Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende
Erweiterte Suche
Anmelden
nach oben
Drugs
Erschienen in: Drugs 3/2019

01.02.2019 | Therapy in Practice

The Impact of Comorbidities on the Pharmacological Management of Type 2 Diabetes Mellitus

verfasst von: Shazia Hussain, Tahseen A. Chowdhury

Erschienen in: Drugs | Ausgabe 3/2019

Einloggen, um Zugang zu erhalten

Abstract

Diabetes mellitus affects over 20% of people aged > 65 years. With the population of older people living with diabetes growing, the condition may be only one of a number of significant comorbidities that increases the complexity of their care, reduces functional status and inhibits their ability to self-care. Coexisting comorbidities may compete for the attention of the patient and their healthcare team, and therapies to manage comorbidities may adversely affect a person’s diabetes. The presence of renal or liver disease reduces the types of antihyperglycemic therapies available for use. As a result, insulin and sulfonylurea-based therapies may have to be used, but with caution. There may be a growing role for sodium–glucose co-transporter 2 (SGLT-2) inhibitors in diabetic renal disease and for glucagon-like peptide (GLP)-1 therapy in renal and liver disease (nonalcoholic steatohepatitis). Cancer treatments pose considerable challenges in glucose therapy, especially the use of cyclical chemotherapy or glucocorticoids, and cyclical antihyperglycemic regimens may be required. Clinical trials of glucose lowering show reductions in microvascular and, to a lesser extent, cardiovascular complications of diabetes, but these benefits take many years to accrue, and evidence specifically in older people is lacking. Guidelines recognize that clinicians managing patients with type 2 diabetes mellitus need to be mindful of comorbidity, particularly the risks of hypoglycemia, and ensure that patient-centered therapeutic management of diabetes is offered. Targets for glucose control need to be carefully considered in the context of comorbidity, life expectancy, quality of life, and patient wishes and expectations. This review discusses the role of chronic kidney disease, chronic liver disease, cancer, severe mental illness, ischemic heart disease, and frailty as comorbidities in the therapeutic management of hyperglycemia in patients with type 2 diabetes mellitus.
Literatur
1.
2.
Boyle JP, Thompson TJ, Gregg EW, Barker LE, Williamson DF. Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence. Popul Health Metr. 2010;8:29.CrossRefPubMedPubMedCentral
3.
Hex N, Bartlett C, Wright D, Taylor M, Varley D. Estimating the current and future costs of type 1 and type 2 diabetes in the UK including direct health costs and indirect societal and productivity costs. Diabet Med. 2012;29:855–62.CrossRefPubMed
4.
5.
Piette JD, Kerr EA. The impact of comorbid chronic conditions on diabetes care. Diabetes Care. 2006;29:725–31.CrossRefPubMed
6.
Ciechanowski PS, Katon WJ, Russo JE. Depression and diabetes: impact of depressive symptoms on adherence, function, and costs. Arch Intern Med. 2000;160:3278–85.CrossRefPubMed
7.
Krein SL, Heisler M, Piette JD, Makki F, Kerr EA. The effect of chronic pain on diabetes patients’ self-management. Diabetes Care. 2005;28:65–70.CrossRefPubMed
8.
Schoenberg NE, Drungle SC. Barriers to non-insulin dependent diabetes mellitus (NIDDM) self-care practices among older women. J Aging Health. 2001;13:443–66.CrossRefPubMed
9.
Jaen CR, Stange KC, Nutting PA. Competing demands of primary care: a model for the delivery of clinical preventive services (review). J Fam Pract. 1994;38:166–71.PubMed
