Anales de la Facultad de Ciencias Médicas (Asunción)
versão impressa ISSN 1816-8949
PALACIOS DE SCHNEIDER, Concepción Mafalda. TYPE DIABETES MELLITUS Análisis of the objectives, tratment options and risk in elderly population. An. Fac. Cienc. Méd. (Asunción) [online]. 2005, vol.38, n.3, pp. 30-43. ISSN 1816-8949.
The prevalence of abnormal glucose tolerance and type 2 Diabetes Mellitus (T2DM) increase with age. Insulinresistance and ß-cell deficit coexists in the natural history of diabetes and the progression of ß-cell function deficit has a negative influence on the therapeutic response. The pursue and therefore benefits of an appropriate metabolic control also applies to those diabetics older than 60 years and even more when in those patients has frequent co-morbidities but the therapeutic options are frequently limited because renal and cardiovascular conditions, polipharmacy, depressive states and an increase risk of hypoglycemia. Aims: To explore the benefits, risks and acceptability of a simple therapeutic scheme using Insulin Glargine (IG)alone or combined with oral antidiabetic agents (ODA) in a group of patients with T2DM older than 60 years of age and >5 years of diabetes with and without co-morbidities treated in the usual clinical practice environment. Population and Methods: 62 T2DM (M7F:35/27), mean age 68.7±years (range 60-91years), diabetic duration 14.5±6.5 years (5-35years); 11.29% without co-morbidities but 62.3% were hypertensive, 53.3% dyslipidemic; 29.03% had macroangiopathy; history of MI, stroke or evident peripheral vascular disease or revascularization. 22.6% had microangiopathy; 4.8% chronic renal insufficiency and 4.8% were depressive. 88.7% were on 3 or more therapeutic drugs. Results: The mean time of clinical observation were 12±8.2 months (3 - 36 months). At entry the mean body weight was 74.8±4.1kg and BMI:25.6±2.0kg/m2; fasting blood glucose (FBG) 181.4±58.5mg/dL and HbA1c 9.03±1.7%. 79.03% were included because poor control and 20.96% had frequent hypoglycemic episodes. IG alone was initiated in 16.13%; 56.7% was treated with IG+sulfonylurea (SU); 14.5% with IG+Metformin (MT), 3.2% IG+Repaglinide and 8.06% received IG+ a one tablet combination of Rosiglitazone and Metformin. Adjustment was made by phone contact every week using the mean of three self-monitoring FBG. Body weight has not change significantly from baseline at any time point of observation. Meanwhile FBG were 130±43; 122.2±37.6; 126.8±47 and 125.1±34mg/dl at 3,6, 12 months and the end of the study respectively, significantly less than at baseline (p<0.0001). HbA1c was 7.9±1.17; 7.54±0.96; 7.58±0.98 and 7.39±0.87% at the respective time points and significantly coger than baseline (p<0.001). Lipids were not significantly different at any time from entry. Hypoglycemic episodes were less frequent and 71% said was very satisfied with treatment. Conclusions: Treatment with IG alone or combine with ODA improves and sustained metabolic and with less frequent hypoglycemia in an elder population with and without co-morbidities using a simplified insulin titration scheme in an ambulatory settlement.