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09-05-2018 | Older adults | Review | Article

Diabetes Treatment in the Elderly: Incorporating Geriatrics, Technology, and Functional Medicine

Journal: Current Diabetes Reports

Authors: Willy Marcos Valencia, Diana Botros, Maria Vera-Nunez , Stuti Dang

Publisher: Springer US

Abstract

Purpose of Review

The current approach to diabetes in the elderly incorporates components from the comprehensive geriatric approach. The most updated guidelines from the American Diabetes Association reflect influence from the consensus made in 2012 with the American Geriatrics Society. Notably, the framework included the evaluation for geriatric syndromes (falls and urinary incontinence), functional and cognitive abilities. The goal for this review is to provide an updated summary of treatment strategies for community-dwelling older adults. We identified the need to expand our approach by addressing innovative approaches and scientific concepts from telemedicine, functional medicine, and geriatrics.

Recent Findings

Findings on cardiovascular protection with sodium-glucose co-transporter 2 inhibitors (SGLT-2i) and some glucagon-like peptide 1 receptor agonists (GLP-1RA) support their use for older patients with diabetes. However, careful consideration for agent selection must incorporate the presence of geriatric issues, such as geriatric syndromes, or functional and cognitive decline, as they could increase the risk and impact adverse reactions. Telemedicine interventions can improve communication and connection between older patients and their providers, and improve glycemic control. Functional medicine concepts can offer additional adjuvant strategies to support the therapeutic interventions and management of diabetes in the elderly.

Summary

A systematic review confirmed the efficacy and safety of metformin as first-line therapy of type 2 diabetes in the older adult, but multiple reports highlighted the risk for vitamin B12 deficiency. Randomized controlled trials showed the efficacy and safety of antihyperglycemic agents in the elderly, including some with longer duration and lesser risk for hypoglycemia. Randomized clinical trials showed cardiovascular protection with SGLT-2i (empagliflozin, canagliflozin) and GLP-1RA (liraglutide, semaglutide). The most current guidelines recommend addressing for geriatric syndromes, physical and cognitive function in the elderly, in order to individualize targets and therapeutic strategies. Clinicians managing diabetes in the elderly can play a major role for the early detection and evaluation of geriatric issues in their patients. Telemedicine interventions improve glycemic control, and certain functional medicine strategies could be adjuvant interventions to reduce inflammation and stress, but more studies focused on the elderly population are needed.
Literature
1.
World Health Organization. Ageing and health. Fact sheet N404. Available from http://​www.​who.​int/​mediacentre/​factsheets/​fs404/​en/​, accessed on June 1, 2018.
2.
Boyle JP, Thompson TJ, Gregg EW, Barker LE, Williamson DF. Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence. Popul Health Metr. 2010;8:29. https://​doi.​org/​10.​1186/​1478-7954-8-29.CrossRefPubMedPubMedCentral
3.
Centers for Disease Control and Prevention (CDC). Prevalence of overweight and obesity among adults with diagnosed diabetes--United States, 1988–1994 and 1999–2002. MMWR Morb Mortal Wkly Rep. 2004;53(45):1066–8.
4.
Menke A, Casagrande S, Geiss L, Cowie CC. Prevalence of and trends in diabetes among adults in the United States, 1988-2012. JAMA. 2015 Sep 8;314(10):1021–9. https://​doi.​org/​10.​1001/​jama.​2015.​10029.CrossRefPubMed
5.
• Bhupathiraju SN, Hu FB. Epidemiology of obesity and diabetes and their cardiovascular complications. Circ Res. 2016;118(11):1723–35. https://​doi.​org/​10.​1161/​CIRCRESAHA.​115.​306825. This review article highlights the growing incidence of T2D and obesity. CrossRefPubMedPubMedCentral
6.
Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA. 2002;287(3):356–9.CrossRefPubMed
7.
Valencia WM, Palacio A, Tamariz L, Florez H. Metformin and ageing. Diabetologia. 2017;60(9):1630–8. https://​doi.​org/​10.​1007/​s00125-017-4349-5.CrossRefPubMedPubMedCentral
8.
Kirkman MS, Briscoe VJ, Clark N, Florez H, Haas LB, Halter JB, et al. Diabetes in older adults. Diabetes Care. 2012;35(12):2650–64. https://​doi.​org/​10.​2337/​dc12-1801.CrossRefPubMedPubMedCentral
9.
• Beverly EA, Ritholz MD, Shepherd C, Weinger K. The Psychosocial Challenges and Care of Older Adults with Diabetes: “Can’t Do What I Used To Do; Can’t Be Who I Once Was”. Curr Diab Rep. 2016;16(6):48. https://​doi.​org/​10.​1007/​s11892-016-0741-7. This review article summarizes evidence and recommendations for psychosocial care in older adults with diabetes. CrossRefPubMedPubMedCentral
10.
De Felice FG, Ferreira ST. Inflammation, defective insulin signaling, and mitochondrial dysfunction as common molecular denominators connecting type 2 diabetes to Alzheimer disease. Diabetes. 2014;63(7):2262–72.CrossRefPubMed
11.
Bonora E, Kiechl S, Willeit J, Oberhollenzer F, Egger G, Meigs JB, et al. Insulin resistance as estimated by homeostasis model assessment predicts incident symptomatic cardiovascular disease in Caucasian subjects from the general population: the Bruneck study. Diabetes Care. 2007;30(2):318–24.CrossRefPubMed
12.
Djioque S, Nwabo Kamdje AH, Vecchio L, Kipanyula MJ, Farahna M, Aldebasi Y, et al. Insulin resistance and cancer: the role of insulin and IGFs. Endocr Relat Cancer. 2013;20(1):R1–17. https://​doi.​org/​10.​1530/​ERC-12-0324.CrossRef
13.