10.
Chernof BA, Sherman SE, Lanto AB, Lee ML, Yano EM, Rubenstein LV. Health habit counseling amidst competing demands: effects of patient health habits and visit characteristics. Med Care. 1999;37:738–47.CrossRefPubMed
11.
12.
13.
14.
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ. 1998;317:703–13.CrossRefPubMedCentral
15.
Hansson L, Zanchetti A, Carruthers SG, Dahlöf B, Elmfeldt D, Julius S, Mѐnard J, Rahn KH, Wedel H, Westerling S, For the HOT Study Group. Effects of intensive blood-pressure lowering and low dose aspirin in patients with hypertension: principal results of the hypertension optimal treatment (HOT) randomized trial. Lancet. 1998;351(9118):1755–62.CrossRefPubMed
16.
SPRINT Research Group. A randomized trial of intensive vs standard blood-pressure control. N Engl J Med. 2015;373:2103–16.CrossRef
17.
Colhoun HM, Betteridge DJ, Durrington PN, Hitman GA, Neil HA, Livingstone SJ, Thomason MJ, Mackness MI, Charlton-Menys V, Fuller JH, CARDS Investigators. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomized placebo-controlled trial. Lancet. 2004;364(9435):685–96.CrossRefPubMed
18.
Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20536 high-risk individuals: a randomized placebo-controlled trial. Lancet. 2002;360:7–22.CrossRef
19.
Kunutsor SK, Seidu S, Khunti K. Aspirin for primary prevention of cardiovascular and all-cause mortality events in diabetes: updated meta-analysis of randomized control trials. Diabet Med. 2017;34(3):316–27.CrossRefPubMed
20.
21.
22.
Paneni F, Beckman JA, Creager MA, Cosentino F. Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: part I. Eur Heart J. 2013;34:2436–43.CrossRefPubMedPubMedCentral
23.
24.
UK Prospective Diabetes Study Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998;352(9131):837–53.CrossRef
25.
26.
27.
ADVANCE Collaborative Group. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358:2560–72.CrossRef
28.
29.
Control Group, Turnbull FM, Abraira C, et al. Intensive glucose control and macrovascular outcomes in type 2 diabetes. Diabetologia. 2009;52:2288–98.CrossRef
30.
Kelly TN, Bazzano LA, Fonseca VA, et al. Systematic review: glucose control and cardiovascular disease in type 2 diabetes. Ann Int Med. 2009;151:394–403.CrossRefPubMed
31.
Zoungas S, Arami H, Gerstein HC, et al. Collaborators on trials of lowering glucose (CONTROL) group. Effects of intensive glucose control on microvascular outcomes in patients with type 2 diabetes: a meta-analysis of individual participant data from randomised controlled trials. Lancet Diabetes Endocrinol. 2017;5:431–7.CrossRefPubMed
32.
33.
Clinical Guidelines Committee of the American College of Physicians. Hemoglobin A1c targets for glycemic control with pharmacologic therapy for nonpregnant adults with type 2 diabetes mellitus: a guidance statement update from the American College of Physicians. Ann Intern Med. 2018;168(8):569–76. https://​doi.​org/​10.​7326/​m17-0939.CrossRef
34.
Look AHEAD Research Group. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Eng J Med. 2013;369:145–54.CrossRef
35.
UKPDS Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet. 1998;352(9131):854–65.CrossRef
36.
Schwartz TB, Meinert CL. The UGDP controversy: thirty-four years of contentious ambiguity laid to rest. Perspect Biol Med. 2004;47(4):564–74.CrossRefPubMed
37.
