To Reduce Hypoglycemia in Older Adults, Improve Antidiabetic Treatments
Hypoglycemia is a potentially life-threatening drug event in diabetic patients and a serious risk for older individuals. A study in the September issue of JAMDA suggests that antidiabetic treatments can be improved to reduce severe hypoglycemia in this population.
In Hypoglycemia in Older Adults: Time Trends and Treatment Differences in Patients Aged ≥ 75 Years with Type 2 Diabetes, the authors saw a trend toward decreased incidence of severe hypoglycemia over the last 15 years from 6.7 events per 100 person-years to 4.1. Rates in the oldest age group (85 years old and older) decreased most profoundly compared with younger groups; however, there was a spike of hypoglycemia in this oldest group, as well as in those aged 80-84, around 2007 and 2008. Nonetheless, while severe hypoglycemia decreased the most in the top age group, it remained consistently higher in this population compared with the youngest patients in the study, those aged 75-79.
In recent years, new noninsulinotropic drug classes have been approved, the authors noted, which do not substantially increase the risk for hypoglycemia. These include sodium-glucose transport protein 2 inhibitors and drugs acting on the incretin system. The use of these medication classes could reduce hypoglycemic events in older adults, they said. However, the authors noted that evidence about drug treatment of older adults from clinical trials and the drug approval process is still sparse.
Antidiabetic treatment decisions need to be based on individual benefits and risks of the treatment and the underlying disease, the authors stressed. Hypoglycemia is among the treatment risks, and it can impair older adults’ health status. The authors concluded, “While drugs with intrinsic risk for hypoglycemia were used less frequently, antidiabetic treatment in older adults should be further improved to continue reducing severe hypoglycemia in this age group, potentially accepting less strict metabolic control and age-specific target ranges.”
The study was conducted by researchers at the Institute of Clinical Pharmacology, University Hospital RWTH Aachen, Aachen, Germany; Ulm University, Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany; Department of Geriatrics, University Hospital RWTH Aachen, Aachen, Germany; Diabetes Center Lindlar, Lindlar, Germany; Division of Endocrinology and Diabetology, Department of Medicine II, Medical Centre – University of Freiburg, Faculty of Medicine, Germany; Department of General Internal Medicine, Endocrinology and Diabetology and Palliative Medicine, Medius Clinic, Ostfildern, Germany; and Specialized Diabetes Practice, Rosenheim, Germany.
JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit www.jamda.com for more information.
About AMDA – The Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit www.paltc.org for more information.