Suitable Use of Injectable Agents to Overcome Hypoglycemia Risk, Barriers, and Clinical Inertia in Community-Dwelling Older Adults with Type 2 Diabetes Mellitus.

Abstract:

:The management of type 2 diabetes mellitus in older adults requires a comprehensive understanding of the relationship between the disease (medical) and the functional, psychological/cognitive, and social geriatric domains, to individualize both glycemic targets and therapeutic approaches. Prevention of hypoglycemia is a major priority that should be addressed as soon as its presence or risk is detected, adjusting the target and therapeutics accordingly. Nonetheless, treatment intensification should not be neglected when applicable, consistent with recommendations from organizations such as the American Geriatrics Society and the American Diabetes Association, to reduce not only long-term macrovascular and microvascular complications (individualization), but also short-term complications from hyperglycemia (polyuria, volume depletion, urinary incontinence). Such complications can negatively impact the physical and cognitive function of older adults, worsen their quality of life, and additionally affect their families and society. We emphasize individualization, utilizing the multiple classes of antihyperglycemic agents available. Metformin remains as first-line therapy, and additional agents offer advantages and disadvantages that ought to be considered when developing a patient-centric plan of care. For selected cases, injectable therapies such as long-acting basal insulin analogs and glucagon-like peptide-1 receptor agonists can offer advantages to counter hypoglycemia risk, patient-related barriers, and clinical inertia. Furthermore, some injectable agents could potentially simplify regimens while providing safe and effective glycemic control. In this review, we discuss the use of injectable therapies for selected community-dwelling older adults, barriers to transition to injectable therapy, and measures aimed at removing these barriers and assisting physicians and their teams to transition older patients to injectable therapies when appropriate.

journal_name

Drugs Aging

journal_title

Drugs & aging

authors

Valencia WM,Florez HJ,Palacio AM

doi

10.1007/s40266-019-00706-4

subject

Has Abstract

pub_date

2019-12-01 00:00:00

pages

1083-1096

issue

12

eissn

1170-229X

issn

1179-1969

pii

10.1007/s40266-019-00706-4

journal_volume

36

pub_type

杂志文章,评审
  • Metronomic chemotherapy for metastatic prostate cancer: a 'young' concept for old patients?

    abstract::Prostate cancer is a common disease in the elderly, and the number of older prostate cancer patients will probably increase with both the aging of the population and the increased rate of screening. In elderly patients with several co-morbidities, cancer management can be complex, and the risk of administering toxic t...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.2165/11537480-000000000-00000

    authors: Fontana A,Falcone A,Derosa L,Di Desidero T,Danesi R,Bocci G

    更新日期:2010-09-01 00:00:00

  • Amitriptyline. A review of its pharmacological properties and therapeutic use in chronic pain states.

    abstract::Amitriptyline is a tricyclic antidepressant agent which also has analgesic properties. Whether its analgesic effects are linked to its mood-altering activity or attributable to a discrete pharmacological action (or a combination of both) is unknown. Clinical trials demonstrate that oral amitriptyline achieves at least...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.2165/00002512-199608060-00008

    authors: Bryson HM,Wilde MI

    更新日期:1996-06-01 00:00:00

  • Lower Prescription Rates in Centenarians with Heart Failure and Heart Failure and Kidney Disease Combined: Findings from a Longitudinal Cohort Study of Very Old Patients.

    abstract:BACKGROUND:Centenarians are considered as models of successful aging and represent a special group of patients. The aim of this study was to analyze heart failure epidemiology and treatment trajectories in centenarians compared to nonagenarians (90-99 years of age) and octogenarians (80-89 years of age) with heart fail...

    journal_title:Drugs & aging

    pub_type: 杂志文章

    doi:10.1007/s40266-018-0581-z

    authors: Schmidt IM,Kreutz R,Dräger D,Zwillich C,Hörter S,Kuhlmey A,Gellert P

    更新日期:2018-10-01 00:00:00

  • Evidence-Based Management of Diabetes in Older Adults.

    abstract::The number of older adults with diabetes is rapidly increasing worldwide. A variety of factors contribute to the age-related increase in the incidence of diabetes. The lack of empiric evidence in the field has limited the management guidelines to mostly expert opinion. Given uncertainty over the rate at which to lower...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.1007/s40266-018-0598-3

    authors: Mooradian AD

    更新日期:2018-12-01 00:00:00

  • Streptogramins and their potential role in geriatric medicine.