Stuart MJ, Baune BT. Depression and type 2 diabetes: inflammatory mechanisms of a psychoneuroendocrine comorbidity. Neurosci Biobehav Rev. 2012;36(1):658–76. https://​doi.​org/​10.​1016/​j.​neubiorev.​2011.​10.​001.CrossRefPubMed
14.
Bianchi L, Zuliani G, Volpato S. Physical disability in the elderly with diabetes: epidemiology and mechanisms. Curr Diab Rep. 2013;13(6):824–30. https://​doi.​org/​10.​1007/​s11892-013-0424-6.CrossRefPubMed
15.
Tyrovolas S, Koyanagi A, Garin N, Olaya B, Ayuso-Mateos JL, Miret M, et al. Diabetes mellitus and its association with central obesity and disability among older adults: a global perspective. Exp Gerontol. 2015;64:70–7. https://​doi.​org/​10.​1016/​j.​exger.​2015.​02.​010.CrossRefPubMed
16.
Bouillon K, Kivimäki M, Hamer M, Shipley MJ, Akbaraly TN, Tabak A, et al. Diabetes risk factors, diabetes risk algorithms, and the prediction of future frailty: the Whitehall II prospective cohort study. J Am Med Dir Assoc. 2013;14(11):851.e1–6. https://​doi.​org/​10.​1016/​j.​jamda.​2013.​08.​016.CrossRef
17.
Cacciatore F, Testa G, Galizia G, Della-Morte D, Mazzella F, Langellotto A, et al. Clinical frailty and long-term mortality in elderly subjects with diabetes. Acta Diabetol. 2013;50(2):251–60. https://​doi.​org/​10.​1007/​s00592-012-0413-2.CrossRefPubMed
18.
• Jang HC. Sarcopenia, frailty, and diabetes in older adults. Diabetes Metab J. 2016;40(3):182–9. https://​doi.​org/​10.​4093/​dmj.​2016.​40.​3.​182. This review article highlights the role of sarcopenia and frailty in diabetes. CrossRefPubMedPubMedCentral
19.
Peron EP, Ogbonna KC. Antidiabetic medications and polypharmacy. Clin Geriatr Med. 2015;31:17–27. https://​doi.​org/​10.​1016/​j.​cger.​2014.​08.​017.CrossRefPubMed
20.
Valencia WM, Florez H. Pharmacological treatment of diabetes in older people. Diabetes Obes Metab. 2014;16(12):1192–203. https://​doi.​org/​10.​1111/​dom.​12362.CrossRefPubMed
21.
Williamson JD, Launer LJ, Bryan RN, Coker LH, Lazar RM, Gerstein HC, et al. Action to control cardiovascular risk in diabetes memory in diabetes investigators. Cognitive function and brain structure in persons with type 2 diabetes mellitus after intensive lowering of blood pressure and lipid levels: a randomized clinical trial. JAMA Intern Med. 2014;174:324–33. https://​doi.​org/​10.​1001/​jamainternmed.​2013.​13656.CrossRefPubMedPubMedCentral
22.
Wong RH, Scholey A, Howe PR. Assessing premorbid cognitive ability in adults with type 2 diabetes mellitus--a review with implications for future intervention studies. Curr Diab Rep. 2014;14(11):547. https://​doi.​org/​10.​1007/​s11892-014-0547-4.CrossRefPubMed
23.
Bashshur RL, Shannon GW, Smith BR, Woodward MA. The empirical evidence for the telemedicine intervention in diabetes management. Telemed J E Health. 2015;21(5):321–54. https://​doi.​org/​10.​1089/​tmj.​2015.​0029.CrossRefPubMedPubMedCentral
24.
Li HK, Horton M, Bursell SE, Cavallerano J, Zimmer-Galler I, Tennant M, et al. Telehealth practice recommendations for diabetic retinopathy, second edition. Telemed J E Health. 2011;17(10):814–37. https://​doi.​org/​10.​1089/​tmj.​2011.​0075.CrossRefPubMedPubMedCentral
25.
Nelson LA, Coston TD, Cherrington AL, Osborn CY. Patterns of user engagement with mobile- and web-delivered self-care interventions for adults with T2DM: a review of the literature. Curr Diab Rep. 2016;16(7):66. https://​doi.​org/​10.​1007/​s11892-016-0755-1.CrossRefPubMedPubMedCentral
26.
Dang S, Sanchez A, Oropesa L, Roos BA, Florez H. Telehealth-assisted care coordination of older veterans with type 2 diabetes lowers coronary heart disease risk despite clinical inertia. Diabetes Technol Ther. 2010;12(12):995–1001. https://​doi.​org/​10.​1089/​dia.​2010.​0066.CrossRefPubMed
27.
Valencia WM, Stoutenberg M, Florez H. Weight loss and physical activity for disease prevention in obese older adults: an important role for lifestyle management. Curr Diab Rep. 2014;14(10):539. https://​doi.​org/​10.​1007/​s11892-014-0539-4.CrossRefPubMed
28.
• Mora JC, Valencia WM. Exercise and older adults. Clin Geriatric Med. 2018;34(1):145–62. https://​doi.​org/​10.​1016/​j.​cger.​2017.​08.​007. A current review on the multiple benefits from exercise in older adults. CrossRef
29.
Brokaw SM, Carpenedo D, Campbell P, Burtcher MK, Furshong G, Helgerson SD, et al. Effectiveness of an adapted diabetes prevention program lifestyle intervention in older and younger adults. J Am Geriatr Soc. 2015;63(6):1067–74. https://​doi.​org/​10.​1111/​jgs.​13428.CrossRefPubMed
30.
