Purpose of review: Care for elderly diabetic patients poses a unique clinical challenge. This review highlights distinct aspects of the pathophysiology and the risks for secondary complications in the geriatric diabetic population. Based on these considerations, we discuss emerging therapeutic options based on the actions of the incretin hormone glucagon-like peptide (GLP)-1, which may be ideal for achieving glycemic control in the elderly diabetic patient.
Recent findings: Aging is associated with diminished capacity of pancreatic β-cells to respond to glucose. This functional decline in β-cell insulin secretion is a major contributor to the development of diabetes in the older patient. In addition, elderly diabetics suffer from a broader range of diabetic complications than do younger diabetics, warranting aggressive glycemic control. GLP-1 is known to improve β-cell insulin secretion, increase β-cell mass, and suppress glucagon secretion. Recent studies investigating improved GLP-1 activity have yielded promising results, with improved glycemic control in elderly patients with type 2 diabetes and without significant risk for hypoglycemia.
Summary: Elderly diabetics are a growing subset of the type 2 diabetic population with unique pathophysiologic characteristics and diabetic risk profiles. Therapeutic strategies that incorporate enhancement of GLP-1 action on β-cells to improve β-cell insulin secretion and glycemic control may be ideal for this distinct population and should be validated with further long-term clinical studies.
Columbia University, Department of Medicine, Division of Endocrinology, Naomi Berrie Diabetes Center, New York, New York, USA
Correspondence to Anne Marie B. Brillantes, MD, Columbia University, Department of Medicine, Division of Endocrinology, Naomi Berrie Diabetes Center, 1150 St. Nicholas Ave., Room 238, New York, NY 10032, USA Tel: +1 212 851 5305; fax: +1 212 851 5306; e-mail: firstname.lastname@example.org
Abbreviations ADA: American Diabetes Association AGI: α-glucosidase inhibitor AGS: American Geriatrics Society DPP: dipeptidyl peptidase GLP: glucagon-like peptide NHANES: National Health and Nutrition Examination Survey T2DM: type 2 diabetes mellitus