Skip to main content
Log in

Individualisierte Diabetestherapie bei älteren Menschen

Individualized diabetes therapy in older persons

  • Arzneimitteltherapie
  • Published:
Der Internist Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Eine große Zahl älterer Menschen mit Diabetes ist multimorbid, gebrechlich oder in den Funktionen eingeschränkt. Polypharmakotherapie ist leider eher die Regel und riskant. Insbesondere der Einsatz von antihyperglykämischen Therapien muss vor dem Hintergrund der Gefahren durch Hypoglykämien gründlich abgewogen werden.

Ziel

Besonderheiten des älteren Menschen mit Diabetes und die hierdurch bedingten Besonderheiten der individualisierten Pharmakotherapie sollen diskutiert werden.

Datenlage und Schlussfolgerung

Vor- und Nachteile von oralen Antidiabetika, Insulinen und Substanzen mit neuen Wirkprinzipien, wie Gliflozinen, werden dargestellt; die Eignung bei Älteren wird diskutiert. Sowohl ältere orale Therapeutika wie Metformin als auch neue Substanzgruppen wie Gliptine bieten Vorteile in dieser Patientengruppe. Injektionstherapien mit Inkretinmimetika und neue Insuline können bei wohlüberlegtem Einsatz das Therapiespektrum ebenfalls erweitern.

Abstract

Background

A majority of older people with type 2 diabetes are multimorbid, frail or have limitations in functions. Polypharmacotherapy is unfortunately a frequent occurrence and dangerous. In particular the administration of antihyperglycemic therapy must be carefully weighed up against the risks associated with hypoglycemia.

Aim

The conditions and characteristics of older persons with diabetes are highlighted with respect to the use of individualized therapy of diabetes.

Results and conclusion

The advantages and disadvantages of oral antidiabetic agents, insulins and substances with novel active principles, such as gliflozin drugs are discussed. Established oral therapeutic drugs, such as metformin as well as the new substance groups, such as gliptins are advantageous in this patient group. Injection-based therapies with glucagon-like peptide 1 (GLP-1) mimetics and the new insulins can also expand the spectrum of therapy if they are prudently used.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Becker RHA, Dahmen R, Bergmann K et al (2015) New insulin glargine 300 Units. mL-1 provides a more even activity profile and prolonged glycemic control at steady state compared with insulin glargine 100 Units. mL-1. Diabetes Care 38:637–643

    CAS  PubMed  Google Scholar 

  2. Boyd CM, Darer J, Boult C et al (2005) Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA 294:716–724

    Article  CAS  PubMed  Google Scholar 

  3. Bremer JP, Jauch-Chara K, Hallschmid M et al (2009) Hypoglycemia unawareness in older compared with middle-aged patients with type 2 diabetes. Diabetes Care 32:1513–1517

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Bruce DG, Davis WA, Casey GP et al (2009) Severe hypoglycaemia and cognitive impairment in older patients with diabetes: the Fremantle Diabetes Study. Diabetologia 52:1808–1815

    Article  CAS  PubMed  Google Scholar 

  5. Coll-Planas L, Bergmann A, Schwarz P et al (2007) Vergleich der Versorgungsqualität älterer Diabetiker durch ambulante Pflegedienste im häuslichen Bereich mit der im stationären Bereich in Pflegeheimen in Dresden. Z Arztl Fortbild Qualitatssich 101:623–629

    PubMed  Google Scholar 

  6. Curkendall SM, Thomas N, Bell KF et al (2013) Predictors of medication adherence in patients with type 2 diabetes mellitus. Curr Med Res Opin 29:1275–1286

    Article  CAS  PubMed  Google Scholar 

  7. BARMER GEK (2006) Gesundheitsbericht

  8. Heidemann C, Du Y, Schubert I et al (2013) Prevalence and temporal trend of known diabetes mellitus: results of the German Health Interview and Examination Survey for Adults (DEGS1). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 56:668–677

    Article  CAS  PubMed  Google Scholar 

  9. Heneka MT, Fink A, Doblhammer G (2015) Effect of pioglitazone medication on the incidence of dementia. Ann Neurol 78:284–294

    Article  CAS  PubMed  Google Scholar 

  10. Holt S, Schmiedl S, Thürmann PA (2010) Potentially inappropriate medications in the elderly: the PRISCUS list. Dtsch Arztebl Int 107:543–551

    PubMed  PubMed Central  Google Scholar 

  11. Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, Peters AL, Tsapas A, Wender R et al (2015) Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 38:140–149

    Article  PubMed  Google Scholar 

  12. Kuhn-Thiel AM, Weiss C, Wehling M (2014) Consensus validation of the FORTA (Fit fOR The Aged) List: a clinical tool for increasing the appropriateness of pharmacotherapy in the elderly. Drugs Aging 31:131–140

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Mogensen UM, Andersson C, Fosbol EL et al (2015) Metformin in combination with various insulin secretagogues in type 2 diabetes and associated risk of cardiovascular morbidity and mortality - a retrospective nationwide study. Diabetes Res Clin Pract 107:104–112