Villareal DT, Aguirre L, Gurney AB, Waters DL, Sinacore DR, Colombo E, et al. Aerobic or resistance exercise, or both, in dieting obese older adults. N Engl J Med. 2017;376(20):1943–55. https://​doi.​org/​10.​1056/​NEJMoa1616338.CrossRefPubMedPubMedCentral
31.
Daly RM, Miller EG, Dunstan DW, Kerr DA, Solah V, Menzies D, et al. The effects of progressive resistance training combined with a whey-protein drink and vitamin D supplementation on glycaemic control, body composition and cardiometabolic risk factors in older adults with type 2 diabetes: study protocol for a randomized controlled trial. Trials. 2014;15:431. https://​doi.​org/​10.​1186/​1745-6215-15-431.CrossRefPubMedPubMedCentral
32.
Rodriguez-Mañas L, Bayer AJ, Kelly M, Zeyfang A, Izquierdo M, Laosa O, et al. An evaluation of the effectiveness of a multi-modal intervention in frail and pre-frail older people with type 2 diabetes--the MID-Frail study: study protocol for a randomised controlled trial. Trials. 2014;15:34. https://​doi.​org/​10.​1186/​1745-6215-15-34.CrossRefPubMedPubMedCentral
33.
Schlender L, Martinez YV, Adeniji C, Reeves D, Faller B, Sommerauer C, et al. Efficacy and safety of metformin in the management of type 2 diabetes mellitus in older adults: a systematic review for the development of recommendations to reduce potentially inappropriate prescribing. BMC Geriatr. 2017;17(Suppl 1):227. https://​doi.​org/​10.​1186/​s12877-017-0574-5.CrossRefPubMedPubMedCentral
34.
Wang CP, Lorenzo C, Espinoza SE. Frailty attenuates the impact of metformin on reducing mortality in older adults with type 2 diabetes. J Endocrinol Diabetes Obes. 2014;2(2):1031.PubMedPubMedCentral
35.
Espinoza S. Metformin for preventing frailty in high-risk older adults. ClinicalTrials.​gov Identifier: NCT02570672. Available from https://​clinicaltrials.​gov/​ct2/​show/​NCT02570672, accessed on June 1, 2018.
36.
Liu Q, Li S, Quan H, Li J. Vitamin B12 status in metformin treated patients: systematic review. PLoS One. 2014;9(6):e100379. https://​doi.​org/​10.​1371/​journal.​pone.​0100379.CrossRefPubMedPubMedCentral
37.
Niafar M, Hai F, Porhomayon J, Nader ND. The role of metformin on vitamin B12 deficiency: a meta-analysis review. Intern Emerg Med. 2015;10(1):93–102. https://​doi.​org/​10.​1007/​s11739-014-1157-5.CrossRefPubMed
38.
Kancherla V, Elliott JL Jr, Patel BB, Holland NW, Johnson TM 2nd, Khakharia A, et al. Long-term metformin therapy and monitoring for vitamin B12 deficiency among older veterans. J Am Geriatr Soc. 2017;65(5):1061–6. https://​doi.​org/​10.​1111/​jgs.​14761.CrossRefPubMedPubMedCentral
39.
Simpson SH, Lee J, Choi S, Vandermeer B, Abdelmoneim AS, Featherstone TR. Mortality risk among sulfonylureas: a systematic review and network meta-analysis. Lancet Diabetes Endocrinol. 2015;3(1):43–51. https://​doi.​org/​10.​1016/​S2213-8587(14)70213-X.CrossRefPubMed
40.
Rosenstock J, Jelaska A, Zeller C, Kim G, Broedl UC, Woerle HJ, et al. Impact of empagliflozin added on to basal insulin in type 2 diabetes inadequately controlled on basal insulin: a 78-week randomized, double-blind, placebo-controlled trial. Diabetes Obes Metab. 2015;17(10):936–48. https://​doi.​org/​10.​1111/​dom.​12503.CrossRefPubMedPubMedCentral
41.
Zhang Q, Dou J, Lu J. Combinational therapy with metformin and sodium-glucose cotransporter inhibitors in management of type 2 diabetes: systematic review and meta-analyses. Diabetes Res Clin Pract. 2014;105(3):313–21. https://​doi.​org/​10.​1016/​j.​diabres.​2014.​06.​006.CrossRefPubMed
42.
Bailey CJ, Morales Villegas EC, Woo V, Tang W, Ptaszynska A, List JF. Efficacy and safety of dapagliflozin monotherapy in people with type 2 diabetes: a randomized double-blind placebo-controlled 102-week trial. Diabet Med. 2015;32(4):531–41. https://​doi.​org/​10.​1111/​dme.​12624.CrossRefPubMed
43.
Sinclair AJ, Bode B, Harris S, Vijapurkar U, Shaw W, Desai M, et al. Efficacy and safety of canagliflozin in individuals aged 75 and older with type 2 diabetes mellitus: a pooled analysis. J Am Geriatr Soc. 2016;64(3):543–52. https://​doi.​org/​10.​1111/​jgs.​14028.CrossRefPubMedPubMedCentral
44.
Deeks ED, Scheen AJ. Canagliflozin: a review in type 2 diabetes. Drugs. 2017;77(14):1577–92. https://​doi.​org/​10.​1007/​s40265-017-0801-6.CrossRefPubMed
45.
Eng C, Kramer CK, Zinman B, Retnakaran R. Glucagon-like peptide-1 receptor agonist and basal insulin combination treatment for the management of type 2 diabetes: a systematic review and meta-analysis. Lancet. 2014;384(9961):2228–34. https://​doi.​org/​10.​1016/​S0140-6736(14)61335-0.CrossRefPubMed
46.
