medigraphic.com
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

2010, Number 4

<< Back Next >>

Rev Invest Clin 2010; 62 (4)

Pharmacological treatment of diabetes in the elderly

García-Lara JMA, Ávila-Funes JA, Aguilar-Navarro S

Language: Spanish
References: 28
Page: 357-365
PDF size: 76.09 Kb.


ABSTRACT

Diabetes mellitus (DM) is a higly prevalent disease in the geriatric population. The elderly are at increased risk for adverse drug reactions (hypoglycemia) compared with the young due to physiological changes associated with age, high number of comorbidities and polypharmacy usually present, causing changes in drugs pharmacokinetics and pharmacodynamics. At present, there are wide therapeutic options to treat DM, so it is important to know the different drug families and their potential side effects. As a general principle, metformin remains an appropriate option for the management of DM in the elderly, first-generation sulfonylureas (chlorpropamide) is preferable not to use due the high risk of hypoglycemia. Some thiazolidinediones have been associated with heart failure, as their use in the elderly is controversial. About the new drugs that act on the DPP-4, results are promising with a low risk profile of adverse reactions. We must consider the use of human insulin or insulin analogues in the elderly when not achieved with other hypoglycaemic agents. At the start of therapy is important to establish the most appropriate management goals based on patient comorbidities and their life expectancy.


REFERENCES

  1. Lerman IG, Villa AR, Martínez CL, et al. The prevalence of diabetes and associated coronary risk factors in urban and rural older Mexican populations. J Am Geriatr Soc 1998; 46: 1387-95.

  2. Harris MI, Flegal KM, Cowie CC, et al. Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S. adults. The Third National Health and Nutrition Examination Survey, 1988-1994. Diab Car 1998; 21: 518-24.

  3. Campbell NR, Leiter LA, Larochelle P, et al. Hypertension in diabetes: a call to action. Can J Cardiol 2009; 25: 299-302.

  4. Hornick T, Aron DC. Managing diabetes in the elderly: go easy, individualize. Cleve Clin J Med 2008; 75: 70-8.

  5. American Diabetes Association. Executive summary: standards of medical care in diabetes-2009. Diab Car 2009; 32(Suppl 1): S6-S12.

  6. Van de Laar FA, Lucassen PL, Akkermans RP, et al. Alphaglucosidase inhibitors for patients with type 2 diabetes: results from a Cochrane systematic review and meta-analysis. Diab Car 2005; 28: 154-63.

  7. Josse RG, Chiasson JL, Ryan EA, et al. Acarbose in the treatment of elderly patients with type 2 diabetes. Diab Res Clin Pract 2003;59:37-42.

  8. Meneilly GS. Diabetes in the elderly. Med Clin North Am 2006; 90: 909-23.

  9. Brown AF, Mangione CM, Saliba D, et al. Guidelines for improving the care of the older person with diabetes mellitus. J Am Geriatr Soc 2003; 51: S265-S280.

  10. Thisted H, Johnsen SP, Rungby J. Sulfonylureas and the risk of myocardial infarction. Metabol 2006; 55: S16-S19.

  11. 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.

  12. Holstein A, Stumvoll M. Contraindications can damage your health-is metformin a case in point? Diabetol 2005; 48: 2454-9.

  13. Salpeter SR, Greyber E, Pasternak GA, et al. Risk of fatal and nonfatal lactic acidosis with metformin use in type 2 diabetes mellitus: systematic review and meta-analysis. Arch Intern Med 2003; 163: 2594-602.

  14. Jones GC, Macklin JP, Alexander WD. Contraindications to the use of metformin. BMJ 2003; 326: 4-5.

  15. Mooradian AD, Chehade J, Thurman JE. The role of thiazolidinediones in the treatment of patients with type 2 diabetes mellitus. Treat Endocrinol 2002; 1: 13-20.

  16. Rizos CV, Elisaf MS, Mikhailidis DP, et al. How safe is the use of thiazolidinediones in clinical practice? Expert Opin Drug Saf 2009; 8: 15-32.

  17. Taylor C, Hobbs FD. Type 2 diabetes, thiazolidinediones, and cardiovascular risk. Br J Gen Pract 2009; 59: 520-4.

  18. 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 randomized controlled trial. Lancet 2005; 366: 1279-89.

  19. Singh S, Furberg CD. Thiazolidinediones and cardiovascular outcomes in type 2 diabetes. Heart 2009;95:1-3.

  20. Johansen OE, Birkeland KI. Defining the role of repaglinide in the management of type 2 diabetes mellitus: a review. Am J Cardiovasc Drugs 2007; 7: 319-35.

  21. Cayea D, Boyd C, Durso SC. Individualizing therapy for older adults with diabetes mellitus. Drugs Aging 2007; 24: 851-63.

  22. Quillen DM, Kuritzky L, Samraj GP. Improving management of type 2 diabetes mellitus: 4. Meglitinides. Hosp Pract Minneap 1999; 34: 38-40.

  23. Abbatecola AM, Maggi S, Paolisso G. New approaches to treating type 2 diabetes mellitus in the elderly: role of incretion therapies. Drugs Aging 2008;25:913-25.

  24. Kolterman OG, Kim DD, Shen L, et al. Pharmacokinetics, pharmacodynamics, and safety of exenatide in patients with type 2 diabetes mellitus. Am J Health Syst Pharm 2005; 62: 173-81.

  25. Lyseng-Williamson KA. Sitagliptin. Drugs 2007; 67: 587-97.

  26. Motta M, Bennati E, Ferlito L, et al. A review on the actual trends of insulin treatment in elderly with diabetes. Arch Gerontol Geriatr 2008; 47: 151-61.

  27. Ober SK, Watts S, Lawrence RH. Insulin use in elderly diabetic patients. Clin Interv Aging 2006; 1: 107-13.

  28. Durso SC. Using clinical guidelines designed for older adults with diabetes mellitus and complex health status. JAMA 2006; 295: 1935-40.




2020     |     www.medigraphic.com