Diabetes Treatment in the Elderly

Incorporating Geriatrics, Technology, and Functional Medicine

Willy Marcos Valencia, Diana Botros, Maria Vera-Nunez, Stuti Dang

Research output: Contribution to journalReview article

1 Citation (Scopus)

Abstract

Purpose of Review: The current approach to diabetes in the elderly incorporates components from the comprehensive geriatric approach. The most updated guidelines from the American Diabetes Association reflect influence from the consensus made in 2012 with the American Geriatrics Society. Notably, the framework included the evaluation for geriatric syndromes (falls and urinary incontinence), functional and cognitive abilities. The goal for this review is to provide an updated summary of treatment strategies for community-dwelling older adults. We identified the need to expand our approach by addressing innovative approaches and scientific concepts from telemedicine, functional medicine, and geriatrics. Recent Findings: Findings on cardiovascular protection with sodium-glucose co-transporter 2 inhibitors (SGLT-2i) and some glucagon-like peptide 1 receptor agonists (GLP-1RA) support their use for older patients with diabetes. However, careful consideration for agent selection must incorporate the presence of geriatric issues, such as geriatric syndromes, or functional and cognitive decline, as they could increase the risk and impact adverse reactions. Telemedicine interventions can improve communication and connection between older patients and their providers, and improve glycemic control. Functional medicine concepts can offer additional adjuvant strategies to support the therapeutic interventions and management of diabetes in the elderly. Summary: A systematic review confirmed the efficacy and safety of metformin as first-line therapy of type 2 diabetes in the older adult, but multiple reports highlighted the risk for vitamin B12 deficiency. Randomized controlled trials showed the efficacy and safety of antihyperglycemic agents in the elderly, including some with longer duration and lesser risk for hypoglycemia. Randomized clinical trials showed cardiovascular protection with SGLT-2i (empagliflozin, canagliflozin) and GLP-1RA (liraglutide, semaglutide). The most current guidelines recommend addressing for geriatric syndromes, physical and cognitive function in the elderly, in order to individualize targets and therapeutic strategies. Clinicians managing diabetes in the elderly can play a major role for the early detection and evaluation of geriatric issues in their patients. Telemedicine interventions improve glycemic control, and certain functional medicine strategies could be adjuvant interventions to reduce inflammation and stress, but more studies focused on the elderly population are needed.

Original languageEnglish (US)
Article number95
JournalCurrent Diabetes Reports
Volume18
Issue number10
DOIs
StatePublished - Oct 1 2018

Fingerprint

Geriatrics
Medicine
Technology
Sodium-Glucose Transporter 2
Telemedicine
Symporters
Therapeutics
Randomized Controlled Trials
Guidelines
Independent Living
Vitamin B 12 Deficiency
Safety
Aptitude
Metformin
Urinary Incontinence
Hypoglycemia
Hypoglycemic Agents
Type 2 Diabetes Mellitus
Cognition
Consensus

Keywords

  • Diabetes
  • Functional medicine
  • Geriatrics
  • Management
  • Older adult
  • Telemedicine

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

Diabetes Treatment in the Elderly : Incorporating Geriatrics, Technology, and Functional Medicine. / Valencia, Willy Marcos; Botros, Diana; Vera-Nunez, Maria; Dang, Stuti.

In: Current Diabetes Reports, Vol. 18, No. 10, 95, 01.10.2018.

Research output: Contribution to journalReview article

Valencia, Willy Marcos ; Botros, Diana ; Vera-Nunez, Maria ; Dang, Stuti. / Diabetes Treatment in the Elderly : Incorporating Geriatrics, Technology, and Functional Medicine. In: Current Diabetes Reports. 2018 ; Vol. 18, No. 10.
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