Hanefeld M, Berria R, Lin J, Aronson R, Darmon P, Evans M, et al. Lixisenatide treatment for older patients with type 2 diabetes mellitus uncontrolled on oral antidiabetics: meta-analysis of five randomized controlled trials. Adv Ther. 2014;31(8):861–72. https://​doi.​org/​10.​1007/​s12325-014-0146-4.CrossRefPubMed
47.
Raccah D, Miossec P, Esposito V, Niemoeller E, Cho M, Gerich J. Efficacy and safety of lixisenatide in elderly (≥ 65 years old) and very elderly (≥ 75 years old) patients with type 2 diabetes: an analysis from the GetGoal phase III programme. Diabetes Metab Res Rev. 2015;31:204–11. https://​doi.​org/​10.​1002/​dmrr.​2588.CrossRefPubMed
48.
Meneilly GS, Roy-Duval C, Alawi H, Dailey G, Bellido D, Trescoli C, et al. GetGoal-O trial investigators. Lixisenatide therapy in older patients with type 2 diabetes inadequately controlled on their current antidiabetic treatment: the GetGoal-O randomized trial. Diabetes Care. 2017;40:485–93. https://​doi.​org/​10.​2337/​dc16-2143.CrossRefPubMed
49.
Charbonnel B, Bertolini M, Tinahones FJ, Domingo MP, Davies M. Lixisenatide plus basal insulin in patients with type 2 diabetes mellitus: a meta-analysis. J Diabetes Complicat. 2014;28(6):880–6. https://​doi.​org/​10.​1016/​j.​jdiacomp.​2014.​07.​007.CrossRef
50.
Thong KY, Gupta PS, Blann AD, Ryder RE. The influence of age and metformin treatment status on reported gastrointestinal side effects with liraglutide treatment in type 2 diabetes. Diabetes Res Clin Pract. 2015;109:124–9.CrossRefPubMed
51.
Xue X, Ren Z, Zhang A, Yang Q, Zhang W, Liu F. Efficacy and safety of once-weekly glucagon-like peptide-1 receptor agonists compared with exenatide and liraglutide in type 2 diabetes: a systemic review of randomised controlled trials. Int J Clin Pract. 2016;70:649–56. https://​doi.​org/​10.​1111/​ijcp.​12847.CrossRefPubMed
52.
Barnett AH, Huisman H, Jones R, von Eynatten M, Patel S, Woerle HJ. Linagliptin for patients aged 70 years or older with type 2 diabetes inadequately controlled with common antidiabetes treatments: a randomised, double-blind, placebo-controlled trial. Lancet. 2013;382(9902):1413–23. https://​doi.​org/​10.​1016/​S0140-6736(13)61500-7.CrossRefPubMed
53.
Inzucchi SE, Nauck MA, Hehnke U, Woerle HJ, von Eynatten M, Henry RR. Improved glucose control with reduced hypoglycaemic risk when linagliptin is added to basal insulin in elderly patients with type 2 diabetes. Diabetes Obes Metab. 2015;17(9):868–77. https://​doi.​org/​10.​1111/​dom.​12490.CrossRefPubMed
54.
Iqbal N, Allen E, Öhman P. Long-term safety and tolerability of saxagliptin add-on therapy in older patients (aged ≥ 65 years) with type 2 diabetes. Clin Interv Aging. 2014;9:1479–87. https://​doi.​org/​10.​2147/​CIA.​S68193.CrossRefPubMedPubMedCentral
55.
Leiter LA, Teoh H, Braunwald E, Mosenzon O, Cahn A, Kumar KM, et al. Efficacy and safety of saxagliptin in older participants in the SAVOR-TIMI 53 trial. Diabetes Care. 2015;38(6):1145–53. https://​doi.​org/​10.​2337/​dc14-2868.CrossRefPubMed
56.
Round EM, Engel SS, Golm GT, Davies MJ, Kaufman KD, Goldstein BJ. Safety of sitagliptin in elderly patients with type 2 diabetes: a pooled analysis of 25 clinical studies. Drugs Aging. 2014;31(3):203–14. https://​doi.​org/​10.​1007/​s40266-014-0155-7.CrossRefPubMed
57.
Schott G, Martinez YV, Ediriweera de Silva RE, Renom-Guiteras A, Vögele A, Reeves D, et al. Effectiveness and safety of dipeptidyl peptidase 4 inhibitors in the management of type 2 diabetes in older adults: a systematic review and development of recommendations to reduce inappropriate prescribing. BMC Geriatr. 2017;17(Suppl 1):226. https://​doi.​org/​10.​1186/​s12877-017-0571-8.CrossRefPubMedPubMedCentral
58.
Jovanovic L, Peters AL, Jiang HH, Hadin DS. Durability of glycemic control with insulin lispro mix 75/25 versus insulin glargine for older patients with type 2 diabetes. Aging Clin Exp Res. 2014;26:115–21. https://​doi.​org/​10.​1007/​s40520-013-0140-8.CrossRefPubMed
59.
Yki-Järvinen H, Bergenstal R, Ziemen M, Wardecki M, Muehlen-Bartmer I, Boelle E, et al. New insulin glargine 300 units/mL versus glargine 100 units/mL in people with type 2 diabetes using oral agents and basal insulin: glucose control and hypoglycemia in a 6-month randomized controlled trial (edition 2). Diabetes Care. 2014;37:3235–43. https://​doi.​org/​10.​2337/​dc14-0990.CrossRefPubMed
60.
Bolli GB, Riddle MC, Bergenstal RM, Ziemen M, Sestakauskas K, Goyeau H, et al. New insulin glargine 300 U/ml compared with glargine 100 U/ml in insulin-naïve people with type 2 diabetes on oral glucose-lowering drugs: a randomized controlled trial (EDITION 3). Diabetes Obes Metab. 2015;17(4):386–94. https://​doi.​org/​10.​1111/​dom.​12438.CrossRefPubMedPubMedCentral
61.
Russell-Jones D, Gall MA, Niemeyer M, Diamant M, Del Prato S. Insulin degludec results in lower rates of nocturnal hypoglycaemia and fasting plasma glucose vs. insulin glargine: a meta-analysis of seven clinical trials. Nutr Metab Cardiovasc Dis. 2015;25:898–905. https://​doi.​org/​10.​1016/​j.​numecd.​2015.​06.​005.CrossRefPubMed
62.
Nagai Y, Murakami M, Igarashi K, Nakamura Y, Tsukiyama H, Matsubara F, et al. Efficacy and safety of thrice-weekly insulin degludec in elderly patients with type 2 diabetes assessed by continuous glucose monitoring. Endocr J. 2016;63:1099–106. https://​doi.​org/​10.​1507/​endocrj.​EJ16-0252.CrossRefPubMed
63.
Zinman B, Wanner C, Lachin JM, Fitchett D, Bluhmki E, Hantel S, et al. EMPA-REG outcome investigators. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015;373(22):2117–28. https://​doi.​org/​10.​1056/​NEJMoa1504720.CrossRefPubMed
64.
Chilton R, Tikkanen I, Cannon CP, Crowe S, Woerle HJ, Broedl UC, et al. Effects of empagliflozin on blood pressure and markers of arterial stiffness and vascular resistance in patients with type 2 diabetes. Diabetes Obes Metab. 2015;17(12):1180–93. https://​doi.​org/​10.​1111/​dom.​12572.CrossRefPubMedPubMedCentral
65.
Neal B, Perkovic V, Mahaffey KW, de Zeeuw D, Fulcher G, Erondu N, et al. CANVAS Program Collaborative Group. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med. 2017;377(7):644–57. https://​doi.​org/​10.​1056/​NEJMoa1611925.CrossRefPubMed
66.
Mahaffey KW, Neal B, Perkovic V, de Zeeuw D, Fulcher G, Erondu N, et al. Canagliflozin for primary and secondary prevention of cardiovascular events: results from the CANVAS program (canagliflozin cardiovascular assessment study). Circulation. 2018;137(4):323–4. https://​doi.​org/​10.​1161/​CIRCULATIONAHA.​117.​032038.CrossRefPubMedPubMedCentral
67.
Rådholm K, Figtree G, Perkovic V, Solomon SD, Mahaffey KW, de Zeeuw D, et al. Canagliflozin and heart failure in type 2 diabetes mellitus: results from the CANVAS Program (Canagliflozin Cardiovascular Assessment Study). Circulation. 2018. https://​doi.​org/​10.​1161/​CIRCULATIONAHA.​118.​034222.CrossRefPubMedCentralPubMed
68.
Januzzi JL Jr, Butler J, Jarolim P, Sattar N, Vijapurkar U, Desai M, et al. Effects of canagliflozin on cardiovascular biomarkers in older adults with type 2 diabetes. J Am Coll Cardiol. 2017;70(6):704–12. https://​doi.​org/​10.​1016/​j.​jacc.​2017.​06.​016.CrossRefPubMed
69.
Wiviott SD, Raz I, Bonaca MP, Mosenzon O, Kato ET, Cahn A, et al. The design and rationale for the dapagliflozin effect on cardiovascular events DECLARE-TIMI 58 Trial. Am Heart J. 2018;200:83–9. https://​doi.​org/​10.​1016/​j.​ahj.​2018.​01.​012.CrossRefPubMed
70.
Marso SP, Daniels GH, Brown-Frandsen K, Kristensen P, Mann JF, Nauck MA, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2016;375(4):311–22. https://​doi.​org/​10.​1056/​NEJMoa1603827.CrossRef
71.
Marso SP, Bain SC, Consoli A, Eliaschewitz FG, Jódar E, Leiter LA, et al. SUSTAIN-6 investigators. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2016;375(19):1834–44.CrossRef
72.
Zheng SL, Roddick AJ, Aghar-Jaffar R, Shun-Shin MJ, Francis D, Oliver N, et al. Association between use of sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide 1 agonists, and dipeptidyl peptidase 4 inhibitors with all-cause mortality in patients with type 2 diabetes: a systematic review and meta-analysis. JAMA. 2018;319(15):1580–91. https://​doi.​org/​10.​1001/​jama.​2018.​3024.CrossRefPubMedPubMedCentral
73.
•• Damluji AA, Cohen ER, Moscucci M, Myerburg RJ, Cohen MG, Brooks MM, et al. Insulin provision therapy and mortality in older adults with diabetes mellitus and stable ischemic heart disease: insights from BARI-2D trial. Int J Cardiol. 2017;241:35–40. https://​doi.​org/​10.​1016/​j.​ijcard.​2017.​03.​048. This article showed evidence of greater mortality in subjects aged ≥ 75, when receiving exogenous insulin or insulin secretagogues, compared to insulin sensitizers. CrossRefPubMed
74.
Pfeffer MA, Claggett B, Diaz R, Dickstein K, Gerstein HC, Køber LV, et al. Lixisenatide in patients with type 2 diabetes and acute coronary syndrome. N Engl J Med. 2015;373(23):2247–57. https://​doi.​org/​10.​1056/​NEJMoa1509225.CrossRefPubMed
75.
Blonde L, Jendle J, Gross J, Woo V, Jiang H, Fahrbach JL, et al. Once-weekly dulaglutide versus bedtime insulin glargine, both in combination with prandial insulin lispro, in patients with type 2 diabetes (AWARD-4): a randomized, open label, phase 3, non-inferiority study. Lancet. 2015;385:2057–66. https://​doi.​org/​10.​1016/​S0140-6736(15)60936-9.CrossRefPubMed
76.
