November 18, 2016
A presentation from the 2016 ASCP conference discussed how the recent updates for diabetes management affect older adults as well as treatment methods and options “beyond metformin.”
Speakers Diana Isaacs, PharmD, BCPS, BC-ADM, CDE, (Cleveland Clinic) and Lalita Prasad-Reddy, PharmD, MS, BCPS, BCACP, CDE, (Chicago State University) specifically expanded upon the recent updates to the 2016 American Diabetes Association (ADA) Standards of Care and the 2016 American Association of Clinical Endocrinologists (AACE) treatment algorithm.
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The speakers said 25.9% of the population aged 65 years and older have type 2 diabetes, and the numbers are only rising. Older adults with diabetes have higher rates of premature death, functional disability, hypertension, coronary heart disease, and stroke. They also are at greater risk for polypharmacy, cognitive impairment, urinary incontinence, serious falls, and persistent pain.
Based on the new recommendations, the presenters addressed advantages and disadvantages of various medication classes used to treat type 2 diabetes and examined factors to guide therapeutic decision-making when adding-on to or replacing metformin in older patients.
Using a patient case, they brought up the issues of patient glucose goals, current medications, options for medication regimen optimization, and contraindications. They also discussed ways of optimizing metformin and provided other treatment options. Comorbid conditions, cost, drug combinations, and patient specific factors were also factored into the presentation.—Amanda Del Signore