Cardiac risk factors and hypoglycemia in an elderly patient: how good is good enough?
OBJECTIVE
This clinical review highlights emerging data regarding the complex relationship among glycosylated hemoglobin (A1C) goals, risk of cardiovascular disease, and hypoglycemia in elderly patients with type 2 diabetes mellitus (T2DM). According to the ADVANCE and VADT trials, lowering patients' A1C levels did not decrease the risk of cardiovascular disease, and the ACCORD trial found a slightly higher risk of cardiovascular disease with tighter glycemic control. Long-term follow-up data from the UKPDS indicated good glycemic control, when achieved early in newly diagnosed patients, lowered cardiovascular risk over the long-term (at least 15 to 20 years). Moreover, tight glycemic control, if it results in severe hypoglycemic events, may pose a serious risk among elderly patients with T2DM.


METHODS
Live symposium presentation based on clinical practice and research, medical literature, and studies published between October 2005 and January 2010 on managing diabetes in older adults, government statistics, and medical society guidelines.


CONCLUSIONS
If it can be achieved safely, early glycemic control is beneficial to elderly patients with T2DM. Treatment goals for older adults should be an individualized process and must include a number of considerations. Pharmacists need to manage the dual issues of avoiding intensive lowering of A1C levels and averting the risk of hypoglycemia.
Triplitt
Curtis
C
Texas Diabetes Institute, San Antonio, Texas 78207, USA. curtis.triplitt@uhs-sa.com
D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010595:Pharmacists / Q000458:organization & administration; D017410:Practice Guidelines as Topic; D024382:Professional Role; D012307:Risk Factors; D012720:Severity of Illness Index
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents