Personalized Treatment Selection and Its Effects on Glycemic Control in Older Adults with Diabetes: A Single Center Experience

Yıl: 2024 Cilt: 20 Sayı: 1 Sayfa Aralığı: 7 - 14 Metin Dili: İngilizce DOI: 10.4274/BMJ.galenos.2023.2023.8-5 İndeks Tarihi: 10-06-2024

Personalized Treatment Selection and Its Effects on Glycemic Control in Older Adults with Diabetes: A Single Center Experience

Öz:
Objective: As society ages, managing people with diabetes gains importance and becomes difficult because of accompanying diseases and complications. This study examined the effects of treatment changes in people with diabetes over 65. Methods: The data of patients aged ≥65 who were followed up in the İstanbul University, İstanbul Faculty of Medicine between 2010 and 2017 were retrospectively analyzed. Demographic data, comorbidities, complications, and metabolic effects of treatment changes were evaluated. Results: The study included 250 patients with a mean age of 72.0±6.6 years. Of the patients, 78.8% had hypertension, 58.4% had dyslipidemia, 32% had coronary artery disease, and 10% had chronic renal failure. The frequency of diabetic neuropathy was 26%, nephropathy 22.8%, and retinopathy 20.8%. The incidence of hypoglycemia was 16.4%. While oral antidiabetic drugs (OAD) alone decreased by 19%, 14% of these patients switched to OAD + basal insulin therapy and 4% to basal-bolus therapy during the follow-up period. With the addition of basal insulin to OAD, an additional 0.9% reduction in glycated hemoglobin (HbA1c) was achieved, and a further 1.2% reduction was achieved by switching to basal-bolus insulin. Conclusion: Our study has shown that continuing the use of metformin in older adults with diabetes with preserved renal functions and adding insulin to their existing treatments when needed, despite all the reservations, provides an effective treatment by decreasing the HbA1c level. However, the lower-than-expected hypoglycemia frequency in our study may be due to the progressive age of diabetes and hypoglycemia unawareness due to accompanying autonomic neuropathy. Education of patients gains importance in this regard.
Anahtar Kelime:

Yaşlı Diyabetli Yetişkinlerde Kişiye Özel Tedavi Seçimi ve Glisemik Kontrol Üzerine Etkileri: Tek Merkez Deneyimi

