Skip to main content
×
Home
    • Aa
    • Aa

Recent clinical trials in diabetes – implications for managing older patients

  • GC Hawthorne (a1) and AJ Yarnall (a2)
  • DOI: http://dx.doi.org/10.1017/S0959259809990104
  • Published online: 17 August 2009
Abstract
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.

Copyright
Corresponding author
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
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

2DW Haslam , WP James . Obesity. Lancet 2005; 366: 1197–209.

3AM Chang , JB Halter . Aging and insulin secretion. Am J Physiol Endocrinol Metab 2003; 284: E712.

4JE Morley . Diabetes mellitus: a major disease of older persons. J Gerontol Med Sci 2000; 55: M25556.

5LN Pani , L Korenda , JB Meigs Effect of aging on A1c levels in individuals without diabetes. Diabetes Care 2008; 31: 1991–99.

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.

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.

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.

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.

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.

12P Gaede , H Lund-Andersen , H-H Parving , O Pedersen . Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med 2008; 358: 580–91.

13R Holman , SK Paul , MA Bethel , DR Matthews , HAW Neil . 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 2008; 359: 1577–89.

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.

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.

16W Duckworth , C Abraira , T Moritz Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med 2009; 360: 129–39.

17EW Gregg , K Yaffe , JA Cauley Is diabetes associated with cognitive impairment and cognitive decline among older women? Arch Int Med 2000; 160: 174–81.

18R Peila , BL Rodriguez , LJ Launer . Type 2 diabetes, APOE gene, and the risk for dementia and related pathologies: The Honolulu-Asia Aging Study. Diabetes 2002; 51: 1256–62.

19JA Luchsinger , C Reitz , B Patel Relation of Diabetes to Mild Cognitive Impairment. Arch Neurol 2007; 64: 570–76.

20RO Roberts , YE Geda , DS Knopman , Christianson TJH Association of Duration and Severity of Diabetes Mellitus With Mild Cognitive Impairment. Arch Neurol 2008; 65: 1066–74.

23JA Sonnen , EB Larson , K Brickell Different Patterns of Cerebral Injury in Dementia With or Without Diabetes. Arch Neurol 2009; 66: 315–24.

24MEJ Lean , FG Pajonk . Patients on atypical anti-psychotic drugs: Another high risk group for type 2 diabetes. Diabetes Care 2003; 26: 1597–607.

25T Cukierman-Yaffe , HC Gerstein , JD Williamson 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.

26AG Bertoni , JS Krop , GF Anderson Diabetes-related morbidity and mortality in a national sample of U.S. elders. Diabetes Care 2002; 25: 471–75.

27N Kagansky , S Levy , E Rimon Hypoglycaemia as a predictor of mortality in hospitalised elderly patients. Arch Intern Med 2003; 163: 1825–29.

28RI Shorr , WA Ray , JR Daugherty Incidence and risk factors for serious hypoglycaemia in older persons using insulin or sulphonylureas. Arch Intern Med 1997; 157: 1681–86.

29A Chelliah , MR Burge . Hypoglycaemia in elderly patients with diabetes mellitus: causes and strategies for prevention. Drugs and Aging 2004; 21: 511–30.

30RA Whitmer , AJ Karter , K Yaffe Hypoglycaemic episodes and risk of dementia in older patients with type 2 diabetes mellitus. JAMA 2009; 301: 1565–72.

31KK Ray , SRK Seshasai , S Wijesuriya 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.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Reviews in Clinical Gerontology
  • ISSN: 0959-2598
  • EISSN: 1469-9036
  • URL: /core/journals/reviews-in-clinical-gerontology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords: