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Recent clinical trials in diabetes – implications for managing older patients

Part of: Bespoke shallow archive Weizmann

Published online by Cambridge University Press:  17 August 2009

GC Hawthorne  and
AJ Yarnall
GC Hawthorne*
Affiliation:
Diabetes Centre, Newcastle General Hospital, Newcastle upon Tyne, UK
AJ Yarnall
Affiliation:
Department of Care of the Elderly, Freeman Hospital, Newcastle upon Tyne, UK
*
Address for correspondence: Dr Gillian Hawthorne, Newcastle Diabetes Centre, Newcastle General Hospital, Westgate Road, Newcastle upon Tyne NE4 6BE. Email: gillian.hawthorne@newcastle-pct.nhs.uk
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Summary

The prevalence of type 2 diabetes is set to increase, and with it the complications associated with diabetes. Since 2007 there have been a number of significant trials that may change the way we think about treating people with diabetes, especially our older patients. These trials include the Steno-2 trial, UKPDS legacy trial, ADVANCE, ACCORD and VADT. These trials are reviewed in detail in this article, including the implications for the patients we treat. Recent work assessing the effect of HbA1c on cognitive function and the effects of hypoglycaemia are also discussed. We conclude with suggestions for targets for glycated haemoglobin level based on NICE guidance.

Keywords

Diabetes mellituselderlyglycaemic targetsmicrovascular diseasemacrovascular diseasehypoglycaemiacognitive function
Type
Clinical geriatrics
Information
Reviews in Clinical Gerontology , Volume 19 , Issue 1 , February 2009 , pp. 25 - 33
Copyright
Copyright © Cambridge University Press 2009

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References

1Diabetes UK. Diabetes in the UK. London: Diabetes UK, 2004.Google Scholar
2Haslam, DW, James, WP. Obesity. Lancet 2005; 366: 1197–209.CrossRefGoogle ScholarPubMed
3Chang, AM, Halter, JB. Aging and insulin secretion. Am J Physiol Endocrinol Metab 2003; 284: E7–12.CrossRefGoogle ScholarPubMed
4Morley, JE. Diabetes mellitus: a major disease of older persons. J Gerontol Med Sci 2000; 55: M255–56.CrossRefGoogle Scholar
5Pani, LN, Korenda, L, Meigs, JB et al. Effect of aging on A1c levels in individuals without diabetes. Diabetes Care 2008; 31: 1991–99.CrossRefGoogle ScholarPubMed
6UK Prospective Diabetes Study Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352: 837–53.CrossRefGoogle Scholar
7UK Prospective Diabetes Study Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet 1998; 352: 854–66.CrossRefGoogle Scholar
8UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 1998; 317: 703–14.CrossRefGoogle Scholar
9UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. BMJ 1998; 317: 713–21.CrossRefGoogle Scholar
10UK Prospective Diabetes Study Group. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000; 321: 405–12.CrossRefGoogle Scholar
11Gaerde, P, Vedel, P, Larsen, N, Jensen, G, Parving, H-H, Pedersen, O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med 2003; 348: 383–93.Google Scholar
12Gaede, P, Lund-Andersen, H, Parving, H-H, Pedersen, O. Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med 2008; 358: 580–91.CrossRefGoogle ScholarPubMed
13Holman, R, Paul, SK, Bethel, MA, Matthews, DR, Neil, HAW. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 2008; 359: 1577–89.CrossRefGoogle ScholarPubMed
14The ADVANCE Collaboration Group. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 2008; 358: 2560–72.CrossRefGoogle Scholar
15The Action to Control Cardiovascular Risk in Diabetes (ACCORD) Study Group. The effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008; 358: 2545–55.CrossRefGoogle Scholar
16Duckworth, W, Abraira, C, Moritz, T et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med 2009; 360: 129–39.CrossRefGoogle ScholarPubMed
17Gregg, EW, Yaffe, K, Cauley, JA et al. Is diabetes associated with cognitive impairment and cognitive decline among older women? Arch Int Med 2000; 160: 174–81.CrossRefGoogle ScholarPubMed
18Peila, R, Rodriguez, BL, Launer, LJ. Type 2 diabetes, APOE gene, and the risk for dementia and related pathologies: The Honolulu-Asia Aging Study. Diabetes 2002; 51: 1256–62.CrossRefGoogle ScholarPubMed
19Luchsinger, JA, Reitz, C, Patel, B et al. Relation of Diabetes to Mild Cognitive Impairment. Arch Neurol 2007; 64: 570–76.CrossRefGoogle ScholarPubMed
20Roberts, RO, Geda, YE, Knopman, DS, Christianson TJH, et al. Association of Duration and Severity of Diabetes Mellitus With Mild Cognitive Impairment. Arch Neurol 2008; 65: 1066–74.CrossRefGoogle ScholarPubMed
21Arvanitakis, Z, Wilson, RS, Bennett, DA. Diabetes mellitus, dementia and cognitive function in older persons. J Nutr Health & Aging 2006; 10: 287–91.Google ScholarPubMed
22Aspray, TJ. Diabetes in later life. Reviews Clin Gerontol 2005; 15: 27–38.CrossRefGoogle Scholar
23Sonnen, JA, Larson, EB, Brickell, K et al. Different Patterns of Cerebral Injury in Dementia With or Without Diabetes. Arch Neurol 2009; 66: 315–24.CrossRefGoogle ScholarPubMed
24Lean, MEJ, Pajonk, FG. Patients on atypical anti-psychotic drugs: Another high risk group for type 2 diabetes. Diabetes Care 2003; 26: 1597–607.CrossRefGoogle Scholar
25Cukierman-Yaffe, T, Gerstein, HC, Williamson, JD et al. Relationship Between Baseline Glycemic Control and Cognitive Function in Individuals With Type 2 Diabetes and Other Cardiovascular Risk Factors: The Action to Control Cardiovascular Risk in Diabetes-Memory in Diabetes (ACCORD-MIND) trial. Diabetes Care 2009; 32: 221–26.CrossRefGoogle ScholarPubMed
26Bertoni, AG, Krop, JS, Anderson, GF et al. Diabetes-related morbidity and mortality in a national sample of U.S. elders. Diabetes Care 2002; 25: 471–75.CrossRefGoogle Scholar
27Kagansky, N, Levy, S, Rimon, E et al. Hypoglycaemia as a predictor of mortality in hospitalised elderly patients. Arch Intern Med 2003; 163: 1825–29.CrossRefGoogle Scholar
28Shorr, RI, Ray, WA, Daugherty, JR et al. Incidence and risk factors for serious hypoglycaemia in older persons using insulin or sulphonylureas. Arch Intern Med 1997; 157: 1681–86.CrossRefGoogle ScholarPubMed
29Chelliah, A, Burge, MR. Hypoglycaemia in elderly patients with diabetes mellitus: causes and strategies for prevention. Drugs and Aging 2004; 21: 511–30.CrossRefGoogle ScholarPubMed
30Whitmer, RA, Karter, AJ, Yaffe, K et al. Hypoglycaemic episodes and risk of dementia in older patients with type 2 diabetes mellitus. JAMA 2009; 301: 1565–72.CrossRefGoogle ScholarPubMed
31Ray, KK, Seshasai, SRK, Wijesuriya, S et al. Effect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus: a meta-analysis of randomised controlled trials. Lancet 2009; 373: 1765–72.CrossRefGoogle ScholarPubMed
32European Diabetes Working Party for Older People. Clinical Guidelines for Type 2 Diabetes Mellitus 2004. Available at: www.instituteofdiabetes.orgGoogle Scholar