Metformin use in elderly

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    Metformin use in elderly


    Diabetes mellitus is a significant health concern for older persons in the United States. Approximately 23% of patients over the age of 60 have diabetes, with the majority suffering from type 2 diabetes. Older patients are also more likely to have comorbidities such as hypertension, dyslipidemia, and cardiovascular disease, as well as geriatric syndromes like cognitive impairment, depression, and urinary incontinence. However, the spectrum of diabetes is diverse in the elderly, and not all patients benefit from stringent glycemic control. Evidence from clinical trials demonstrates that approximately 8 years of glycemic control is required before reductions in microvascular events can be appreciated. Thus, for frail elders, patients with limited life expectancy, or those with significant complications or comorbidities, a less aggressive glycemic goal is reasonable (TABLE 1). At a minimum, glycemic control should be adequate to prevent symptoms such as polyuria and to avoid hyperglycemic crises. Metformin is usually prescribed as first line therapy for type 2 diabetes mellitus (DM2). However, the benefits and risks of metformin may be different for older people. This systematic review examined the available evidence on the safety and efficacy of metformin in the management of DM2 in older adults. The findings were used to develop recommendations for the electronic decision support tool of the European project PRIMA-e DS. The systematic review followed a staged approach, initially searching for systematic reviews and meta-analyses first, and then individual studies when prior searches were inconclusive. The target population was older people (≥65 years old) with DM2. Studies were included if they reported safety or efficacy outcomes with metformin (alone or in combination) for the management of DM2 compared to placebo, usual or no treatment, or other antidiabetics.

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    The problems of analyzing use of biguanides in the geriatric population are the same as with sulfonylureas. There have. Metformin is the first-line agent for older adults with type 2 diabetes. Recent studies have indicated that it may be used safely in patients with estimated. Jul 11, 2014. As patients become older, they become more vulnerable to the risk of side effects that are present with diabetic medications. Older diabetes.

    Jones et al (1) criticise current guidelines, which highlight possible contraindications to the use of metformin, as too vague and potentially leading to underuse in patients with type 2 diabetes. Although their desire for a “less ambiguous” approach seems sensible, their own guidelines still lack clarity. They note that any specific value of serum creatinine chosen as a cut -off for prescription of metformin will be arbitrary, because of variations in muscle mass and protein turnover. Despite this they then select – for undefined reasons- a serum creatinine value of 150 micromols/L as the cut-off point in their guideline. Hendra TJ, Sinclair AJ (1997) Improving the care of elderly diabetic patients ; the final report of the St Vincent Joint Task Force for Diabetes. They then suggest “caution should therefore be used in prescribing metformin for elderly patients”. This is a vague statement, which could be interpreted as meaning that metformin shouldn’t be prescribed at all in the elderly; that specialist opinion should be sought or creatinine clearance calculated before it is prescribed; or that renal function or serum lactate should be monitored after it is prescribed.(2) In addition, we are not informed of the authors' own definition of “elderly”. Chehade JM, Mooradian AD in Diabetes in old age eds Sinclair AJ, Finucane P. Given that the growing majority of patients with type 2 diabetes are over the age of 65 years,and that there is already evidence of undertreatment of such patients (3), it would seem particularly desirable to be as clear as is possible about this age group, if the full benefits of treatment are to be attained. Clinical judgements for a 25-year-old patient will be different than those for a 65-year-old patient because of changes in kidney function, weight distribution, metabolism, and many other age-associated factors. Still, some aspects of diabetes treatment for younger patients remain the same for the elderly. For instance, all smokers with diabetes are recommended to take smoking cessation measures regardless of age. Meanwhile, hypertension treatment has shown benefit in all patients with diabetes, including those 80 years or older. Plus, the benefits of lipid-lowering statin therapy are similar in older and younger patients with diabetes, but older patients see greater benefits overall. As recommended for younger patients, exercise and diet modifications are important for properly managing diabetes in older patients. In terms of pharmacotherapy, the first-line recommendation for type 2 diabetes in elderly patients is metformin.

    Metformin use in elderly

    Diabetes Management in Older Adults with Cardiovascular Disease., Older Adults Standards of Medical Care in Diabetes—2018.

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  3. The main oral anti-hyperglycemic agents used in elderly patients with. Also in older adults with diabetes the first-line medication is metformin, which is.

    • Management of diabetes in older adults - ScienceDirect.
    • Too Much Medication for Elderly Diabetes Patients?.
    • Comparison of Tolbutamide and Metformin in Elderly Diabetic Patients.

    Jul 20, 2009. This is of particular concern since older adults with diabetes have a high. Metformin should be used with caution in patients older than 80. Jul 6, 2016. For those with a contraindication or intolerance to metformin, a short-acting. The use of sliding-scale insulin in elderly patients isn't. Elderly patients, whose insulin resistance is complicated by age-related loss of. Metformin can cause a reduction in vitamin B12 levels after long-term use in.

     
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