diabetes elderly drug benefit - Benefits have been extrapolated from trials manfaat biji mahoni untuk diabetes of older adults that include but are not limited to those with diabetes and trials of people with diabetes including but not limited to older adults A statin study in older adults participants aged 7082 years found a 15 reduction in coronary artery disease events with pravastatin 39 40 After risk and benefit evaluations some experts suggest metformin or dipeptidyl peptidase4 DPP4 inhibitors as drugs of choice for the elderly 12 41 In Table 3 Brunton S Initiating insulin therapy in type 2 diabetes benefits of insulin analogs and insulin pens Diabetes Technol Ther 2008104247256 doi 101089dia20080287 They suggest that getting HbA1c between 75 and 9 should maximize benefits and minimize harms JAMA March 8 2016 This recommendation contrasts with previous goals of getting HbA1c to a lower level that was believed more optimal The ACCORD trial showed unexpectedly that getting HbA1c a measure of blood sugar over several weeks What Are the Best Treatments for Type 2 Diabetes in Older Adults PDF Rational GoalSetting and Management of Diabetes in the Elderly US Pharm 20094374448 Diabetes mellitus is a significant health concern for older persons in the United States Approximately 23 of patients over the age of 60 have diabetes with the majority suffering from type 2 diabetes 1 Elderly patients may experience critical health consequences of diabetes including accelerated aging and increased rates of premature death and disability 23 Treatment of Diabetes in Older Adults An Endocrine Society Management of Type 2 Diabetes Mellitus in the Very Elderly One Considerations for the Pharmacological Treatment of Diabetes in Older Epidemiology Among older adults with diabetes 90 have type 2 diabetes T2D and in one study this value was 96 1 T2D is an agerelated disease with a prevalence of 33 in the US population aged 65 years or older and nearly 50 of older type 1 diabetes nick jonas people meet the criteria for prediabetes 2 Metformin great with new GFR guidance please use metformin ER Sulfonylureas cheap but risk of hypoglycemia no more glyburide and its evil metabolite norglyburide cleared through kidneys now 4 monthly glimepiride TZDs no hypoglycemia but risks of edema CHF and possibly fractures and malignancies Diabetes in Older Adults PMC Diabetes in Older People More than 20 million people in America are estimated to have diabetes with the prevalence in adults 60 years of age now 20 1 The increased prevalence in older adults may be the result of several factors including physiological changes in glucose metabolism that occur with aging reduced physical activity and increased prevalence of the metabolic syndrome with aging Arguments have been made for and against extrapolating data showing benefit lowering A1c from patients younger than 65 to the very elderly 20 Zheng et al showed a correlation between increased A1c and increased dementia 15 One can make an argument supporting lowering A1c in the very elderly as long as one avoids drugs that cause hypoglycemia Achieving glycemic control in elderly patients with type 2 diabetes a Treatment of type 2 diabetes mellitus in the older patient A typical starting dose of a sulfonylurea is as follows see Sulfonylureas and meglitinides in the treatment of type 2 diabetes mellitus section on Dosing and monitoring Glipizide 25 mg taken 30 minutes before breakfast Glimepiride 1 mg taken with breakfast or the first main meal Pharmacotherapy of Diabetes in the Elderly Healthy behaviour interventions are effective in reducing the risk of developing diabetes in older people at high risk for the development of the disease Acarbose rosiglitazone and pioglitazone also are effective in preventing diabetes in highrisk elderly Metformin may not be effective Since several of these drugs have significant toxicity in the older adult see diabetes in 20s symptoms below and since there
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