title: Pharmacological treatment of diabetes in older people.
abstract: The pharmacological management of diabetes in older people is complex and challenging. It requires a comprehensive understanding of the individual beyond the diabetes itself. Through the ageing years, the older individual presents with diabetes-related and non-related comorbidities and complications, develops functional limitations and psychological issues, and may lack social support and access to care. A disturbance in these categories, known as the four geriatric domains, will negatively affect diabetes self-management and self-efficacy, leading to poor outcomes and complications. Furthermore, older people with diabetes may be more interested in the management of other chronic conditions such as pain or impaired mobility, and diabetes may be lower in their list of priorities. Proper education must be provided to the older individual and caregivers, with continuous monitoring and counselling, especially when pharmacological interventions offer risks of side effects, adverse reactions and interactions with other medications. Informed shared medical decisions will help to improve adherence to the regimen; however, such discussions ought to be based on the best evidence available, which is unfortunately limited in this age group. We performed a review focused on pharmacological agents and summarize current evidence on their use for the treatment of diabetes in older people. We encourage clinicians to investigate and incorporate the four geriatrics domains in the selection and monitoring of these agents.
authors: Geriatrics Research, Education and Clinical Center, Miami Bruce W. Carter VA Medical Center, Miami, FL, USA; Department of Public Health Sciences, Division of Epidemiology, University of Miami Miller School of Medicine, Miami, FL, USA.
authors: W M
authors: WM
authors: Valencia
authors: H
authors: H
authors: Florez
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D015897:Comorbidity; D048909:Diabetes Complications / Q000517:prevention & control; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000523:psychology; D018450:Disease Progression; D004347:Drug Interactions; D057220:Health Literacy; D006297:Health Services Accessibility; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D055118:Medication Adherence / Q000523:psychology; D010353:Patient Education as Topic; D019338:Polypharmacy; D011788:Quality of Life / Q000523:psychology*; D012307:Risk Factors; D012648:Self Care / Q000523:psychology*; D012944:Social Support
chemical_list: D007004:Hypoglycemic Agents
keywords: antidiabetic drug; diabetes mellitus; medicines management; type 2 diabetes