A Q&A with Inpatient Pharmacy
There are new agents on the market for diabetes care. What is recommended for the older patient?
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A brief conversation with Stephanie Yager, PharmD, and Marigel Constantiner, RPh, MSc, BCPS, CGP, CPh
Diabetes care must always be managed cautiously in the older patient. Hypoglycemia can result in poor outcomes, and older adults may display more neuroglycopenic manifestations of hypoglycemia such as dizziness, weakness, delirium and confusion. On the other hand, hyperglycemia increases dehydration, impairs vision and cognition, and increases the risk of infection.
There are several new diabetes agents on the market that have potential benefits and concerns for an older patient:
DPP4 inhibitors: sitagliptin, saxagliptin, linagliptin and alogliptin
SGLT2 inhibitors: dapagliflozin, canagliflozin and empagliflozin
GLP1 agonists: exenatide (Byetta®), exenatide ER (Bydureon®), liraglutide (Victoza®), albiglutide (TanzeumTM), lixesenatide (Lyxumia®), and dulaglutide (Trulicity®). There are also new combination therapies; SoliquaTM: lixesenatide and insulin glargine, and Xultophy®: liraglutide and insulin degludec
Stephanie Yager, PharmD, is an ambulatory care pharmacy resident at Cleveland Clinic’s main campus.
Marigel Constantiner, RPh, MSc, BCPS, CGP, CPh, is specialized as a drug information pharmacist and preceptor at Cleveland Clinic with a special interest in geriatrics. She can be reached at constam@ccf.org or 216.444.1126.
References:
American Diabetes Association. Older adults. Sec. 11. In Standards of Medical Care in Diabetesd2017. Diabetes Care 2017;40(Suppl. 1):S99–S104
Januvia (sitagliptin) [prescribing information]. Whitehouse Station, NJ: Merck and Co Inc; January 2017.
Jardiance (empagliflozin) [prescribing information]. Ridgefield, CT: Boehringer Ingelheim Pharmaceuticals, Inc; December 2016.
FDA Drug Safety Communication: FDA confirms increased risk of leg and foot amputations with the diabetes medicine canagliflozin (Invokana, Invokamet, Invokamet XR). https://www.fda.gov/drugs/drugsafety/ucm557507.htm
Victoza (liraglutide) [prescribing information]. Plainsboro, NJ: Novo Nordisk Inc; April 2016.
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