PMID- 32303827 OWN - NLM STAT- MEDLINE DCOM- 20210506 LR - 20220422 IS - 1435-1269 (Electronic) IS - 0948-6704 (Print) IS - 0948-6704 (Linking) VI - 54 IP - 3 DP - 2021 May TI - Evidence gap on antihyperglycemic pharmacotherapy in frail older adults : A systematic review. PG - 278-284 LID - 10.1007/s00391-020-01724-3 [doi] AB - BACKGROUND: Although antihyperglycemic pharmacotherapy in frail older adults with type 2 diabetes mellitus (T2DM) is challenging, recommendations from international guidelines are mainly based on indirect evidence from trials not including frail participants. OBJECTIVE: This systematic review investigated the effectiveness and safety of pharmacotherapy in frail older adults with T2DM. MATERIAL AND METHODS: Randomized (RCT) and non-randomized prospective clinical trials (non-RCT) were searched in three electronic databases (Medline, Embase, Central) up to October 2018. Trials in older adults with T2DM who were assessed as significantly or severely impaired by defined cut-off scores of assessment instruments on frailty, activities of daily living or physical functional impairment were included. RESULTS: Two reviewers independently screened 17,391 references for inclusion and assessed risk of bias with ROBINS‑I. Five non-RCTs and no RCT were identified. Treatment of T2DM without insulin compared to insulin could be associated with increased improvement in cardiac functions in patients with cardiac resynchronization therapy and with decreased falls in frail older women. While better glycemic control with low variability and low HbA1c (hemoglobin A1c) values (<7%) was associated with better maintenance of physical function in community-dwelling older persons, higher HbA1c values (8-8.9%) were associated with a reduction in the composite outcome of death or functional decline in community-dwelling diabetic older adults with need for skilled assistance. Due to serious risk of bias in all studies, results should be considered with caution. CONCLUSION: Well-designed, large-scale RCTs including this important group of patients are required to assess the effectiveness and safety of pharmacotherapy and HbA1c targets. FAU - Bollig, Claudia AU - Bollig C AD - Institute for Evidence in Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany. bollig@ifem.uni-freiburg.de. AD - Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany. bollig@ifem.uni-freiburg.de. FAU - Torbahn, Gabriel AU - Torbahn G AD - Institute for Evidence in Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany. AD - Institute for Biomedicine of Aging, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Nuremberg, Germany. FAU - Bauer, Jurgen AU - Bauer J AD - Center for Geriatric Medicine, University of Heidelberg and Agaplesion Bethanien Hospital, Heidelberg, Germany. FAU - Brefka, Simone AU - Brefka S AD - Agaplesion Bethesda Clinic, Geriatric Research Unit Ulm University, Ulm, Germany. FAU - Dallmeier, Dhayana AU - Dallmeier D AD - Agaplesion Bethesda Clinic, Geriatric Research Unit Ulm University, Ulm, Germany. FAU - Denkinger, Michael AU - Denkinger M AD - Agaplesion Bethesda Clinic, Geriatric Research Unit Ulm University, Ulm, Germany. FAU - Eidam, Annette AU - Eidam A AD - Center for Geriatric Medicine, University of Heidelberg and Agaplesion Bethanien Hospital, Heidelberg, Germany. FAU - Kloppel, Stefan AU - Kloppel S AD - University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland. FAU - Zeyfang, Andrej AU - Zeyfang A AD - Department of Epidemiology, University of Ulm, Ulm, Germany. FAU - Voigt-Radloff, Sebastian AU - Voigt-Radloff S AD - Institute for Evidence in Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany. sebastian.voigt@uniklinik-freiburg.de. AD - Center for Geriatric Medicine and Gerontology Freiburg, Medical Center Faculty of Medicine, University of Freiburg, Freiburg, Germany. sebastian.voigt@uniklinik-freiburg.de. CN - MedQoL-Group (Medication and Quality of Life in frail older persons) LA - eng PT - Journal Article PT - Review PT - Systematic Review TT - Evidenzmangel fur die antihyperglykamische Pharmakotherapie gebrechlicher alterer Patienten : Ein systematisches Review. DEP - 20200417 PL - Germany TA - Z Gerontol Geriatr JT - Zeitschrift fur Gerontologie und Geriatrie JID - 9506215 RN - 0 (Hypoglycemic Agents) SB - IM MH - Activities of Daily Living MH - Aged MH - Aged, 80 and over MH - *Diabetes Mellitus, Type 2/diagnosis/drug therapy MH - Female MH - *Frail Elderly MH - Humans MH - Hypoglycemic Agents/therapeutic use MH - Prospective Studies PMC - PMC8096761 OTO - NOTNLM OT - Aged OT - Diabetes mellitus OT - Drug therapy OT - Frailty OT - Systematic review COIS- C. Bollig, G. Torbahn, S. Brefka, D. Dallmeier, M. Denkinger, A. Eidam, S. Kloppel and S. Voigt-Radloff for the MedQoL-Group (Medication and Quality of Life in frail older persons) declare that they have no competing interests. J. Bauer: outside the submitted work: personal fees from Fresenius, Nestle, Nutricia Danone, Novartis, Pfizer and Bayer, transferred to his institution; grants from Nestle and Nutricia Danone. A. Zeyfang Outside the submitted work: personal fees from Berlin-Chemie AG. EDAT- 2020/04/19 06:00 MHDA- 2021/05/07 06:00 PMCR- 2020/04/17 CRDT- 2020/04/19 06:00 PHST- 2020/02/18 00:00 [received] PHST- 2020/03/25 00:00 [accepted] PHST- 2020/04/19 06:00 [pubmed] PHST- 2021/05/07 06:00 [medline] PHST- 2020/04/19 06:00 [entrez] PHST- 2020/04/17 00:00 [pmc-release] AID - 10.1007/s00391-020-01724-3 [pii] AID - 1724 [pii] AID - 10.1007/s00391-020-01724-3 [doi] PST - ppublish SO - Z Gerontol Geriatr. 2021 May;54(3):278-284. doi: 10.1007/s00391-020-01724-3. Epub 2020 Apr 17.