Dormandy JA, Charbonnel B, Eckland DJ, Erdmann E, Massi-Benedetti M, Moules IK, PROactive Investigators, et al. Secondary prevention of macrovascular events in patients with type 2 diabetes in the PROactive study (PROspective pioglitAzone Clinical Trial in macroVascular Events): a randomized controlled trial. Lancet. 2005;366(9493):1279–89.CrossRefPubMed
38.
Shah M, Kolandaivelu A, Fearon WF. Pioglitazone-induced heart failure despite normal left ventricular function. Am J Med. 2004;117:973–4.CrossRefPubMed
39.
40.
Scirica BM, Bhatt DL, Braunwald E, Steg PG, Davidson J, Hirshberg B, SAVOR-TIMI 53 Steering Committee and Investigators, et al. Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus. N Engl J Med. 2013;369(14):1317–26.CrossRefPubMed
41.
White WB, Cannon CP, Heller SR, Nissen SE, Bergenstal RM, Bakris GL, EXAMINE Investigators, et al. Alogliptin after acute coronary syndrome in patients with type 2 diabetes. N Engl J Med. 2013;369(14):1327–35.CrossRefPubMed
42.
Green JB, Bethel MA, Armstrong PW, Buse JB, Engel SS, Garg J, TECOS Study Group, et al. Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2015;37(3):232–42.CrossRef
43.
Marso SP, Daniels GH, Brown-Frandsen K, Kristensen P, Mann JF, Nauck MA, LEADER Steering Committee, LEADER Trial Investigators, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2016;375(4):311–22.CrossRefPubMedPubMedCentral
44.
Marso SP, Bain SC, Consoli A, Eliaschewitz FG, Jόdar E, Leiter LA, SUSTAIN-6 Investigators, et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2016;375:1834–44.CrossRefPubMed
45.
Holman RR, Bethel MA, Mentz RJ, Thompson VP, Lokhnygina Y, Buse JB, EXSCEL Study Group, et al. Effects of once-weekly exenatide on cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2017;377:1228–39.CrossRefPubMed
46.
Neal B, Perkovic V, Mahaffey KW, de Zeeuw D, Fulcher G, Erondu N, CANVAS Program Collaborative Group, et al. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med. 2017;377(7):644–57.CrossRef
47.
Zinman B, Wanner C, Lachin JM, Fitchett D, Bluhmki E, Hantel S, EMPA-REG OUTCOME Investigators, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015;373(22):2117–28.CrossRefPubMed
48.
49.
Byrne C, Caskey F, Castledine C, Davenport A, Dawnay A, Fraser S, Maxwell H, Medcalf JF, Wilkie M, Williams AJ. UK Renal Registry 20th annual report of the Renal Association UK Renal Registry. The Renal Association. Nephron 2018;139(suppl1).
50.
Winocour P, Bain SC, Chowdhury TA, De P, Pokrajac A, Fogarty D, Frankel A, Banerjee D, Wahba M, Dasgupta I. Managing hyperglycaemia in patients with diabetes and diabetic nephropathy-chronic kidney disease. Summary of recommendations 2018. Br J Diabetes. 2018;18:78–89.CrossRef
51.
Chowdhury TA, Srirathan D, Abraham G, Oei E, Fan SL, McCafferty K, Yaqoob MM. Could metformin be used in patients with diabetes and advanced chronic kidney disease. Diabetes Obes Metab. 2017;19(2):156–61.CrossRefPubMed
52.
53.
54.
55.
Morioka T, Emoto M, Tabata T, Shoji T, Tahara H, Kishimoto H, Ishimura E, Nishizawa Y. Glycaemic control is a predictor of survival for diabetic patients on haemodialysis. Diabetes Care. 2001;24:909–13.CrossRefPubMed
56.
McCaleb ML, Izzo MS, Lockwood DH. Characterisation and partial purification of a factor from uremic human serum that induces insulin resistance. J Clin Invest. 1985;75:391–6.CrossRefPubMedPubMedCentral
57.
58.
Frankel AH, Kazempour-Ardebili S, Bedi R, Chowdhury TA, De P, El-Sherbini N, Game F, Gray S, Hardy D, James J, Kong MF, Ramlan G, Southcott E, Winocour P. Management of adults with diabetes on the haemodialysis unit: summary of guidance from the Joint British Diabetes Societies and the Renal Association. Diabet Med. 2018;35(8):1018–26. https://​doi.​org/​10.​1111/​dme.​13676.CrossRefPubMed
