For older adults with diabetes, personalize remedy to enhance ‘well being span’
Key takeaways:
- Trials assessing DPP-IV inhibitors, SGLT2 inhibitors and GLP-1s discovered no elevated CV danger for older adults.
- Remedy steering ought to embody suggestions tailor-made to older populations.
PHILADELPHIA — The worldwide populating is growing old, and roughly 29% of individuals with diabetes worldwide are aged 65 years and older, representing 123 million individuals, in response to a speaker on the Coronary heart in Diabetes CME Convention.
Many adults on this age group have had diabetes for a minimum of 10 years and are in danger for cardiovascular issues resembling ischemic coronary heart illness, acute myocardial infarction and cerebrovascular accident, in response to Richard E. Pratley, MD, the Samuel E. Crockett Chair in Diabetes Analysis, medical director of AdventHealth Diabetes Institute and a Healio | Endocrine At this time Co-editor, stated right here. Nonetheless, most steering for treating diabetes is targeted on assembly glycemic targets. Pratley advocated for an method that individualizes remedy and focuses on measures past glycemia for adults aged 65 years and older.
Personalised remedy that focuses on “enhancing well being span” somewhat than life span is essential for treating older adults with diabetes, in response to a speaker on the Coronary heart in Diabetes CME Convention.
“Our remedy pointers must proceed to evolve to take into consideration the heterogeneity of older people in addition to accumulating information on advantages and dangers,” Pratley stated throughout a presentation. “We have to personalize remedy in our older adults with diabetes, much more so than different populations.”
No elevated CV danger for older adults
Extensively used drugs — DPP-IV inhibitors, SGLT2 inhibitors and GLP-1 receptor agonists — don’t elevate CV danger for older adults. Nonetheless, well being care professionals ought to concentrate on different potential dangers when prescribing drugs, Pratley stated.
Richard E. Pratley
FDA-issued steering to evaluate CV danger for diabetes therapies has led to twenty-eight CV end result trials, up to now, being performed for eight lessons of medicine for sort 2 diabetes. Pratley stated these information have aided researchers in higher understanding how diabetes drugs have an effect on CV outcomes for adults aged 65 years and older in contrast with youthful adults.
A meta-analysis printed within the Journal of Diabetes and Its Problems in 2024 examined CV danger with a number of lessons of diabetes therapies by age group. In 5 trials that assessed DPP-IV inhibitors included within the meta-analysis, there was no distinction in CV danger for adults aged 65 years and older and people 75 years and older in contrast with youthful adults.
Some SGLT2 inhibitors might confer CV advantages for older adults. Within the EMPA-REG Consequence trial, adults aged 65 years and older who obtained empagliflozin (Jardiance, Boehringer Ingelheim) had decrease danger for CV outcomes and CV loss of life in contrast with those that obtained placebo. Equally, within the CANVAS trial, these aged 65 years and older who obtained canagliflozin (Invokana, Janssen) had decreased danger for CV outcomes in contrast with these within the placebo group.
CV advantages for older adults have been additionally noticed in some GLP-1 trials. In a post-hoc evaluation of the LEADER trial printed in Annals of Inner Medication, adults aged 75 years and older who obtained liraglutide (Victoza/Saxenda, Novo Nordisk) had decrease danger for CV outcomes and all-cause mortality than those that obtained placebo.
“We are able to use these medicine in sufferers who’re older and who’re at excessive danger for CVD safely.” Pratley stated. “However we now have to match advantages that we hope to realize with these drugs, which embody reductions in CVD, coronary heart failure, stroke and probably diabetic kidney illness, with the dangers of the remedy.”
Influence of lean mass loss
For older adults, a danger of remedy with a GLP-1 is a potential discount in lean mass that would result in falls or opposed bone well being, in response to Pratley. He stated that is particularly a priority for older adults who’ve sarcopenia once they begin a GLP-1.
“Now we have to enter remedy with our eyes open,” Pratley stated. “What we need to be certain that is that in our efforts to enhance CV outcomes, we’re not main down a path the place there’s accelerated lack of skeletal muscle and, consequently, operate.”
Pratley concluded that whereas beforehand printed trials confirmed older adults might confer extra advantages from SGLT2s and GLP-1s, extra research are wanted so researchers can higher perceive which adults might confer essentially the most advantages from therapies.
Pratley stated the objective ought to be customized remedy for older adults that focuses on “enhancing well being span” somewhat than life span.
References:
Sources/Disclosures
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Pratley R. Diabetes Comorbidities. Introduced at: Coronary heart in Diabetes CME Convention; June 6-8, 2025; Philadelphia.
Disclosures:
Pratley stories talking for Eli Lilly and Novo Nordisk; consulting for AbbVie, Altanine, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Corcept Therapeutics, Eli Lilly, Endogenex, F. Hoffman-La Roche, Gasherbrum Bio, Genprex, Getz Pharma, Hanmi Pharmaceutical, Intas Prescribed drugs, Lexicon, Novo Nordisk, Pfizer, Regeneron, Scholar Rock and Solar Prescribed drugs; and receiving analysis grants from Biomea Fusion, Carmot Therapeutics, Dompe, Eli Lilly, Endogenex, Fractyl, Novo Nordisk and Sanofi.
