Open Collections

UBC Faculty Research and Publications

Safe diabetes treatment for older adults Therapeutics Initiative (University of British Columbia)

Description

Background: In older adults with type 2 diabetes (T2DM), tight glycemic control (HbA1c <7%) can result in more harm than benefit, especially when using insulin or sulfonylureas. Older adults are at higher risk for adverse drug events, especially hypoglycemia, which may cause falls, confusion, and hospitalizations. Aims: This Therapeutics Letter evaluates the risks of tight glycemic control in older adults with T2DM, focusing on deprescribing diabetes medications in those over 65, especially those with multimorbidities and polypharmacy. It assesses the evidence from clinical trials and guidelines, with a focus on preventing hypoglycemia and improving patient-centered care through relaxed HbA1c targets. Recommendations: Large RCTs show that intensive glycemic control (HbA1c ≤7%) does not reduce cardiovascular risk but increases hypoglycemia and mortality, particularly in older adults. Instead, glycemic targets should be adjusted based on the patient’s overall health and life expectancy. Deprescribing may be considered, starting with drugs most likely to cause hypoglycemia (sulfonylureas or insulin). Regular reassessment and patient involvement in creating individualized treatment plans are essential.

Item Metadata

Title
Safe diabetes treatment for older adults
Alternate Title
Minimizing harms of tight glycemic control in older people with type 2 diabetes; Therapeutics Letter 151
Creator
Therapeutics Initiative (University of British Columbia)
Date Issued
2024-10
Description
Background: In older adults with type 2 diabetes (T2DM), tight glycemic control (HbA1c <7%) can result in more harm than benefit, especially when using insulin or sulfonylureas. Older adults are at higher risk for adverse drug events, especially hypoglycemia, which may cause falls, confusion, and hospitalizations. Aims: This Therapeutics Letter evaluates the risks of tight glycemic control in older adults with T2DM, focusing on deprescribing diabetes medications in those over 65, especially those with multimorbidities and polypharmacy. It assesses the evidence from clinical trials and guidelines, with a focus on preventing hypoglycemia and improving patient-centered care through relaxed HbA1c targets. Recommendations: Large RCTs show that intensive glycemic control (HbA1c ≤7%) does not reduce cardiovascular risk but increases hypoglycemia and mortality, particularly in older adults. Instead, glycemic targets should be adjusted based on the patient’s overall health and life expectancy. Deprescribing may be considered, starting with drugs most likely to cause hypoglycemia (sulfonylureas or insulin). Regular reassessment and patient involvement in creating individualized treatment plans are essential.
Subject
Aged; Deprescriptions; Diabetes Mellitus; Drug-Related Side Effects and Adverse Reactions; Glucagon-Like Peptide-1 Receptor Agonists; Glycemic Control; Hypoglycemic Agents; Medication Therapy Management; Polypharmacy; Sodium-Glucose Transporter 2 Inhibitors
Genre
Other
Type
Text
Language
eng
Notes
The UBC TI is funded by the BC Ministry of Health to provide evidence-based information about drug therapy. We neither formulate nor adjudicate provincial drug policies.
Date Available
2024-10-16
Provider
Vancouver : University of British Columbia Library
Rights
Attribution-NonCommercial-NoDerivatives 4.0 International
DOI
10.14288/1.0445578
URI
http://hdl.handle.net/2429/89418
Affiliation
Medicine, Faculty of; Anesthesiology, Pharmacology and Therapeutics, Department of
Peer Review Status
Reviewed
Scholarly Level
Faculty; Researcher
Rights URI
http://creativecommons.org/licenses/by-nc-nd/4.0/
Aggregated Source Repository
DSpace

Item Media

Item Citations and Data

Rights

Attribution-NonCommercial-NoDerivatives 4.0 International