- Title
- Deintensification of antihyperglycaemics in older patients with type 2 diabetes
- Creator
- Thornton, Olivia; Kerr, Karen
- Relation
- Australian Pharmacist Vol. 38, Issue 2, p. 36-43
- Publisher
- Pharmaceutical Society of Australia
- Resource Type
- journal article
- Date
- 2019
- Description
- Rationale for deintensification of antihyperglycaemics in older patients with type 2 diabetes Deintensification is defined as 'stopping or scaling back the intensity or frequency of medical interventions that are currently part of a patient's ongoing management.' The risk to benefit ratio changes as patients age, particularly when glycaemic control is tight (HbA1c <53 mmol/mol (7%). The benefits of intensive treatment decline with an increase in risks. Risks may begin to approximate benefits e.g. in older patients the rates of acute hypoglycaemic events are similar to those of cerebrovascular and coronary artery disease. Hence, both the risk of antihyperglycaemic therapy-induced hypoglycaemia and the risk of diabetes complications need to be considered when setting therapeutic goals. Benefits of intensive antihyperglycaemic therapy in older patients become less clear for a number of reasons. Shorter life-expectancies (e.g. 10 years) do not allow the window of time required for cardiovascular, microvascular and mortality benefits of intensive treatment. Changes in appetite and weight associated with increased age (and comorbidities) require less intensive antihyperglycaemic regimens to control blood glucose. This is particularly the case in frail patients where type 2 diabetes may become regressive, increasing the risk of hypoglycaemia with intensive antihyperglycaemic therapy.
- Subject
- older patients; type 2 diabetes; hypoglycaemia; intensive antihyperglycaemic therapy; SDG 3; Sustainable Development Goals
- Identifier
- http://hdl.handle.net/1959.13/1470559
- Identifier
- uon:48504
- Identifier
- ISSN:0728-4632
- Language
- eng
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