This study was done to assess the glycemic control in elderly patients with type 2 diabetes mellitus and to evaluate the trends in prescription of antidiabetic agents in this group .
Type 2 Diabetic patients admitted to the Medical Ward of a tertiary care Government hospital in the United Arab Emirates with ages of 60 years and above were selected for the study. Patients were divided into 3 age groups of 60-69 years, 70-79 years and 80 years and above. Data was collected regarding glycemic control (HbA1c) and the home medications used by the patients prior to their admission. Exclusions included type 1 diabetes, and patients admitted with diabetic emergencies such as diabetic ketoacidosis, hyperosmolar states and hypoglycemia.
Among the group studied , 56% were males and 43% were females. 40% of the patients were between 70-79years of age and 24% were 80 years and above. Injectable therapies were used in 50%, 40% and 33% in the age group 60-69, 70-79 and 80 and above ages. DDP4 inhibitors accounted for 80% of the oral agents used in the 80 years and above group.
Almost 45% of the patients in the 60-69 age group had an HbA1c below 7 gm% which increased to 60% in other 2 age groups. This may be a reflection of other factors such as poor nutrition and progressive renal impairment among others. There was a progressive increasing trend of no medication usage as age increased reaching nearly 40% In the 80 years and above group. DDP4 and SGLT2 inhibitors usage appeared to be increasing over sulphonylureas particularly in higher age groups<./p>
Our study showed an increasing use of metformin and basal insulin among the above 80 age group . This is similar to results from Landon et al. (1) The relative rise in use of newer classes such as DPP4 and SGLT2 inhibitors over traditional agents such as sulphonyl ureas may reflect the greater emphasis on safety and potential cardiovascular benefits afforded by these agents.
Treatment of diabetes in the elderly particularly in the more senior members such as those aged 80 years and above remains a huge challenge in view of the patients’ inherent frailties and comorbidities in addition to logistic , social and financial constraints. Newer antidiabetic agents developed over the last 10 years afford an opportunity for greater individualization of treatment and assist in targeting goals beyond glycemic control.
Long term studies in this age group, particularly in those above 80 years are especially few . More studies will be needed in this vulnerable yet burgeoning groups to establish evidence based guidelines for the optimal management of diabetes in our elderly patients.
Manoj Mathews– INTERNIST, Dubai Hospital, Sharjah, Sharjah, United Arab Emirates
Fadhil Mustafa Abdulla Alshama– HEAD OF INTERNAL MEDICINE DEPARTMENT, CONSULTANT ENDOCRINOLOGIST, DUBAI HOSPITAL, Dubai, Dubai, United Arab Emirates
Sara Yousuf– Resident, Department of Internal Medicine, Dubai Hospital, Dubai, United Arab Emirates
Budoor Alemadi– endocrine specialist, Dubai Hospital
Sharjah, Sharjah, United Arab Emirates
Internist with more than 20 years experience, working in a multi speciality tertiary care teaching hospital under the Goverment in Dubai in the United Arab Emirates. Special interest in DIabetes especially Type 2 DIabetes. Involved in various audits, KPI and publications. Speaker at several conferences and reviewer for Medical journals.
HEAD OF INTERNAL MEDICINE DEPARTMENT, CONSULTANT ENDOCRINOLOGIST
Dubai, Dubai, United Arab Emirates
HEAD of Internal Medicine Department which is one of the largest Departments in DUBAI HOSPITAL - the largest tertiary care multi speciality Government Hospital in Dubai in the United Arab Emirates. Consultant Endocrinologist with more than 30 years of experience in Endocrinology and Internal Medicine. Teaching Faculty member for undergraduate and post graduate medical students. Speaker and Chairperson at several National and International Endocrinology Conferences.
Resident, Department of Internal Medicine
Dubai Hospital, Dubai, United Arab Emirates
Resident in the Department of Internal Medicine.