Unique characteristics of the geriatric diabetic population and the role for therapeutic strategies that enhance glucagon-like peptide-1 activity.
OBJECTIVE
Care for elderly diabetic patients poses a unique clinical challenge. This review highlights distinct aspects of the pathophysiology and the risks for secondary complications in the geriatric diabetic population. Based on these considerations, we discuss emerging therapeutic options based on the actions of the incretin hormone glucagon-like peptide (GLP)-1, which may be ideal for achieving glycemic control in the elderly diabetic patient.


RESULTS
Aging is associated with diminished capacity of pancreatic beta-cells to respond to glucose. This functional decline in beta-cell insulin secretion is a major contributor to the development of diabetes in the older patient. In addition, elderly diabetics suffer from a broader range of diabetic complications than do younger diabetics, warranting aggressive glycemic control. GLP-1 is known to improve beta-cell insulin secretion, increase beta-cell mass, and suppress glucagon secretion. Recent studies investigating improved GLP-1 activity have yielded promising results, with improved glycemic control in elderly patients with type 2 diabetes and without significant risk for hypoglycemia.


CONCLUSIONS
Elderly diabetics are a growing subset of the type 2 diabetic population with unique pathophysiologic characteristics and diabetic risk profiles. Therapeutic strategies that incorporate enhancement of GLP-1 action on beta-cells to improve beta-cell insulin secretion and glycemic control may be ideal for this distinct population and should be validated with further long-term clinical studies.
Thearle
Marie
M
Columbia University, Department of Medicine, Division of Endocrinology, Naomi Berrie Diabetes Center, New York, New York, USA.
Brillantes
Anne Marie B
AM
D000368:Aged; D000375:Aging / Q000378:metabolism*; D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D005853:Geriatrics; D005934:Glucagon / Q000009:adverse effects / Q000378:metabolism / Q000627:therapeutic use*; D052216:Glucagon-Like Peptide 1; D006801:Humans; D007328:Insulin / Q000378:metabolism*; D000078790:Insulin Secretion; D007515:Islets of Langerhans / Q000187:drug effects / Q000378:metabolism; D010446:Peptide Fragments / Q000009:adverse effects / Q000378:metabolism / Q000627:therapeutic use*; D011498:Protein Precursors / Q000009:adverse effects / Q000378:metabolism / Q000627:therapeutic use*
D001786:Blood Glucose; D007328:Insulin; D010446:Peptide Fragments; D011498:Protein Precursors; D052216:Glucagon-Like Peptide 1; D005934:Glucagon