    abstract::Despite advances in antimicrobial chemotherapy over recent decades, morbidity and mortality secondary to infection continues to rise. In addition, the incidence of infection caused by resistant organisms has also increased. Concurrently, the elderly are living longer than prior generations, often with disabling chroni...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.2165/00002512-199813060-00004

    authors: Lomaestro BM,Briceland LL

    更新日期:1998-12-01 00:00:00

  • Age-related changes in male gonadal function. Implications for therapy.

    abstract::In contrast with women, who experience a complete and abrupt cessation of ovarian function during the menopause, aging men largely maintain their testicular androgen production. Nevertheless, most cross-sectional studies indicate that there is a partial decrease in testosterone levels with aging, although this has not...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.2165/00002512-199711010-00005

    authors: Maas D,Jochen A,Lalande B

    更新日期:1997-07-01 00:00:00

  • Continuity and adherence to long-term drug treatment by geriatric patients after hospital discharge: a prospective cohort study.

    abstract:BACKGROUND:Increased life expectancy is associated with an increased prevalence of chronic diseases and drug consumption. Changes often occur in the medication regimen after hospitalization. The extent and nature of these changes and the adherence of elderly patients have not yet been fully investigated. OBJECTIVE:To ...

    journal_title:Drugs & aging

    pub_type: 杂志文章

    doi:10.2165/00002512-200825100-00005

    authors: Mansur N,Weiss A,Hoffman A,Gruenewald T,Beloosesky Y

    更新日期:2008-01-01 00:00:00

  • Safety of Antidepressant Classes Used Following Traumatic Brain Injury Among Medicare Beneficiaries: A Retrospective Cohort Study.

    abstract:OBJECTIVE:There is poor evidence supporting the use of any pharmacologic treatments for neuropsychiatric disorders following traumatic brain injury (TBI), especially among older adults. Informed by our recent characterization of psychotropic medication use among Medicare beneficiaries with TBI, the objective of this st...

    journal_title:Drugs & aging

    pub_type: 杂志文章

    doi:10.1007/s40266-018-0570-2

    authors: Albrecht JS,Rao V,Perfetto EM,Daniel Mullins C

    更新日期:2018-08-01 00:00:00

  • Stroke prevention in atrial fibrillation: putting the guidelines into practice.

    abstract::Atrial fibrillation confers a 5-fold increase in risk of stroke. A number of drugs aimed at reducing this risk have been tested in randomized controlled trials. These include antiplatelet agents (singly and in combination); anticoagulants, including vitamin K antagonists and direct thrombin inhibitors; and anticoagula...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.2165/11538620-000000000-00000

    authors: Mant J,Edwards D

    更新日期:2010-11-01 00:00:00

  • Immunogenicity and Safety of Intradermal Influenza Vaccine in the Elderly: A Meta-Analysis of Randomized Controlled Trials.

    abstract:INTRODUCTION:Immunosenescence makes the elderly more susceptible to influenza complications and less responsive to vaccination. An intradermal formulation (IDflu) is one of several strategies being investigated to increase the immunogenicity of influenza vaccines. OBJECTIVE:The overall goal of the study was to assess ...

    journal_title:Drugs & aging

    pub_type: 杂志文章,meta分析

    doi:10.1007/s40266-015-0303-8

    authors: Pileggi C,Mascaro V,Bianco A,Nobile CG,Pavia M

    更新日期:2015-10-01 00:00:00

  • Pharmacological approaches to the prevention of restenosis after coronary angioplasty.

    abstract::Restenosis in the months following a successful percutaneous transluminal coronary angioplasty (PTCA) remains the main limitation to this technique for myocardial revascularisation. Despite intensive investigation in this area, no pharmacological therapy has yet been found to be useful in preventing restenosis after c...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.2165/00002512-199813040-00005

    authors: Hamon M,Lécluse E,Monassier JP,Grollier G,Potier JC

    更新日期:1998-10-01 00:00:00

  • Bacterial skin infections in the elderly: diagnosis and treatment.

    abstract::Skin and soft tissue infections are quite common in elderly people. A number of special conditions and circumstances need to be considered in the diagnosis and therapy. It is important to try to establish the causative organism, exclude other cutaneous disorders and identify precipitating factors. Treatment modalities...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.2165/00002512-200219050-00002

    authors: Laube S,Farrell AM

    更新日期:2002-01-01 00:00:00

  • Age-related changes in laboratory test results. Clinical implications.

