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Oral Antihyperglycaemics

Considerations in Older Patients with Non-Insulin-Dependent Diabetes Mellitus

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Summary

Non-insulin-dependent diabetes mellitus (NIDDM) is increasing in incidence as the population in most countries ages. Multiple pathology is common in the elderly, and cardiovascular disease is usually present at diagnosis. Patients who develop NIDDM at age 65 years may live long enough to develop microvascular complications. Others who are frail and have multiple pathologies may require treatment to prevent both symptomatic hyperglycaemia and dehydration, whilst avoiding hypoglycaemia.

The goals in the management of NIDDM in elderly people are the prevention of complications and the relief of symptoms. Treatment must be tailored to the individual’s expectations and should be reviewed regularly with the changing circumstances of aging. If dietary measures fail to control glucose levels, antihyperglycaemic sulphonylureas are the most frequently prescribed form of treatment. However, concern over the potential of these drugs to cause hypoglycaemia limits the choice to second generation sulphonylureas, agents that preserve the first phase of insulin release and have non-biologically active metabolites that are promptly eliminated.

The biguanide agent metformin is also appropriate in elderly obese patients with NIDDM who do not have renal, liver or cardiac failure. The combination of a sulphonylurea and metformin can be effective in patients in whom insulin would otherwise be required. Novel compounds such as acarbose and the thiazolinediones may also be useful in the treatment of older diabetic patients.

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References

  1. Meneilly GS, Tessier D. Diabetes in the elderly. Diabet Med 1995; 12: 949–60

    Article  PubMed  CAS  Google Scholar 

  2. Damsgaard EM, Froland A, Green A. Use of hospital services by elderly patients with diabetes. Diabet Med 1987; 4: 317–21

    Article  PubMed  CAS  Google Scholar 

  3. Stout RW. Diabetes in old age. In: Pickup JC, Williams G, editors. Textbook of diabetes. Oxford: Blackwell, 1991: 897–904

    Google Scholar 

  4. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long term complications in IDDM. ? Engl J Med 1993; 329: 977–86

    Article  Google Scholar 

  5. Sinclair AJ. Initial management of NIDDM in the elderly. In: Finucane P, Sinclair AJ, editors. Diabetes in old age. Chichester: John Wiley and Sons, 1995: 181–201

    Google Scholar 

  6. UK Prospective Diabetes Study: I. Effect of diet, sulphonylurea, insulin or biguanide therapy on fasting plasma glucose and body weight over one year: multicentre study. Diabetologia 1983; 24: 404–11

    Google Scholar 

  7. Holman RR, Turner TC. Oral agents and insulin in the treatment of NIDDM. In: Pickup JC, Williams G, editors. Textbook of diabetes. Oxford: Blackwell, 1991: 462–78

    Google Scholar 

  8. Groop LC. Sulphonylureas in NIDDM. Diabetes Care 1992; 15: 737–72

    Article  PubMed  Google Scholar 

  9. Melander A, Bitzen PO, Faber O, et al. Sulphonylurea antidiabetic drugs. Drugs 1989; 35: 58–72

    Article  Google Scholar 

  10. Reaven GM. Role of insulin resistance in human disease. Diabetes 1988; 37; 1596–607

    Google Scholar 

  11. Feldman JM, Lebovitz HE. Endocrine and metabolic effects of glibenclamide: evidence for an extrapancreatic mechanism of action. Diabetes 1971; 20: 745–50

    CAS  Google Scholar 

  12. Melander A. Sulphonylureas in the treatment of NIDDM. In: Nattrass M, Hale PJ, editors. Non-insulin-dependent diabetes. Vol. 2. London: Bailliere, 1988: 443–53

    Google Scholar 

  13. Wiles PG, Pyke DA. The chlorpropamide alcohol flush. Clin Sci 1984; 67: 375–81

    PubMed  CAS  Google Scholar 

  14. UK Prospective Diabetes Study. Relative efficacy of randomly allocated diet, sulphonylurea, insulin or metformin in patients with newly diagnosed non-insulin dependent diabetes followed for 3 years. BMJ 1995; 310: 83–8

    Article  Google Scholar 

  15. Bailey CJ, Flatt PR, Marks V. Drugs inducing hypoglycaemia. Pharmacol Ther 1989; 42: 361–84

    Article  PubMed  CAS  Google Scholar 

  16. Oida T, Yoshida K, Kagemoto A, et al. The metabolism of gliclazide in man. Xenobiotica 1985; 15: 87–96

    Article  PubMed  CAS  Google Scholar 

  17. Knight PV, Temple CG, Kessen CV. The use of metformin in the older patient. J Clin Exp Gerontol 1986; 8: 57–8

    Google Scholar 

  18. Bailey CJ. Biguanides and NIDDM. Diabetes Care 1992; 15: 755–72

    Article  PubMed  CAS  Google Scholar 

  19. Hotta N, Kakata H, San T, et al. Long term effect of acarbose on glycaemic control in NIDDM: a placebo-controlled double-blind trial. Diabet Med 1993; 10: 134–8

    Article  PubMed  CAS  Google Scholar 

  20. Clissold SP, Edwards C. Acarbose: a preliminary review of its pharmacodynamic and pharmacokinetic properties and therapeutic potential. Drugs 1988; 35: 214–43

    Article  PubMed  CAS  Google Scholar 

  21. Raskin P. Combination therapy in NIDDM. N Engl J Med 1992; 327: 1453–4

    Article  PubMed  CAS  Google Scholar 

  22. Quattro A, Conson G, Ceriello A, et al. Combined insulin and sulphonylurea therapy in non-insulin dependent diabetics with secondary failure to oral drugs in a one year follow up. Diabete Metab 1986; 12: 315–8

    Google Scholar 

  23. Tattersall R, Mansell P. Fibre in the management of diabetes: benefits of fibre itself are uncertain. BMJ 1990; 300: 1336–7

    Article  PubMed  CAS  Google Scholar 

  24. Pestell G, Crock PA, Ward GM, et al. Fenfluramine increases insulin action in patients with NIDDM. Diabetes Care 1989; 12: 252–8

    Article  PubMed  CAS  Google Scholar 

  25. Wolffenbuttel BHR, Nijst L, Sels JPJE, et al. Effects of a new oral hypoglycaemic agent, repaglinide, on metabolic control in sulphonylurea-treated patients with NIDDM. Eur J Clin Pharmacol 1993; 45: 113–6

    Article  PubMed  CAS  Google Scholar 

  26. Saltiel AR, Horikashi H. Thiazolidinediones are novel insulin-sensitising agents. Curr Opin Endocrinol Diabetes 1995; 2: 341–7

    Article  Google Scholar 

  27. Bailey CJ. Novel compounds for NIDDM. Diabet Rev Int 1996; 5: 9–12

    Google Scholar 

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Jennings, P.E. Oral Antihyperglycaemics. Drugs & Aging 10, 323–331 (1997). https://doi.org/10.2165/00002512-199710050-00001

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