Glucagon-like peptide 1 (GLP-1) agonists may help clinicians manage uncontrolled type 2 diabetes in some older patients without the need for additional glucose controlling medications, according to a study (poster #150) presented on November 8 at the 2023 annual meeting of the Gerontological Society of America.
The study analyzed charts of 30 adults aged 65-84 years who were seen in clinic from January 2022 to February 2023 and were started on GLP-1 or GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) agonists. Participants had uncontrolled type 2 diabetes with initial A1c levels ranging from 9.6% to 12.6% and a body mass index (BMI) between 27 and 48.2. The patients also received education about their conditions as well as counseling on diet and lifestyle modifications.
All participants experienced a reduction in A1c to a range of 5.8% to 7.7%, and a moderate reduction in BMI to between 23 and 39.8 within the year.
“The reduction in BMI that we saw in our patients even though they were still in the category of obesity produces a substantial benefit in the management [of type II diabetes],” because weight loss helps to control the condition, said Anna Pendrey, MD, assistant professor of clinical family medicine and geriatrics at Indiana University School of Medicine in Indianapolis, and sole author of the study.
In some cases, the addition of a GLP-1 agonist or GLP-1/GIP agonist allowed for clinicians to deprescribe other medications such as insulin and sulfonylureas, which can cause hypoglycemia in older adults, Pendrey said.
Approximately 11% of US adults have type 2 diabetes, a percentage that is likely to grow given the prevalence of childhood obesity, according to the US Centers for Disease Control and Prevention. Pendrey highlighted the increased incidence of newly diagnosed diabetes in individuals aged 65-79 years.
Previous studies have shown that GLP-1 agonists have the potential to aid in weight reduction, glucose control, and the prevention of major adverse cardiovascular events in these patients.
The new study is one of many post hoc analyses that mark another step forward in addressing the complex challenges associated with diabetes in older adults, according to Rodolfo Galindo, MD, director of the Comprehensive Diabetes Center at the University of Miami Health System in Florida.
“I believe this is important because unfortunately many of our older adults have both diabetes and obesity,” Galindo, who was not involved with the research, told Medscape Medical News. “You can induce remission of type 2 diabetes through weight loss that GLP-1s can cause.”
The treatment paradigm has shifted away from focusing only on lowering glucose levels as the primary means to prevent complications from diabetes, Galindo said.
Indeed, weight loss can modify diseases and prevent other complications associated with type 2 diabetes, Pendrey said.
“Weight loss and diabetes mellitus control also produces cardiovascular protection that is significant for patients with diabetes, so this group of patients in my opinion are the ones that benefit the most from GLP-1s,” she said.
Side effects of GLP-1 agonists can include nausea and vomiting, which could lead to dehydration. GLP-1s can also increase the risk for pancreatitis. For older adults, weight loss from the drug could cause sarcopenia, or loss of muscle mass, Galindo said.
“This is the reason why patients in treatment with GLP-1s have to be in close contact with their providers,” Pendrey said.
This study was independently supported. Pendrey and Galindo report no relevant conflicts.
Lara Salahi is a journalist based in Boston, Massachusetts.
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Publish date : 2023-11-14 23:40:21
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