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Glycemic Targets and Medication Limitations for Type 2 Diabetes Mellitus in the Older Adult

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Objective: To review the optimal management of type 2 diabetes mellitus (T2DM) in the older adult.

Data Sources: A PubMed search was completed to identify publications in the English language from 1947 to 2013 using combinations of the search terms: geriatrics, aged, diabetes mellitus, and type 2 diabetes mellitus. References of articles were also reviewed for inclusion if not identified in the PubMed search.

Study Selection and Data Extraction: Original studies, clinical reviews, and guidelines were identified and evaluated for clinical relevance.

Data Synthesis: Although the number of older adults with T2DM is growing, evidence for the treatment of T2DM in this population is lacking. Barriers such as polypharmacy, comorbid conditions, economic limitations, cognitive impairment, and increased risk of hypoglycemia may limit optimal glycemic control in older adults. Several organizations provide recommendations for glycemic targets and recommend using standard glycemic goals in most healthy older adults. However, less stringent goals are necessary in certain older populations such as those patients with limited life expectancy and severe hypoglycemia. In general, glycemic goals should be individualized in older patients. Age-related pharmacokinetic and pharmacodynamic changes, comorbid conditions, adverse drug reactions, ease of medication administration, and cost of medications necessitate the need to individualize pharmacologic therapy.

Conclusion: Glycemic targets and medication use for T2DM should be individualized in older adults.
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Keywords: A1c = Glycated hemoglobin; AACE = American Association of Clinical Endocrinologists; ADA = American Diabetes Association; AUC = Area under the curve; Aged; CV = cardiovascular; Clcr = Creatinine clearance; Cmax = Maximum concentration; DM = Diabetes mellitus; DPP-IV = Dipeptidyl peptidase; Diabetes mellitus; EASD = European Association for the Study of Diabetes; FDA = Food and Drug Administration; Food and Drug Administration; GFR = Glomerular filtration rate; GI = Gastrointestinal; GLP = Glucagon-like peptide; Geriatrics; Hypoglycemia; Insulin; NPH = Neutral protamine Hagedorn; NYHA = New York Heart Association; SCr = Serum creatinine; T2DM = Type 2 diabetes mellitus; TZD = Thiazolidinedione; Thiazolidinediones; Type 2 diabetes mellitus; UKPDS = United Kingdom Prospective DM Study; m = Meter; min = Minute

Document Type: Research Article

Publication date: 2014-02-01

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  • The Consultant Pharmacist® is the official peer-reviewed journal of the American Society of Consultant Pharmacists. It is dedicated exclusively to the medication needs of the elderly in all settings, including adult day care, ambulatory care, assisted living, community, hospice, and nursing facilities. This award-winning journal is a member benefit of ASCP. Individuals who are not members and wish to receive The Consultant Pharmacist® will want to consider joining ASCP.
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