    abstract::Many quantities assayed in clinical laboratories demonstrate age-related changes. Particularly important periods are early life, adolescence, old age, and after the menopause in females. The changes that occur until adulthood are well documented. Fewer data are available on elderly people even though they consume a la...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.2165/00002512-199303030-00006

    authors: Fraser CG

    更新日期:1993-05-01 00:00:00

  • Potential applications of gene therapy in the patient with cancer.

    abstract::The elderly population has much to gain from the advances of molecular medicine, although at present genetic pharmacology remains mostly at the conceptual level. Cancer, in particular, is an increasing health burden and the majority (over 70%) of gene therapy trials are aimed at tackling this problem. Available strate...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.2165/00002512-200017020-00004

    authors: Szlosarek PW,Dalgleish AG

    更新日期:2000-08-01 00:00:00

  • Warfarin for prevention of thrombosis among long-term care residents with atrial fibrillation: evidence of continuing low use despite consideration of stroke and bleeding risk.

    abstract:OBJECTIVES:The aims of the study were to evaluate usage rates of warfarin in stroke prophylaxis and the association with assessed stages of stroke and bleeding risk in long-term care (LTC) residents with atrial fibrillation (AFib). METHODS:A cross-sectional analysis of two LTC databases (the National Nursing Home Surv...

    journal_title:Drugs & aging

    pub_type: 杂志文章

    doi:10.1007/s40266-013-0067-y

    authors: Reardon G,Nelson WW,Patel AA,Philpot T,Neidecker M

    更新日期:2013-06-01 00:00:00

  • The role of nitric oxide in neurodegeneration. Potential for pharmacological intervention.

    abstract::Nitric oxide (NO) is involved in important physiological functions of the CNS, including neurotransmission, memory and synaptic plasticity. Depending on the redox state of NO, it can act as a neurotoxin or it can have a neuroprotective action. Data suggest that NO may have a role in the pathogenesis of neurodegenerati...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.2165/00002512-199812040-00001

    authors: Molina JA,Jiménez-Jiménez FJ,Ortí-Pareja M,Navarro JA

    更新日期:1998-04-01 00:00:00

  • Topical analgesics for neuropathic pain in the elderly: current and future prospects.

    abstract::Neuropathic pain (NeP) is a significant medical and socioeconomic burden with limited therapeutic options. Elderly patients exhibit a higher incidence of several NeP conditions and pose a particular challenge due to age-related pharmacokinetic and pharmacodynamic issues, comorbid conditions, and polypharmacy, as well ...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.1007/s40266-014-0218-9

    authors: Sawynok J

    更新日期:2014-12-01 00:00:00

  • Acute cough in the elderly: aetiology, diagnosis and therapy.

    abstract::Although the frequency of physician consultations and the sale of over-the-counter remedies establish the high prevalence of acute cough in the elderly, epidemiological studies have tended to be imprecise. However, respiratory tract infections in nose, larynx and/or bronchi, either viral or bacterial or both, are by f...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.2165/00002512-200421040-00003

    authors: Widdicombe J,Kamath S

    更新日期:2004-01-01 00:00:00

  • Prevention and treatment of urinary catheter-related infections in older patients.

    abstract::The elderly population is more likely to have urinary catheters used than younger populations. Most patients with short term indwelling catheters (those in place less than 30 days) will be residents of acute care institutions. The frequency of catheter-acquired bacteriuria is greater with longer durations of catheteri...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.2165/00002512-199404050-00003

    authors: Nicolle LE

    更新日期:1994-05-01 00:00:00

  • Disease-modifying antirheumatic drugs. Potential effects in older patients.

    abstract::Disease-modifying antirheumatic drugs (DMARDs) are frequently used in rheumatoid arthritis. A number of physiological changes occur in the elderly which may modify the use of these medications. The most commonly used DMARDs are antimalarial drugs (particularly hydroxychloroquine), sulfasalazine and methotrexate. The p...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.2165/00002512-199507060-00003

    authors: Gardner G,Furst DE

    更新日期:1995-12-01 00:00:00

  • Intermittent claudication in older patients. Practical treatment guidelines.

    abstract::The prevalence of intermittent claudication (IC) increases with age; when questioned, older patients consider increased difficulty in walking to be a normal consequence of aging. Although the prognosis for the involved limb with IC is relatively good, IC is an important clinical predictor of increased cardiovascular m...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.2165/00002512-199914040-00002

    authors: Boccalon H

    更新日期:1999-04-01 00:00:00

  • Hyperparathyroidism in the elderly patient.