Holman RR, Bethel MA, Mentz RJ, Thompson VP, Lokhnygina Y, Buse JB, et al. Effects of once-weekly exenatide on cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2017;377:1228–39. https://​doi.​org/​10.​1056/​NEJMoa1612917.CrossRefPubMed
77.
Green JB, Bethel MA, Armstrong PW, Buse JB, Engel SS, Garg J, et al. Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2015;373(3):232–42. https://​doi.​org/​10.​1056/​NEJMoa1501352. Epub 2015.CrossRef
78.
Bethel MA, Engel SS, Green JB, Huang Z, Josse RG, Kaufman KD, et al. Assessing the safety of sitagliptin in older participants in the trial evaluating cardiovascular outcomes with sitagliptin (TECOS). Diabetes Care. 2017;40(4):494–501. https://​doi.​org/​10.​2337/​dc16-1135.CrossRefPubMed
79.
Karter AJ, Laiteeranpong N, Chin MH, et al. Ethnic differences in geriatric conditions and diabetes complications among older, insured adults with diabetes: the diabetes and aging study. J Aging Health. 2015;27(5):894–918.CrossRefPubMedCentralPubMed
80.
Perna L, Mielck A, Lacruz ME, Emeny RT, von Eisenhart RA, Meisinger C, et al. The association between resilience and diabetic neuropathy by socioeconomic position: cross-sectional findings from the KORA-Age study. J Health Psychol. 2015;20(9):1222–8. https://​doi.​org/​10.​1177/​1359105313510334​.CrossRefPubMed
81.
Thomas MM, Harpaz-Rotem I, Tsai J, Southwick SM, Pietrzak RH. Mental and physical health conditions in US combat veterans: results from the National Health and Resilience in Veterans Study. Prim Care Companion CNS Disord. 2017;19:19(3). https://​doi.​org/​10.​4088/​PCC.​17m02118.CrossRef
82.
Sinclair A, Dunning T, Rodriguez-Manas L. Diabetes in older people: new insights and remaining challenges. Lancet Diabetes Endocrinol. 2015;3(4):275–85. https://​doi.​org/​10.​1016/​S2213-8587(14)70176-7.CrossRefPubMed
83.
Valencia WM, Danet M, Florez H, Bourdel-Marchasson I: Assessment procedures including comprehensive geriatric assessment. In: Sinclair A, Dunning T, Rodríguez Mañas L, Munshi M, editors. Diabetes in old age. Wiley-Blackwell, 4th edition, 2017. https://​doi.​org/​10.​1002/​9781118954621.​ch5 CrossRef
84.
•• American Diabetes Association. 11. Older adults: standards of medical care in diabetes-2018. Diabetes Care. 2018;41(Suppl 1):S119–25. https://​doi.​org/​10.​2337/​dc18-S011. Review. These guidelines present the evidence and current recommendations for clinical practice and care for diabetes, and the chapter 11 focuses on older adults. CrossRef
85.
Doucet J, Le Floch JP, Bauduceau B, Verny C, SFD/SFGG Intergroup. GERODIAB: glycaemic control and 5-year morbidity/mortality of type 2 diabetic patients aged 70 years and older: description of the population at inclusion. Diabetes Metab. 2012;38:523–30. https://​doi.​org/​10.​1016/​j.​diabet.​2012.​07.​001.CrossRefPubMed
86.
Bauduceau B, Doucet J, Le Floch JP, Verny C, SFD/SFGG Intergroup and the GERODIAB Group. Cardiovascular events and geriatric scale scores in elderly (70 years old and above) type 2 diabetic patients at inclusion in the GERODIAB cohort. Diabetes Care. 2014;37(1):304–11. https://​doi.​org/​10.​2337/​dc13-1540.CrossRefPubMed
87.
Le Floch JP, Doucet J, Bauduceau B, Verny C, SFD/SFGG Intergroup. Retinopathy, nephropathy, peripheral neuropathy and geriatric scale scores in elderly people with type 2 diabetes. Diabet Med. 2014;31(1):107–11. https://​doi.​org/​10.​1111/​dme.​12327.CrossRefPubMed
88.
Vinik AL, Vinik EJ, Colberg SR, Morrison S. Falls risk in older adults with type 2 diabetes. Clin Geriatr Med. 2015;31:89–99. https://​doi.​org/​10.​1016/​j.​jdiacomp.​2014.​04.​007.CrossRefPubMed
89.
Vinik AI, Camacho P, Reddy S, Valencia WM, Trence D, Matsumoto AM, et al. Aging, diabetes and falls. Endocr Pract. 2017;23(9):1117–39. https://​doi.​org/​10.​4158/​EP171794.​RA.CrossRefPubMed
90.
Gonnelli S, Caffarelli C, Giordano N, Nuti R. The prevention of fragility fractures in diabetic patients. Aging Clin Exp Res. 2015;27(2):115–24. https://​doi.​org/​10.​1007/​s40520-014-0258-3.CrossRefPubMed
91.
Yau RK, Strotmeyer ES, Resnick HE, Sellmeyer DE, Feingold KR, Cauley JA, et al. Diabetes and risk of hospitalized fall injury among older adults. Diabetes Care. 2013;36:3985–91. https://​doi.​org/​10.​2337/​dc13-0429.CrossRefPubMedPubMedCentral
92.
American Geriatrics Society and British Geriatrics Society. Summary of the updated American Geriatrics Society/British geriatrics Society Clinical Practice Guideline for prevention of falls in older persons. J Am Geriatr Soc. 2011;59(1):148–57. https://​doi.​org/​10.​1111/​j.​1532-5415.​2010.​03234.​x.CrossRef
93.
