEG moiety is believed to slow both renal clearance and absorption from the subcutaneous depot.
LY2605541 exhibits low intra-subject variability and has a longer serum concentrationa€“time profile and duration of action than insulin glargine [81].
A meta-analysis of seven randomized, open-label, phase 3 trials of insulin degludec in patients aged a‰?65A years with type 1 diabetes or T2DM found that rates of nocturnal hypoglycemia, but not overall confirmed hypoglycemia, were significantly lower (by 35%) in patients treated with insulin degludec versus insulin glargine [85]. Similarly, a phase 2 study in patients with T2DM demonstrated comparable glycemic control with LY2605541 and insulin glargine, but significantly lower rates of nocturnal hypoglycemia (after adjusting for baseline hypoglycemia) with LY2605541 [86]. Overall, studies of insulin degludec and LY2605541 in patients with T2DM suggest that these ultra-long-acting formulations of insulin may allow patients to achieve glycemic goals with a reduced risk of hypoglycemia. Moreover, the reduced risk of hypoglycemia may encourage patients and physicians to target tighter glycemic control.
Both of these insulin formulations were well tolerated and may represent an important treatment option for elderly patients with T2DM [82, 84].Clinical ConsiderationsAttaining strict glycemic targets are associated with an increased risk of hypoglycemic events [87].
The occurrence of hypoglycemia is linked with increased morbidity, mortality, and cost, and minimizing hypoglycemia is thought to increase adherence and satisfaction with treatment strategies [88, 89]. Hypoglycemia and fear of hypoglycemia in patients and healthcare providers constitute a major impediment to achieving appropriate glycemic targets, especially in elderly patients.
Conversely, failure to recognize hypoglycemia may lead to potentially catastrophic consequences.
Therefore, the prevention of hypoglycemia is an important goal in considering glycemic targets and treatment strategies for individuals with T2DM. In keeping with this, professional organizations emphasize safety and avoidance of hypoglycemia in their considerations for choosing regimens and therapeutic agents.Hypoglycemia remains a key barrier to glycemic control in elderly patients with T2DM.
The presence of predisposing factors to hypoglycemia, such as cognitive impairment and renal impairment, must be considered when setting glycemic goals and individualizing therapy in the elderly [12, 15, 21]. In addition, numerous studies indicate a direct correlation between hypoglycemia and impaired cognitive function, which may interfere with necessary self-care activities required for managing blood glucose levels. A recent study of 563 older adults demonstrated that the executive function domain of cognition was significantly associated with HbA1c levels [90]. After a mean follow-up of 11A months, no significant changes in clinical cognitive function were found [91]. The impact of diabetes treatment regimens on cognitive performance in 3,421 elderly patients without dementia was investigated [92].
As expected, older adults with diabetes exhibited significantly diminished performance in many areas of cognitive functions compared with non-diabetic patients, with diabetic patients demonstrating a lower overall composite score for the summary measure of cognitive functioning (PA =A 0.01). Metformin constitutes the first line of therapy, and its use is rarely associated with hypoglycemic events [93, 94]. When adequate glucose control necessitates treatment therapies in combination with or as an alternative to metformin, use of a DPP-4 inhibitor, GLP-1 receptor agonist, SGLT2 inhibitor, or insulin analog may be preferred over sulfonylureas or traditional insulins if hypoglycemia is a significant concern in a particular patient.
Thiazolidinediones represent an additional class of antidiabetic agents that increase insulin sensitivity and are associated with a low risk of hypoglycemia [95]. Emerging therapies may offer effective and well-tolerated treatment alternatives for elderly patients with T2DM.
Studies with incretin therapies suggest that elderly patients may achieve similar glycemic benefits to younger patients with a low risk of hypoglycemia [35]. The long-term safety of DPP-4 inhibitors and GLP-1 receptor agonists is under investigation.
The FDA requirement that evidence of cardiovascular safety be provided for new glucose-lowering agents means that all medications developed to enhance incretin action must be evaluated in long-term clinical trials [96]. The forthcoming results of these long-term studies should provide more conclusive information about the safety of GLP-1 receptor agonists, DPP-4 inhibitors, and SGLT2 inhibitors in elderly patients with diabetes.ConclusionThe population of elderly patients with T2DM in the United States is growing at an alarming rate.
Although rates of severe hypoglycemia are relatively low when basal insulin analogs are used, reason for special caution is required when these agents are used concomitantly with sulfonylureas or in patients at an increased risk of hypoglycemia. Initial sulfonylurea use and subsequent insulin therapy in older subjects with type 2 diabetes mellitus.
Individualizing glycemic targets in type 2 diabetes mellitus: implications of recent clinical trials.
Association of diabetes, comorbidities, and A1C with functional disability in older adults: results from the National Health and Nutrition Examination Survey (NHANES), 1999a€“2006. Hypoglycemic episodes and risk of dementia in older patients with type 2 diabetes mellitus. Oral antidiabetic treatment in type-2 diabetes in the elderly: balancing the need for glucose control and the risk of hypoglycemia. Evidence linking hypoglycemic events to an increased risk of acute cardiovascular events in patients with type 2 diabetes. Association between hypoglycaemic events and fall-related fractures in Medicare-covered patients with type 2 diabetes. New approaches to treating type 2 diabetes mellitus in the elderly: role of incretin therapies. Poor cognitive function and risk of severe hypoglycemia in type 2 diabetes: post hoc epidemiologic analysis of the ACCORD trial.
Hypoglycaemia in elderly patients with diabetes mellitus: causes and strategies for prevention.



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