59.
60.
Kasiske BL, et al. Diabetes mellitus after kidney transplantation in the United States. Am J Transplant. 2003;3:178–85.CrossRefPubMed
61.
Israni AK, et al. Clinical diagnosis of metabolic syndrome: predicting new-onset diabetes, coronary heart disease, and allograft failure late after kidney transplant. Transpl Int. 2012;25:748–57.CrossRefPubMed
62.
Tolman KG, Fonseca V, Dalpiaz A, Tan MH. Spectrum of liver disease in type 2 diabetes and management of patients with diabetes and liver disease. Diabetes Care. 2007;30:734–43.CrossRefPubMed
63.
Chitturi S, Abeygunasekera S, Farrell GC, Holmes-Walker J, Hui JM, Fung C, Karim R, Lin R, Samarasinghe D, Liddle C, Weltman M, George J. NASH and insulin resistance: insulin hypersecretion and specific association with the insulin resistance syndrome. Hepatology. 2002;35:373–9.CrossRefPubMed
64.
Mehta SH, Strathdee SA, Thomas DL. Association between hepatitis C virus infection and diabetes mellitus. Epidemiol Rev. 2001;23:302–12.CrossRefPubMed
65.
Naing C, Mak JW, Ahmed SI, Maung M. Relationship between hepatitis C virus infection and type 2 diabetes mellitus: Meta-analysis. World J Gastroenterol. 2012;18:1642–51.CrossRefPubMedPubMedCentral
66.
Singh BM, Grunewald RA, Press M, Muller BR, Wise PH. Prevalence of haemochromatosis amongst patients with diabetes mellitus. Diabet Med. 1992;9:730–1.CrossRefPubMed
67.
Davila JA, Morgan R, Shaib Y, McGlynn K, El-Serag H. Diabetes increases the risk of hepatocellular carcinoma in the United States: a population based case control study. Gut. 2005;54:533–9.CrossRefPubMedPubMedCentral
68.
Chalasani N, Younossi Z, Lavine JE, American Gastroenterological Association, American Association for the Study of Liver Diseases, American College of Gastroenterology, et al. The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology. Gastroenterology. 2012;142:1592–609.CrossRefPubMed
69.
Hickman IJ, Jonsson JR, Prins JB, Ash S, Purdie DM, Clouston AD, Powell EE. Modest weight loss and physical activity in overweight patients with chronic liver disease results in sustained improvements in alanine aminotransferase, fasting insulin, and quality of life. Gut. 2004;53:413–9.CrossRefPubMedPubMedCentral
70.
71.
Sanyal AJ, Chalasani N, Kowdley KV, McCullough A, Diehl AM, Bass NM, Neuschwander-Tetri BA, Lavine JE, Tonascia J, Unalp A, Van Natta M, Clark J, Brunt EM, Kleiner DE, Hoofnagle JH, Robuck PR, NASH CRN. Pioglitazone, vitamin E, or placebo for nonalcoholic steatohepatitis. N Engl J Med. 2010;362:1675–85.CrossRefPubMedPubMedCentral
72.
73.
74.
Armstrong MJ, Gaunt P, Aithal GP, et al. Liraglutide safety and efficacy in patients with non-alcoholic steatohepatitis (LEAN): a multicentre, double-blind, randomised, placebo-controlled phase 2 trial. Lancet. 2016;387:679–90.CrossRefPubMed
75.
76.
Azoulay L, Yin H, Filion KB, Assayag J, Majdan A, Pollak MN, et al. The use of pioglitazone and the risk of bladder cancer in people with type 2 diabetes: nested case control study. BMJ. 2012;344:e3645.CrossRefPubMedPubMedCentral
77.
Elashoff M, Matveyenko AV, Gier B, et al. Pancreatitis, pancreatic and thyroid cancer with glucagon-like peptide-1 based therapies. Gastroenterology. 2011;141:150–6.CrossRefPubMedPubMedCentral
78.
79.
Barone BB, Yeh HC, Snyder CF, Peairs KS, Stein KB, Derr RL, Wolff AC, Brancati FL. Long-term all-cause mortality in cancer patients with pre-existing diabetes mellitus: a systematic review and meta-analysis. JAMA. 2008;300:2754–64.CrossRefPubMedPubMedCentral