Khatutsky G, Walsh EG, Brown DW. Urinary incontinence, functional status, and health-related quality of life among Medicare beneficiaries enrolled in the program for all-inclusive care for the elderly and dual eligible demonstration special needs plans. J Ambul Care Manage. 2013;36(1):35–49. https://​doi.​org/​10.​1097/​JAC.​0b013e318267470a​.CrossRefPubMed
94.
Hsu A, Conell-Price J, Stijacic Cenzer I, Eng C, Huang AJ, Rice-Trumble K, et al. Predictors of urinary incontinence in community-dwelling frail older adults with diabetes mellitus in a cross-sectional study. BMC Geriatr. 2014;14:137. https://​doi.​org/​10.​1186/​1471-2318-14-137.CrossRefPubMedPubMedCentral
95.
Garcia-Esquinas E, Graciani A, Guallar-Castillon P, Lopez-Garcia E, Rodriguez-Mañas L, Rodriguez-Artalejo F. Diabetes and risk of frailty and its potential mechanisms: a prospective cohort study of older adults. J Am Med Dir Assoc. 2015;16(9):748–54.CrossRefPubMed
96.
Abdelhafiz AH, McNicholas E, Sinclair AJ. Hypoglycemia, frailty and dementia in older people with diabetes: reciprocal relations and clinical implications. J Diabetes Complicat. 2016;30(8):1548–54. https://​doi.​org/​10.​1016/​j.​jdiacomp.​2016.​07.​027.CrossRef
97.
Landi F, Cesari M, Calvani R, Cherubini A, Di Bari M, Bejuit R, et al. The “sarcopenia and physical fRailty IN older people: multi-componenT treatment strategies” (SPRINTT) randomized controlled trial: design and methods. Aging Clin Exp Res. 2017;29(1):89–100. https://​doi.​org/​10.​1007/​s40520-016-0715-2.CrossRefPubMed
98.
Mayeda ER, Whitmer RA, Yaffe K. Diabetes and cognition. Clin Geriatr Med. 2015;31:101–15. https://​doi.​org/​10.​1016/​j.​cger.​2014.​08.​021.CrossRefPubMed
99.
Palta P, Carlson MC, Crum RM, Colantuoni E, Sharrett AR, Yasar S, et al. Diabetes and cognitive decline in older adults: the Ginkgo evaluation of memory study. J Gerontol A Biol Sci Med Sci. 2017;73(1):123–30. https://​doi.​org/​10.​1093/​gerona/​glx076.CrossRefPubMedPubMedCentral
100.
Areosa Sastre A, Vernooij RW, González-Colaço Harmand M, Martínez G. Effect of the treatment of type 2 diabetes mellitus on the development of cognitive impairment and dementia. Cochrane Database Syst Rev. 2017;6:CD003804. https://​doi.​org/​10.​1002/​14651858.CrossRefPubMed
101.
Munshi MN. Cognitive dysfunction in older adults with diabetes: what a clinician needs to know. Diabetes Care. 2017;40(4):461–7. https://​doi.​org/​10.​2337/​dc16-1229.CrossRefPubMed
102.
Research 2 guidance mHealth app developer economics 2015: the current status and trends of the mHealth app market. 2015. [2017-03-08]. http://​research2guidanc​e.​com/​r2g/​r2g-mHealth-App-Developer-Economics-2015.​pdf
103.
Wu Y, Yao X, Vespasiani G, Nicolucci A, Dong Y, Kwong J, et al. Mobile app-based interventions to support diabetes self-management: a systematic review of randomized controlled trials to identify functions associated with glycemic efficacy. JMIR Mhealth Uhealth. 2017;5(3):e35. https://​doi.​org/​10.​2196/​mhealth.​6522.CrossRefPubMedPubMedCentral
104.
Whitehead L, Seaton P. The effectiveness of self-management mobile phone and tablet apps in long-term condition management: a systematic review. J Med Internet Res. 2016;18(5):e97. https://​doi.​org/​10.​2196/​jmir.​4883.CrossRefPubMedPubMedCentral
105.
Cui M, Wu X, Mao J, Wang X, Nie M. T2DM self-management via smartphone applications: a systematic review and meta-analysis. PLoS One. 2016;11(11):e0166718. https://​doi.​org/​10.​1371/​journal.​pone.​0166718.CrossRefPubMedPubMedCentral
106.
Greenwood DA, Gee PM, Fatkin KJ, Peeples M. A systematic review of reviews evaluating technology-enabled diabetes self-management education and support. J Diabetes Sci Technol. 2017;11(5):1015–27. https://​doi.​org/​10.​1177/​1932296817713506​.CrossRefPubMedPubMedCentral
107.
Veazie S, Winchell K, Gilbert J, Paynter R, Ivlev I, Eden KB, et al. Rapid evidence review of mobile applications for self-management of diabetes. J Gen Int Med. 2018;33:1167–76. https://​doi.​org/​10.​1007/​s11606-018-4410-1.CrossRef
108.
• Kuo A, Dang S. Secure messaging in electronic health records and its impact on diabetes clinical outcomes: a systematic review. Telemed J E Health. 2016;22(9):769–77. https://​doi.​org/​10.​1089/​tmj.​2015.​0207. This review article shows the role of electronic health record systems and its impact on diabetes clinical outcomes. CrossRefPubMed
109.
Jeong JY, Jeon JH, Bae KH, Choi YK, Park KG, Kim JG, Won KC, Cha BS, Ahn CW, Kim DW, Lee CH, Lee IK Smart care based on telemonitoring and telemedicine for type 2 diabetes care: multi-center randomized controlled trial. Telemed J E Health. 2018. https://​doi.​org/​10.​1089/​tmj.​2017.​0203.CrossRefPubMed
110.
Fatehi F, Menon A, Bird D. Diabetes care in the digital era: a synoptic overview. Curr Diab Rep. 2018;18(7):38. https://​doi.​org/​10.​1007/​s11892-018-1013-5.CrossRefPubMed
111.
