Diabetes & Aging: Personalized Therapy for Healthspan
- PHILADELPHIA — As the global population ages,the prevalence of diabetes in older adults is rising.
- Many in this age group have lived with diabetes for a decade or more, increasing their risk of cardiovascular complications.
- “Our treatment guidelines need to continue to evolve to take into account the heterogeneity of older individuals and also accumulating data on benefits and risks,” Pratley said.
Older adults with diabetes now have more treatment options. This News Directory 3 article reveals that personalized diabetes treatment, which considers cardiovascular risk and overall health, is vital, not just targeting blood sugar levels. Experts are advocating for tailored strategies, as the risk of cardiovascular complications increases with age. While medications like DPP-IV inhibitors,SGLT2 inhibitors,and GLP-1 receptor agonists show promise,continuous monitoring of lean mass is crucial. Discover how you can help personalize diabetes care for older adults and learn about the latest findings in the treatment of this widespread condition.
Personalized Diabetes Treatment Key for Older Adults
PHILADELPHIA — As the global population ages,the prevalence of diabetes in older adults is rising. Richard E. Pratley, MD, speaking at the Heart in Diabetes CME Conference, noted that approximately 29% of peopel with diabetes worldwide are 65 or older, totaling 123 million individuals.
Many in this age group have lived with diabetes for a decade or more, increasing their risk of cardiovascular complications. Pratley,medical director of AdventHealth Diabetes Institute,advocated for individualized treatment plans that extend beyond simply meeting glycemic targets for adults 65 and older.He emphasized the importance of considering cardiovascular risk factors in diabetes treatment.
“Our treatment guidelines need to continue to evolve to take into account the heterogeneity of older individuals and also accumulating data on benefits and risks,” Pratley said. “We need to personalize therapy in our older adults with diabetes, even more so than other populations.”
Cardiovascular Risk and Diabetes Medications
Commonly prescribed medications, including DPP-IV inhibitors, SGLT2 inhibitors, and GLP-1 receptor agonists, do not elevate cardiovascular risk in older adults.Though,Pratley cautioned health care providers to remain vigilant about other potential risks when prescribing these medications for diabetes treatment.
According to Pratley, data from 28 cardiovascular outcome trials across eight medication classes have improved researchers’ understanding of how diabetes medications affect cardiovascular outcomes in older adults compared to their younger counterparts.
A 2024 meta-analysis in the Journal of Diabetes and Its Complications found no difference in cardiovascular risk for older adults (65+) or very old adults (75+) compared to younger adults when using DPP-IV inhibitors.
Some SGLT2 inhibitors may offer cardiovascular benefits for older adults. The EMPA-REG Outcome trial showed that empagliflozin was associated with a lower risk of cardiovascular outcomes and death in adults 65 and older. Similar results were observed with canagliflozin in the CANVAS trial.
GLP-1 trials also indicated cardiovascular benefits for older adults. A post-hoc analysis of the LEADER trial revealed that liraglutide reduced the risk of cardiovascular outcomes and all-cause mortality in adults 75 and older.
“We can use these drugs in patients who are older and who are at high risk for CVD safely,” Pratley said. “But we have to match benefits that we hope to achieve with these medications, wich include reductions in CVD, heart failure, stroke and potentially diabetic kidney disease, with the risks of the therapy.”
Lean Mass Loss Considerations
Pratley cautioned that GLP-1 treatment could lead to lean mass reduction in older adults, potentially increasing the risk of falls or bone health issues, especially in those with sarcopenia. Monitoring lean mass is crucial in diabetes treatment.
“We have to go into treatment with our eyes open,” Pratley said. “What we want to make sure is that in our efforts to improve CV outcomes, we’re not leading down a path where there’s accelerated loss of skeletal muscle and, consequently, function.”
Pratley concluded that while trials suggest potential benefits from SGLT2s and GLP-1s for older adults, further research is needed to identify which individuals benefit most from these therapies. The ultimate goal is personalized therapy focused on improving health span rather than simply extending life span.
What’s next
Future research should focus on identifying specific subgroups of older adults who would benefit most from particular diabetes therapies, balancing cardiovascular benefits with potential risks like lean mass loss to optimize treatment strategies.