80.
81.
82.
83.
84.
85.
Tiihonen J, Lönnqvist J, Wahlbeck K, et al. 11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study). Lancet. 2009;374:620–7.CrossRefPubMed
86.
Sernyak MJ, Leslie DL, Alarcon RD, Losonczy MF, Rosenheck R. Association of diabetes mellitus with use of atypical neuroleptics in the treatment of schizophrenia. Am J Psychiatry. 2002;159:561–6.CrossRefPubMed
87.
Brown S, Birtwistle J, Roe L, Thompson C. The unhealthy lifestyle of people with schizophrenia. Psychol Med. 1999;29(3):697–701.CrossRefPubMed
88.
89.
Cohen A. Diabetes and severe mental illness. Geriatr Med 2018;48(9).
90.
McBain H, Lamontagne-Godwin F, Haddad M, et al. Management of type 2 diabetes mellitus in people with severe mental illness: an online cross-sectional survey of healthcare professionals. BMJ Open. 2018;8(2):e019400.CrossRefPubMedPubMedCentral
91.
92.
Sinclair AJ, Dunning T, Rodriguez-Mañas L. Diabetes in older people: new insights and remaining challenges. Lancet Diabetes Endocrinol. 2015;3:275–85.CrossRefPubMed
93.
Morley JE. Developing novel therapeutic approaches to frailty. Curr Pharm Des. 2009;15:3384–95.CrossRefPubMed
94.
Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56A:M146–56.CrossRef
95.
Volpato S, Bianchi L, Lauretani F, et al. Role of muscle mass and muscle quality in the association between diabetes and gait speed. Diabetes Care. 2012;35:1672–9.CrossRefPubMedPubMedCentral
96.
Lee JSW, Auyeung TW, Leung J, et al. The effect of diabetes mellitus on age-associated lean mass loss in 3153 older adults. Diabet Med. 2010;27:1366–71.CrossRefPubMedPubMedCentral
97.
Abizanda P, Romero L, Sanchez-Jurado PM, et al. Frailty and mortality, disability and mobility loss in a Spanish cohort of older adults: the FRADEA study. Maturitas. 2013;74:54–60.CrossRefPubMed
98.
Larsen RN, Mann NJ, Maclean E, et al. The effect of high-protein, low carbohydrate diets in the treatment of type 2 diabetes: A 12 month randomised controlled trial. Diabetologia. 2011;54:731–40.CrossRefPubMed
99.
Rahi B, Morais JA, Dionne IJ, et al. The combined effects of diet quality and physical activity on maintenance of muscle strength among diabetic older adults from the NuAge cohort. Exp Gerontol. 2014;49:40–6.CrossRefPubMed
100.
Schwartz AV, Vittinghoff E, Sellmeyer DE, et al. Diabetes-related complications, glycemic control, and falls in older adults. Diabetes Care. 2008;31:391–6.CrossRefPubMed
101.
Abdelhafiz AH, Chakravorty P, Gupta S, et al. Can hypoglycaemic medications be withdrawn in older people with type 2 diabetes? Int J Clin Pract. 2014;68:790–2.CrossRefPubMed
Metadaten
Titel
The Impact of Comorbidities on the Pharmacological Management of Type 2 Diabetes Mellitus
verfasst von
Shazia Hussain
Tahseen A. Chowdhury
Publikationsdatum
01.02.2019
Verlag
Springer International Publishing
Erschienen in
Drugs / Ausgabe 3/2019
Print ISSN: 0012-6667
Elektronische ISSN: 1179-1950
DOI
https://doi.org/10.1007/s40265-019-1061-4

Weitere Artikel der Ausgabe 3/2019

Drugs 3/2019 Zur Ausgabe

Leading Article

Emerging Role of SGLT-2 Inhibitors for the Treatment of Obesity

Adis Drug Evaluation

Eravacycline: A Review in Complicated Intra-Abdominal Infections

Review Article

Cefiderocol: A Siderophore Cephalosporin with Activity Against Carbapenem-Resistant and Multidrug-Resistant Gram-Negative Bacilli

AdisInsight Report

Sintilimab: First Global Approval

Adis Drug Evaluation

Tolvaptan: A Review in Autosomal Dominant Polycystic Kidney Disease

AdisInsight Report

Gilteritinib: First Global Approval