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Polypharmacy, or the use of multiple medications, is common in older adults and more prevalent in older adults with diabetes.
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Medications used to treat diabetes and its complications may be associated with falls, fractures, weight changes, cognitive changes, heart disease, and urinary incontinence.
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Shared decision-making should be implemented to ensure appropriate goals of care for older adults with diabetes.
Antidiabetic Medications and Polypharmacy
Section snippets
Key points
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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