Type 2 Diabetes

CME credit available from Harvard Medical School through April 2022

Published materials

The goal of this educational program is to provide practitioners with up-to-date evidence-based treatment recommendations for type 2 diabetes, including individualized glycemic target, choice of glucose-lowering medications based on cardiovascular outcome data, and treatment simplification to avoid hypoglycemia.

Over 86 million Americans have prediabetes. Patients with prediabetes can prevent or delay the progression to diabetes through lifestyle interventions. Changes to diet and exercise are very effective for older adults. The Diabetes Prevention Program can help patients implement and sustain these lifestyle modifications. More information available at AlosaHealth.org/Prediabetes.

Over 30 million Americans have diabetes. Type 2 diabetes, which accounts for 90-95% of diabetes cases, is most prevalent in people age 65 and over.1 These patients require a personalized approach to treatment. For most healthy, younger adults, lower HbA1c targets are best, but for older adults with increasingly complex health concerns a higher goal may be more better.

Individualize treatment goals for older patients with diabetes2,3

Diet and exercise are critical components of diabetes treatment. For patients who are not able to get to goal with lifestyle changes alone, metformin should be started. When adding medications to metformin, emerging trial data has shifted treatment recommendations for patients with existing cardiovascular disease, chronic kidney disease, and heart failure.

Treatment paths for patients who are not at HbA1c goal

 

Insulin is an effective HbA1c lowering medication that may be required to help patients get to goal. Hypoglycemia is a risk for patients on insulin. For older patients hypoglycemia can cause poorer health outcomes. As health and functional status declines, reducing insulin injections and adding non-insulin medications can help reduce hypoglycemia while maintaining HbA1c goal.4

Simplified insulin regimen for older adults with type 2 diabetes

 


Additional Resources for Providers
Additional Resources for Patients

Information current at time of publication, April 2019.

The content of this website is educational in nature and includes general recommendations only; specific clinical decisions should only be made by a treating physician based on the individual patient’s clinical condition.


References
  1. Centers for Disease Control and Prevention. National diabetes statistics report: estimates of diabetes and its burden in the United States. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Published 2017. Accessed.
  2. American Diabetes Association. Standards of medical care in diabetes. Diabetes Care. 2019;42(Suppl 1):S1-187.
  3. LeRoith D, Biessels GJ, Braithwaite SS, et al. Treatment of Diabetes in Older Adults: An Endocrine Society* Clinical Practice Guideline. J Clin Endocrinol Metab. 2019;104(5):1520-1574.
  4. Munshi MN, Slyne C, Segal AR, Saul N, Lyons C, Weinger K. Simplification of Insulin Regimen in Older Adults and Risk of Hypoglycemia. JAMA Intern Med. 2016;176(7):1023-1025.
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