title: Treatment and treatment-related adverse events of type 2 diabetes mellitus in residents of long-term care facilities: a retrospective study.
abstract: BACKGROUND
  In the United States, type 2 diabetes mellitus (DM) is most prevalent among adults aged >75 years. Judicious use of available therapies can improve plasma glucose concentration and reduce the risk for complications in elderly patients. However, selecting the appropriate medication for these patients is often challenging.
  
  
  OBJECTIVE
  The goals of this retrospective study were to determine whether 1 or 2 medications were needed for the treatment of type 2 DM in elderly patients and to identify treatment-related adverse events (AEs).
  
  
  METHODS
  The charts of residents of long-term care (LTC) facilities in New Jersey and Pennsylvania with a diagnosis of type 2 DM and receiving metformin, a sulfonylurea, rosiglitazone, or pioglitazone, either alone or in combination with insulin or another drug, were included. Data for laboratory values (including fasting plasma glucose [FPG] and serum creatinine concentration), body weight, and AEs were analyzed.
  
  
  RESULTS
  The charts of 182 patients (121 women, 61 men) were included. The mean (SD) age of the women was 80.2 (10.2) years; and of the men, 73.7 (12.0) years. Many patients were switched from monotherapy to combination therapy due to a high FPG concentration. Sixty treatment-related AEs occurred in 60 patients; the pioglitazone and metformin groups had the highest incidence of AEs (8/11 [72.7%] patients and 21/48 [43.8%] patients, respectively) and the rosiglitazone group had the lowest (2/13 [15.4%] patients), although the number of patients in the pioglitazone and rosiglitazone groups was extremely low.
  
  
  CONCLUSIONS
  In this study population of older patients, rosiglitazone monotherapy had favorable tolerability and appeared to be more effective than other therapies for type 2 DM. These results suggest that rosiglitazone monotherapy may be the safest and most effective of the 4 treatments for type 2 DM in older patients. The rosiglitazone group was the only group that did not have a second medication added to control plasma glucose. However, additional studies are suggested to determine whether larger groups of older patients residing in LTC facilities would demonstrate similar results.
authors.affiliation: Pharm Rx Consultants, Inc., Union, New Jersey, USA.
authors.forename: I Barton
authors.initials: IB
authors.lastname: Frenchman
keywords: metformin; pioglitazone; rosiglitazone; sulfonylurea; type 2 diabetes mellitus