    abstract::Primary hyperparathyroidism is a common metabolic bone disease and currently presents a significant management dilemma. Most of the patients have few relevant symptoms and surgical parathyroidectomy offers the prospect of cure with freedom from the risk of long-term complications or the need for a follow-up. However, ...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.2165/00002512-200421150-00004

    authors: Sims R,Ubhi C,Hosking D

    更新日期:2004-01-01 00:00:00

  • Intravitreal aflibercept (Eylea(®)): a review of its use in patients with macular oedema secondary to central retinal vein occlusion.

    abstract::Aflibercept is a fully human, recombinant fusion protein that acts as a soluble decoy receptor for vascular endothelial growth factor (VEGF) family members, including VEGF-A, VEGF-B and placental growth factor (P1GF), thereby inhibiting downstream signalling mediated by these ligands. Aflibercept binds all isoforms of...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.1007/s40266-014-0176-2

    authors: Yang LP,McKeage K

    更新日期:2014-05-01 00:00:00

  • Changes in protein kinases in brain aging and Alzheimer's disease. Implications for drug therapy.

    abstract::There is ample evidence for the involvement of aberrant protein phosphorylation reactions in aging and age-associated neurological disorders. Alzheimer's disease (AD) in particular. The exact nature of this involvement, however, is not yet elucidated. In the brain tissue of AD patients, there are numerous examples of ...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.2165/00002512-199506020-00006

    authors: Jin LW,Saitoh T

    更新日期:1995-02-01 00:00:00

  • Management of lipid disorders in the elderly.

    abstract::Cardiovascular disease has been inseparable from aging in developed societies and, as a result, it is the commonest cause of mortality in elderly populations. Atherosclerosis is associated with the progressive vascular accumulation of cholesterol-laden lipoproteins, and is linearly associated with the plasma level of ...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.2165/00002512-199710060-00005

    authors: Playford DA,Watts GF

    更新日期:1997-06-01 00:00:00

  • Prostate cancer, Incidence, management and outcomes.

    abstract::The incidence of prostate carcinoma in the US now appears to be declining slightly, as a consequence of removal of prevalent cases from the population by screening. Screening for serum prostate-specific antigen (PSA) levels has been improved by the use of PSA transformations including PSA density, PSA velocity and age...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.2165/00002512-199813010-00007

    authors: Small EJ

    更新日期:1998-07-01 00:00:00

  • Psychotropic drug-induced falls in older people: a review of interventions aimed at reducing the problem.

    abstract::Falls are a common health problem for older people, and psychotropic medications have been identified as an important independent fall risk factor. The objective of this paper was to review the literature relating to the effect of psychotropic medications on falls in older people, with a particular focus on evidence s...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.2165/11598420-000000000-00000

    authors: Hill KD,Wee R

    更新日期:2012-01-01 00:00:00

  • Opioids for the treatment of chronic non-cancer pain in older people.

    abstract::Chronic pain occurs in 45-85% of the geriatric population and the need to treat chronic pain is growing substantially. Unfortunately, treatment for chronic pain is not always correctly targeted, which leads to a reduced quality of life, with decreased socialization, depression, sleep disturbances, cognitive impairment...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.2165/11534670-000000000-00000

    authors: Gianni W,Ceci M,Bustacchini S,Corsonello A,Abbatecola AM,Brancati AM,Assisi A,Scuteri A,Cipriani L,Lattanzio F

    更新日期:2009-12-01 00:00:00

  • Issues in the perioperative management of the elderly patient with cardiovascular disease.

    abstract::The elderly patient may show normal physiological changes of the cardiovascular and respiratory systems that accompany aging, as well as features of intrinsic cardiac disease. The latter include: a past history of myocardial infarction or ischaemic heart disease; history of congestive cardiac failure; angina; arterial...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.2165/00002512-200219060-00003

    authors: Sear JW,Higham H

    更新日期:2002-01-01 00:00:00

  • Quinolone disposition in the elderly. Practical implications.

    abstract::The fluoroquinolones are antibiotics frequently used in infections that affect elderly individuals. The physiological aging process can profoundly affect the pharmacokinetics of drugs, necessitating adjustment of dosage regimens in the elderly. Changes in pharmacokinetics with age are mainly due to the progressive det...

    journal_title:Drugs & aging

    pub_type: 杂志文章,评审

    doi:10.2165/00002512-199101040-00004

    authors: Nilsson-Ehle I,Ljungberg B

    更新日期:1991-07-01 00:00:00