    Article  CAS  PubMed  Google Scholar 

  14. Naik RG, Brooks-Worrell BM, Palmer JP (2009) Latent autoimmune diabetes in adults. J Clin Endocrinol Metab 94:4635–4644

    Article  CAS  PubMed  Google Scholar 

  15. Platt D, Mutschler E (Hrsg) (1999) Pharmakotherapie im Alter. Ein Lehrbuch für Praxis und Klinik. Wissenschaftliche Verlagsgesellschaft, Stuttgart

    Google Scholar 

  16. Quinzler R, Ude M, Franzmann A et al (2012) Treatment duration (persistence) of basal insulin supported oral therapy (BOT) in Type-2 diabetic patients: comparison of insulin glargine with NPH insulin. Int J Clin Pharmacol Ther 50:24–32

    Article  CAS  PubMed  Google Scholar 

  17. Rao AD, Kuhadiya N, Reynolds K et al (2008) Is the combination of sulfonylureas and metformin associated with an increased risk of cardiovascular disease or all-cause mortality? A meta-analysis of observational studies. Diabetes Care 31:1672–1678

    Article  PubMed  PubMed Central  Google Scholar 

  18. Ratzmann KP (2010) Insulintherapie - Moderne Konzepte für die Praxis. UNI-MED-Verlag, Bremen – London – Boston

    Google Scholar 

  19. Rosenstock J, Hansen L, Zee P et al (2015) Dual add-on therapy in type 2 diabetes poorly controlled with metformin monotherapy: a randomized double-blind trial of saxagliptin plus dapagliflozin addition versus single addition of saxagliptin or dapagliflozin to metformin. Diabetes Care 38:376–383

    Article  CAS  PubMed  Google Scholar 

  20. Sinclair AJ, Girling AJ, Bayer AJ (2000) Cognitive dysfunction in older subjects with diabetes mellitus: impact on diabetes self-management and use of care services. All Wales Research into Elderly (AWARE) Study. Diabetes Res Clin Pract 50:203–212

    Article  CAS  PubMed  Google Scholar 

  21. Sinclair AJ, Morley JE, Rodriguez-Mañas L et al (2012) Diabetes mellitus in older people: position statement on behalf of the International Association of Gerontology and Geriatrics (IAGG), the European Diabetes Working Party for Older People (EDWPOP), and the International Task Force of Experts in Diabetes. J Am Med Dir Assoc 13:497–502

    Article  PubMed  Google Scholar 

  22. Wehling M (2016) How to use the FORTA („Fit fOR The Aged“) list to improve pharmacotherapy in the elderly. Drug Res 66(2):57–62

    CAS  Google Scholar 

  23. Xu T, Brandmaier S, Messias AC et al (2015) Effects of metformin on metabolite profiles and LDL cholesterol in patients with type 2 diabetes. Diabetes Care 38:1858–1867

    Article  PubMed  Google Scholar 

  24. Zeyfang A et al AAA Geriatrie. http://www.bethesda-stuttgart.de/Klinik-fuer-Innere-M.867.0.html. Zugegriffen: 20.3.2016

  25. Zeyfang A, Bahrmann A, Wernecke J (2015) Praxisempfehlungen Diabetes mellitus im Alter. Diabetol Stoffwechs 10:192–198

    Article  Google Scholar 

  26. Zeyfang A, Patzelt-Bath A (2015) Importance of geriatric syndromes in elderly diabetic patients with de novo insulin treatment– the VEGAS study. Drugs Real World Outcomes 2:73–79

    Article  Google Scholar 

  27. Zeyfang A (2015) Diabetes und Geriatrie – Update. In: Gesundheitsbericht Diabetes 2015. Deutsche Diabetes-Gesellschaft, Kirchheim-Verlag, Mainz, S 151–153

    Google Scholar 

  28. Zeyfang A, Berndt S, Aurnhammer G et al (2012) A short easy test can detect ability for autonomous insulin injection by the elderly with diabetes mellitus. J Am Med Dir Assoc 13(81):15–18

    Google Scholar 

  29. Zinman B, Wanner C, Lachin JM et al (2015) Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med 373:2117–2128

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to A. Zeyfang.

Ethics declarations

Interessenkonflikt

A. Zeyfang hat Vorträge für Berlin-Chemie AG, Lilly, Novo Nordisk und Sanofi-Aventis gehalten. Er hat Forschungsunterstützung von Berlin-Chemie AG erhalten und ist Berater für Berlin-Chemie AG und Sanofi-Aventis.

Dieser Beitrag beinhaltet keine vom Autor durchgeführten Studien an Menschen oder Tieren.

Additional information

Redaktion

M. Wehling, Mannheim

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zeyfang, A. Individualisierte Diabetestherapie bei älteren Menschen. Internist 57, 502–507 (2016). https://doi.org/10.1007/s00108-016-0039-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00108-016-0039-5

Schlüsselwörter

Keywords

Navigation