Antidiabetic Medications and Polypharmacy

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Key points

  • Polypharmacy, or the use of multiple medications, is common in older adults and more prevalent in older adults with diabetes.

  • Medications used to treat diabetes and its complications may be associated with falls, fractures, weight changes, cognitive changes, heart disease, and urinary incontinence.

  • Shared decision-making should be implemented to ensure appropriate goals of care for older adults with diabetes.

Factors contributing to polypharmacy in older adults with diabetes

Management of hyperglycemia, microvascular complications (eg, diabetic nephropathy, neuropathy, and retinopathy) and macrovascular complications (eg, coronary artery disease, peripheral arterial disease, stroke), geriatric syndromes associated with diabetes (eg, cognitive impairment, falls, urinary incontinence), and adverse drug events contribute to an increased number of medications among older adults with diabetes. Quality improvement measures and pay-for-performance initiatives aimed at

Risks of antidiabetic medications in older adults

Although nonpharmacologic interventions are important in the management of diabetes, medications are a mainstay of therapy. It is particularly important when treating older adults with diabetes that the risks and benefits of pharmacologic interventions are weighed and discussed with patients and their caregivers to allow for shared decision-making. What makes treating diabetes in older adults even more complex is that the risks versus benefits for an individual are rarely clear from the

Merging concepts with practice

Managing diabetes in an older adult requires careful consideration of comorbidities, medications, and physiologic changes. In practice, providers are often faced with pacifying measures that are disease-specific or guideline-based. Older adult patients are not easily grouped by presentation, health status, or a single disease, making attainment of generalized goals more challenging.25 A variety of guidelines exist for the management of diabetes; however, their focus on a single disease limits

Patient-centered care and quality of life

Given the intricacy and variability of diabetes management in the geriatric population, patient involvement and shared decision-making are essential. Positive outcomes in this patient population rely heavily on the patient’s or caregiver’s ability to manage multiple chronic diseases and medications on a daily basis. Patient-centered care is defined as an approach to “providing care that is respectful of and responsive to individual preferences, needs, and values and ensuring the patient values

Summary

Polypharmacy, or the use of multiple medications, is a common concern in older adults with diabetes. Age, comorbidities, and microvascular and macrovascular complications of diabetes may further complicate diabetes management in older adults. Moreover, older adults may be more sensitive to potentially serious adverse effects of antidiabetic medications, including cognitive changes. Diabetic care in the elderly should not focus on any one of these aspects alone; instead, a comprehensive approach

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References (45)

  • R.B. Keller et al.

    Strategies for prevention of medication-related falls in the elderly

    Consult Pharm

    (2003)
  • R.K. Yau et al.

    Diabetes and risk of hospitalized injury among older adults

    Diabetes Care

    (2013)
  • N.N. Zammitt et al.

    Hypoglycemia in type 2 diabetes: pathophysiology, frequency, and effects of different treatment modalities

    Diabetes Care

    (2005)
  • American Geriatrics Society

    2012 Beers Criteria Update Expert Panel. American Geriatrics Society updated Beers criteria for potentially inappropriate medication use in older adults

    J Am Geriatr Soc

    (2012)
  • H.D. Berlie et al.

    Diabetes medications related to an increased risk of falls and fall-related morbidity in the elderly

    Ann Pharmacother

    (2010)
  • The American Geriatrics Society. 2010 AGS/BGS clinical practice guideline: prevention of falls in older persons....
  • D.H. Solomon et al.

    A cohort study of thiazolidinediones and fractures in older adults with diabetes

    J Clin Endocrinol Metab

    (2009)
  • H.A. Zeina et al.

    Thiazolidinedione use and the longitudinal risk of fractures in patients with type 2 diabetes mellitus

    J Clin Endocrinol Metab

    (2010)
  • N.M. Wedick et al.

    The relationship between weight loss and all-cause mortality in older men and women with and without diabetes mellitus: the Rancho Bernardo study

    J Am Geriatr Soc

    (2002)
  • M.J. Fowler

    Diabetes treatment, part 2: oral agents for glycemic management

    Clin Diabetes

    (2007)
  • K. Hermansen et al.

    Bodyweight changes associated with antihyperglycaemic agents in type 2 diabetes mellitus

    Drug Saf

    (2007)
  • E.M. Moore et al.

    Increased risk of cognitive impairment in patients with diabetes is associated with metformin

    Diabetes Care

    (2013)
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