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Biguanides, particularly metformin (Glucophage), are insulin sensitizers that enhance glucose uptake, thereby reducing insulin resistance. Unlike sulfonylureas, metformin doesn't prompt insulin secretion, which helps to curb hypoglycemia risk. Metformin is beneficial in treating conditions like polycystic ovary syndrome due to its insulin-resistance reduction capability. The drug's primary action involves curtailing hepatic gluconeogenesis, a significant contributor to high blood...
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Diabetes: Management and Pharmacotherapy01:15

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The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
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Dipeptidyl peptidase 4 (DPP-4) is a serine protease widely distributed in the body. It's involved in the inactivation of GLP-1 and GIP hormones, which are crucial for insulin regulation. DPP-4 inhibitors, such as sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), alogliptin (Nesina), and vildagliptin (Galvus), help increase the proportion of active GLP-1, enhancing insulin secretion. These inhibitors work by competitively binding to DPP-4. This binding causes a...
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α-glucosidase inhibitors, including acarbose (Precose), miglitol (Glyset), and voglibose (Voglib) (primarily available in Asia), are drugs that control blood sugar levels by delaying the digestion of starch and disaccharides. They achieve this by inhibiting α-glucosidase enzymes in the intestine, which slow the absorption of carbohydrates in the intestine, which in turn leads to a prolonged release of the glucoregulatory hormone GLP-1 from intestinal L-cells.
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Repaglinide (Prandin) and Nateglinide (Starlix), known as glinides, are oral insulin secretagogues that stimulate insulin release from pancreatic β cells by closing the ATP-sensitive potassium channels (KATP channel). Repaglinide controls insulin release from pancreatic β cells by managing potassium efflux. It shares two binding sites with sulfonylureas and also has a unique site, indicating overlapping mechanisms of action. With a rapid onset and a 4-7 hour duration, it effectively...
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Type 2 diabetes, characterized by insulin resistance, arises when the insulin receptors on cells lose responsiveness to insulin, diminishing the cell's capacity to take up glucose, resulting in elevated blood glucose levels. To receive a diagnosis of Type 2 diabetes, a series of blood glucose tests are necessary to assess whether the blood glucose falls within normal parameters. If the result is out of the normal range, a patient may be diagnosed as prediabetic or diabetic, depending on the...
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[Antidiabetic treatments for the elderly].

Clotilde Picart1, Sophie Hoang2, Mary Soudani3

  • 1Hôpital Ambroise-Paré AP-HP, Université Paris-Saclay, Site Ambroise-Paré, 9 avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France.

Soins. Gerontologie
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Diabetes is prevalent in individuals over 75. Selecting appropriate treatment is crucial for managing specific glycemic targets in this population.

Keywords:
anti-diabetic treatmentdiabetesdiabèteelderlyinsulininsulineprescriptionsujet âgétraitement antidiabétique

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Area of Science:

  • Gerontology
  • Endocrinology
  • Metabolic Diseases

Context:

  • Diabetes mellitus is a significant health concern in the elderly population, particularly those aged 75 and above.
  • The increasing prevalence of diabetes in older adults necessitates tailored management strategies.
  • Advances in pharmacotherapy and lifestyle interventions offer a wide range of treatment options.

Purpose:

  • To emphasize the importance of individualized glycemic target selection in older adults with diabetes.
  • To highlight the need for careful consideration of treatment regimens in the geriatric population.
  • To guide healthcare providers in optimizing diabetes care for patients over 75.

Summary:

  • Diabetes is highly prevalent in individuals exceeding 75 years of age.
  • A comprehensive array of therapeutic interventions is currently accessible for diabetes management.
  • Personalizing treatment plans to align with individual glycemic goals is paramount for effective care.

Impact:

  • Improved clinical outcomes for older adults with diabetes.
  • Reduced risk of diabetes-related complications in the geriatric population.
  • Enhanced quality of life through optimized glycemic control.