Older adults

Less than a third of nursing home residents who meet the criteria for overtreatment of type 2 diabetes have their treatment deintensified, suggests an analysis of Veterans Affairs data.

Findings from the ORACL trial suggest that closed-loop insulin delivery results in better glycemic control than sensor-augmented pump therapy among older adults with longstanding type 1 diabetes.

Older people with type 2 diabetes are more likely to receive inappropriately intensive glucose-lowering treatment if they live in high- versus middle income countries, show data from the global DISCOVER study.

Older people with type 2 diabetes who initiate treatment with long-acting insulin analogs have a lower risk for severe hypoglycemia than those using neutral protamine Hagedorn insulin, real-world study findings suggest.

Analysis of older participants in the BRIGHT trial suggests that this subgroup may do slightly better with insulin glargine-300 than with degludec.

Older individuals with type 2 diabetes and low glycated hemoglobin receiving treatment with a sulfonylurea or insulin have an increased risk for severe hypoglycemia, but there is no clear indication of an increased mortality risk, suggest UK study results.

Older patients with type 2 diabetes and multiple comorbidities continue to achieve lower glycated hemoglobin levels, often while on insulin, than their younger, healthier counterparts, despite guideline advice to the contrary, US researchers report.

The addition of linagliptin to stable insulin treatment improves glycemic control without increasing the risk for clinically important hypoglycemia among older individuals with type 2 diabetes, randomized trial findings suggest.

Older type 2 diabetes patients receiving basal insulin treatment who switch to glargine 300 units/mL experience greater or similar improvements in glycemic control compared with those switching to a first-generation basal insulin, with lower hypoglycemia risk, researchers report.

Research shows an increased mortality risk associated with the use of intensive antidiabetes treatments in older patients with type 2 diabetes.

Insulin titration benefits individuals with type 2 diabetes regardless of age or whether it is self- or physician-managed, according to data presented at the ADA’s 78th Scientific Sessions in Orlando, Florida, USA.

Degludec delivers the same magnitude of protection against hypoglycemia relative to glargine across patient age groups, shows analysis of the SWITCH 2 and DEVOTE trials.

Zhu B et al. Acta Diabetol 2018. doi: 10.1007/s00592-018-1181-4

Ritzel R et al. Diabetes Care 2018: dc180168. doi: 10.2337/dc18-0168

Saetung S et al. Acta Diabetol 2018. doi: 10.1007/s00592-018-1166-3

Oriot P et al. Acta Diabetol 2018. doi: 10.1007/s00592-018-1170-7

McCarthy MM, Grey M. Diabetes Care 2018. doi: 10.2337/dc17-2597

An initiative involving “virtual ward” meetings between diabetes specialist nurses, community nurses, and consultants has led to improvements in glycemic control and a reduction in nurse visits among older diabetes patients in North East Essex, study results suggest.

The drive to achieve lower HbA1c targets in older patients is not without concern or risk. Our UK Board address concerns highlighted by recent trials and discuss whether current guidelines do enough to mitigate the risks of overtreatment.

Research suggests that older diabetes patients, particularly those using insulin, often have nonspecific symptoms of hypoglycemia that are overlooked by healthcare providers.