Öz:
Amaç: Toplum yaşlandıkça, eşlik eden hastalıklar ve komplikasyonlar nedeniyle şeker hastalarının yönetimi önem kazanmakta ve zorlaşmaktadır. Bu çalışma 65 yaş üstü şeker hastalarında tedavi değişikliklerinin etkilerini incelemeyi amaçlamıştır. Gereç ve Yöntem: İstanbul Üniversitesi, İstanbul Tıp Fakültesi’nde 2010-2017 yılları arasında izlenen 65 yaş ve üzeri hastaların verileri retrospektif olarak incelendi. Demografik veriler, komorbiditeler, komplikasyonlar ve tedavi değişikliklerinin metabolik etkileri değerlendirildi. Bulgular: Çalışmaya ortalama yaşları 72,0±6,6 yıl olan 250 hasta dahil edildi. Hastaların %78,8’inde hipertansiyon, %58,4’ünde dislipidemi, %32’sinde koroner arter hastalığı ve %10’unda kronik böbrek yetmezliği vardı. Diyabetik nöropati sıklığı %26, nefropati %22,8, retinopati %20,8 idi. Hipoglisemi görülme sıklığı %16,4 olarak belirlendi. Tek başına oral antidiyabetik ilaçların (OAD) kullanımı %19 azalırken, bu hastaların %14’ünün takip döneminde OAD + bazal insülin tedavisine ve %4'ünün bazal bolus tedavisine geçtiği gözlendi. Glikozillenmiş hemoglobinde (HbA1c) OAD’ye bazal insülin ilavesiyle ek bir %0,9’luk azalma ve bazal-bolus insüline geçilmesiyle ise ilave %1,2’lik azalma sağlandı.Sonuç: Çalışmamız, böbrek fonksiyonları korunmuş yaşlı diyabetlilerde tüm çekincelere rağmen metformin kullanımına devam edilmesinin ve gerektiğinde mevcut tedavilerine insülin eklenmesinin HbA1c değerini düşürerek etkili bir tedavi sağladığını göstermiştir. Ancak hipoglisemi sıklığının beklenenden düşük bulunması, ilerleyen diyabet yaşı ve eşlik eden otonom nöropatiye bağlı hipoglisemi farkındasızlığından kaynaklanıyor olabilir. Bu noktada hastaların eğitimi önem kazanmaktadır.
Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
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APA calikoglu f, Guzey D, Hacisahinogullari H, Cakmak R, Kubat Uzum A, Soyluk Selcukbiricik O, Gül N, Karşıdağ K, YILMAZ M, Dinccag N, Satman I (2024). Personalized Treatment Selection and Its Effects on Glycemic Control in Older Adults with Diabetes: A Single Center Experience. , 7 - 14. 10.4274/BMJ.galenos.2023.2023.8-5
Chicago calikoglu fulya,Guzey Damla yenersu,Hacisahinogullari Hulya,Cakmak Ramazan,Kubat Uzum Ayse,Soyluk Selcukbiricik Ozlem,Gül Nurdan,Karşıdağ Kubilay,YILMAZ MEHMET TEMEL,Dinccag Nevin,Satman Ilhan Personalized Treatment Selection and Its Effects on Glycemic Control in Older Adults with Diabetes: A Single Center Experience. (2024): 7 - 14. 10.4274/BMJ.galenos.2023.2023.8-5
MLA calikoglu fulya,Guzey Damla yenersu,Hacisahinogullari Hulya,Cakmak Ramazan,Kubat Uzum Ayse,Soyluk Selcukbiricik Ozlem,Gül Nurdan,Karşıdağ Kubilay,YILMAZ MEHMET TEMEL,Dinccag Nevin,Satman Ilhan Personalized Treatment Selection and Its Effects on Glycemic Control in Older Adults with Diabetes: A Single Center Experience. , 2024, ss.7 - 14. 10.4274/BMJ.galenos.2023.2023.8-5
AMA calikoglu f,Guzey D,Hacisahinogullari H,Cakmak R,Kubat Uzum A,Soyluk Selcukbiricik O,Gül N,Karşıdağ K,YILMAZ M,Dinccag N,Satman I Personalized Treatment Selection and Its Effects on Glycemic Control in Older Adults with Diabetes: A Single Center Experience. . 2024; 7 - 14. 10.4274/BMJ.galenos.2023.2023.8-5
Vancouver calikoglu f,Guzey D,Hacisahinogullari H,Cakmak R,Kubat Uzum A,Soyluk Selcukbiricik O,Gül N,Karşıdağ K,YILMAZ M,Dinccag N,Satman I Personalized Treatment Selection and Its Effects on Glycemic Control in Older Adults with Diabetes: A Single Center Experience. . 2024; 7 - 14. 10.4274/BMJ.galenos.2023.2023.8-5
IEEE calikoglu f,Guzey D,Hacisahinogullari H,Cakmak R,Kubat Uzum A,Soyluk Selcukbiricik O,Gül N,Karşıdağ K,YILMAZ M,Dinccag N,Satman I "Personalized Treatment Selection and Its Effects on Glycemic Control in Older Adults with Diabetes: A Single Center Experience." , ss.7 - 14, 2024. 10.4274/BMJ.galenos.2023.2023.8-5
ISNAD calikoglu, fulya vd. "Personalized Treatment Selection and Its Effects on Glycemic Control in Older Adults with Diabetes: A Single Center Experience". (2024), 7-14. https://doi.org/10.4274/BMJ.galenos.2023.2023.8-5
APA calikoglu f, Guzey D, Hacisahinogullari H, Cakmak R, Kubat Uzum A, Soyluk Selcukbiricik O, Gül N, Karşıdağ K, YILMAZ M, Dinccag N, Satman I (2024). Personalized Treatment Selection and Its Effects on Glycemic Control in Older Adults with Diabetes: A Single Center Experience. Bakırköy Tıp Dergisi, 20(1), 7 - 14. 10.4274/BMJ.galenos.2023.2023.8-5
Chicago calikoglu fulya,Guzey Damla yenersu,Hacisahinogullari Hulya,Cakmak Ramazan,Kubat Uzum Ayse,Soyluk Selcukbiricik Ozlem,Gül Nurdan,Karşıdağ Kubilay,YILMAZ MEHMET TEMEL,Dinccag Nevin,Satman Ilhan Personalized Treatment Selection and Its Effects on Glycemic Control in Older Adults with Diabetes: A Single Center Experience. Bakırköy Tıp Dergisi 20, no.1 (2024): 7 - 14. 10.4274/BMJ.galenos.2023.2023.8-5
MLA calikoglu fulya,Guzey Damla yenersu,Hacisahinogullari Hulya,Cakmak Ramazan,Kubat Uzum Ayse,Soyluk Selcukbiricik Ozlem,Gül Nurdan,Karşıdağ Kubilay,YILMAZ MEHMET TEMEL,Dinccag Nevin,Satman Ilhan Personalized Treatment Selection and Its Effects on Glycemic Control in Older Adults with Diabetes: A Single Center Experience. Bakırköy Tıp Dergisi, vol.20, no.1, 2024, ss.7 - 14. 10.4274/BMJ.galenos.2023.2023.8-5
AMA calikoglu f,Guzey D,Hacisahinogullari H,Cakmak R,Kubat Uzum A,Soyluk Selcukbiricik O,Gül N,Karşıdağ K,YILMAZ M,Dinccag N,Satman I Personalized Treatment Selection and Its Effects on Glycemic Control in Older Adults with Diabetes: A Single Center Experience. Bakırköy Tıp Dergisi. 2024; 20(1): 7 - 14. 10.4274/BMJ.galenos.2023.2023.8-5
Vancouver calikoglu f,Guzey D,Hacisahinogullari H,Cakmak R,Kubat Uzum A,Soyluk Selcukbiricik O,Gül N,Karşıdağ K,YILMAZ M,Dinccag N,Satman I Personalized Treatment Selection and Its Effects on Glycemic Control in Older Adults with Diabetes: A Single Center Experience. Bakırköy Tıp Dergisi. 2024; 20(1): 7 - 14. 10.4274/BMJ.galenos.2023.2023.8-5
IEEE calikoglu f,Guzey D,Hacisahinogullari H,Cakmak R,Kubat Uzum A,Soyluk Selcukbiricik O,Gül N,Karşıdağ K,YILMAZ M,Dinccag N,Satman I "Personalized Treatment Selection and Its Effects on Glycemic Control in Older Adults with Diabetes: A Single Center Experience." Bakırköy Tıp Dergisi, 20, ss.7 - 14, 2024. 10.4274/BMJ.galenos.2023.2023.8-5
ISNAD calikoglu, fulya vd. "Personalized Treatment Selection and Its Effects on Glycemic Control in Older Adults with Diabetes: A Single Center Experience". Bakırköy Tıp Dergisi 20/1 (2024), 7-14. https://doi.org/10.4274/BMJ.galenos.2023.2023.8-5