Bansal A, Henao-Mejia J, Simmons RA. Immune system: an emerging player in mediating effects of endocrine disruptors on metabolic health. Endocrinology. 2018;159(1):32–45. https://​doi.​org/​10.​1210/​en.​2017-00882.CrossRefPubMed
112.
Huh JY, Park YJ, Kim JB. Adipocyte CD1D determines adipose inflammation and insulin resistance in obesity. Adipocyte. 2018;6:1–8. https://​doi.​org/​10.​1080/​21623945.​2018.​1440928.CrossRef
113.
Gong T, Wang X, Yang Y, Yan Y, Yu C, Zhou R, et al. Plant lectins activate the NLRP3 inflammasone to promote inflammatory disorders. J Immunol. 2017;198(5):2082–92. https://​doi.​org/​10.​4049/​jimmunol.​1600145.CrossRefPubMed
114.
Legler J, Fletcher T, Govarts E, Porta M, Blumberg B, Heindel JJ, et al. Obesity, diabetes, and associated costs of exposure to endocrine-disrupting chemicals in the European Union. J Clin Endocrinol Metab. 2015;100(4):1278–88. https://​doi.​org/​10.​1210/​jc.​2014-4326.CrossRefPubMedPubMedCentral
115.
Morais JBS, Severo JS, de Alencar GRR, de Oliveira ARS, Cruz KJC, Marreiro DDN, et al. Effect of magnesium supplementation on insulin resistance in humans: a systematic review. Nutrition. 2017;38:54–60. https://​doi.​org/​10.​1016/​j.​nut.​2017.​01.​009.CrossRefPubMed
116.
Liu Y, Cotillard A, Vatier C, Bastard J, Fellahi S, Stevant M, et al. A dietary supplement containing cinnamon, chromium and carnosine decreases fasting plasma glucose and increases lean mass in overweight or obese pre-diabetic subjects: a randomized, placebo-controlled trial. PLoS One. 2015;10(9):e0138646. https://​doi.​org/​10.​1371/​journal.​pone.​0138646.CrossRefPubMedPubMedCentral
117.
Wang H, Zhu C, Ying Y, Luo L, Huang D, Luo. Metformin and berberine, two versatile drugs in treatment of common metabolic diseases. Oncotarget. 2017;9(11):10135–46. https://​doi.​org/​10.​18632/​oncotarget.​20807.CrossRefPubMedPubMedCentral
118.
Lan J, Zhao Y, Dong F, Yan Z, Zheng W, Fan J, et al. Meta-analysis of the effect and safety of berberine in the treatment of type 2 diabetes mellitus, hyperlipemia and hypertension. J Ethnopharmacol. 2015;161:69–81. https://​doi.​org/​10.​1016/​j.​jep.​2014.​09.​049.CrossRefPubMed
119.
Valencia WM, Florez H. How to prevent the microvascular complications of type 2 diabetes beyond glucose control. BMJ. 2017;356:i6505. https://​doi.​org/​10.​1136/​bmj.​i6505.CrossRefPubMed
120.
Kucukgoncu S, Zhou E, Lucas KB, Tec C. Alpha-lipoic acid (ALA) as a supplementation for weight loss: results from a meta-analysis of randomized controlled trials. Obes Rev. 2017;18(5):594–601. https://​doi.​org/​10.​1111/​obr.​1252.CrossRefPubMedPubMedCentral
121.
Namazi N, Laijani B, Azadbakht L. Alpha-lipoic acid supplement in obesity treatment: a systematic review and meta-analysis of clinical trials. Clin Nutr. 2018;37(2):419–28. https://​doi.​org/​10.​1016/​j.​clnu.​2017.​06.​002.CrossRefPubMed
122.
Jurisic-Erzen D, Starcevic-Klasan G, Ivanac D, Peharec S, Girotto D, Jerkovic R. The effects of alpha-lipoic acid on diabetic myopathy. J Endocrinol Investig. 2018;41(2):203–9. https://​doi.​org/​10.​1007/​s40618-017-0720-0.CrossRef
123.
Kahn SE, Cooper ME, Del Prato S. Pathophysiology and treatment of type 2 diabetes: perspectives on the past, present, and future. Lancet. 2014;383:1068–83.CrossRefPubMed
124.
Gu Y, Wang X, Li J, Zhang Y, Zhong H, Liu R, et al. Analyses of gut microbiota and plasma bile acids enable stratification of patients for antidiabetic treatment. Nat Commun. 2017;8(1):1785. https://​doi.​org/​10.​1038/​s41467-017-01682-2.CrossRefPubMedPubMedCentral
125.
Tong X, Xu J, Lian F, Yu X, Zhao Y, Xu L, et al. Structural alteration of gut microbiota during the amelioration of human type 2 diabetes with hyperlipidemia by metformin and a traditional Chinese herbal formula: a multicenter, randomized, open label clinical trial. MBio. 2018;9(3):e02392–17. https://​doi.​org/​10.​1128/​mBio.​02392-17.CrossRefPubMedPubMedCentral
126.
Suez J, Korem T, Zeevi D, Zilberman-Schapira G, Thaiss CA, Maza O, et al. Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature. 2014;514(7521):181–6. https://​doi.​org/​10.​1038/​nature13793.CrossRefPubMed
127.
Chia CW, Shardell M, Tanaka T, Liu DD, Gravenstein KS, Simonsick EM, et al. Chronic low-calorie sweetener use and risk of abdominal obesity among older adults: a cohort study. PLoS One. 2016;11(11):e0167241. https://​doi.​org/​10.​1371/​journal.​pone.​0167241.CrossRefPubMedPubMedCentral

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