ada -adtional clinical consedrations

Question 1

Describe the association between type 2 diabetes and declines in physical capacity.

Answer 1

Type 2 diabetes is associated with declines in physical capacity, underpinned by dysfunction within skeletal muscle.

Question 2

What is the risk of impaired physical function and frailty in people with type 2 diabetes?

Answer 2

People with type 2 diabetes are at a high risk of impaired physical function and frailty, which reduces quality of life and increases healthcare use.

Question 3

What is frailty and why is it important in the context of type 2 diabetes?

Answer 3

Frailty is increasingly recognized as a major complication of type 2 diabetes and an important target for treatment.

Question 4

What are the limitations in making informed treatment decisions for older adults with diabetes?

Answer 4

Informed decisions regarding treatment of older adults with diabetes are limited by the underrepresentation of such participants in clinical trials.

Question 5

What did the ADVANCE trial suggest about older individuals with diabetes and intensive control of blood glucose levels and blood pressure?

Answer 5

The ADVANCE trial suggested that more frail individuals have worse outcomes and benefit less from intensive control of blood glucose levels and blood pressure.

Question 6

How has the inclusion of older people in clinical trials improved our confidence in selecting medications for diabetes?

Answer 6

The inclusion of older people in clinical trials has improved our confidence in selecting medications to improve outcomes and determine their efficacy and safety.

Question 7

What did a recent meta-analysis of large outcome trials find about the cardiovascular and kidney outcome benefits of GLP-1 RA or SGLT2i therapy in older people?

Answer 7

A recent meta-analysis found that the cardiovascular and/or kidney outcome benefits of GLP-1 RA or SGLT2i therapy were consistent with the effects seen in the overall trial population for older people.

Question 8

What should be considered when selecting medications for older people with diabetes who are frail or have multiple comorbidities?

Answer 8

Medication choices for older people who are frail or have multiple comorbidities may require modification for safety and tolerability.

Question 9

Why is consideration of deprescribing medication important in older people with diabetes?

Answer 9

Deprescribing medication is important to avoid unnecessary medication or medication associated with harm, such as hypoglycemia and hypotension, in older people with diabetes.

Question 10

How have rates of impaired glucose tolerance and type 2 diabetes changed in the adolescent and young adult population?

Answer 10

Rates of impaired glucose tolerance and type 2 diabetes have increased significantly in the adolescent and young adult population.

Question 11

What are the risks associated with impaired glucose tolerance and type 2 diabetes in young people?

Answer 11

Impaired glucose tolerance and type 2 diabetes in young people increase the risks of progression to type 2 diabetes, CKD, and cardiovascular complications.

Question 12

Which populations are particularly affected by impaired glucose tolerance and type 2 diabetes in young people?

Answer 12

Minority populations, such as Hispanic, non-Hispanic Black, Asian/Pacific Islander, and American Indian populations, are particularly affected by impaired glucose tolerance and type 2 diabetes in young people.

Question 13

Which populations are particularly affected by impaired glucose tolerance and type 2 diabetes in young people?

Answer 13

Minority populations, such as Hispanic, non-Hispanic Black, Asian/Pacific Islander, and American Indian populations, are particularly affected by impaired glucose tolerance and type 2 diabetes in young people.

Question 14

How do young people with impaired glucose tolerance and type 2 diabetes differ from adults in terms of disease progression and complications?

Answer 14

Young people with impaired glucose tolerance and type 2 diabetes have a more rapid deterioration in blood glucose levels, an attenuated response to diabetes medication, and more rapid development of diabetes complications.

Question 15

What are the risks of adverse outcomes in young people with impaired glucose tolerance and type 2 diabetes?

Answer 15

Early disease onset, higher levels of hyperglycemia, and multiple cardiometabolic risk factors contribute to an increase in risk of adverse outcomes in young people with impaired glucose tolerance and type 2 diabetes.

Question 16

What is the recommended approach for treating younger people with type 2 diabetes?

Answer 16

Younger people with type 2 diabetes should be considered at very high risk for complications and treated correspondingly. Early use of combination therapy may be considered.

Question 17

What is the recommended approach for treating younger people with type 2 diabetes?

Answer 17

Younger people with type 2 diabetes should be considered at very high risk for complications and treated correspondingly. Early use of combination therapy may be considered.

Question 18

What is the evidence for health behavior interventions, glucose-lowering approaches, and medication effectiveness in younger people with diabetes?

Answer 18

There is limited evidence for health behavior interventions, glucose-lowering approaches, and medication effectiveness in younger people with diabetes due to their limited enrollment in completed trials.

Question 19

What is the impact of race and ethnicity on diabetes outcomes and trials?

Answer 19

Specific populations, particularly non-White populations, are disproportionately affected by diabetes but are consistently underrepresented in outcomes and other trials.

Question 20

What did a meta-analysis of cardiovascular and kidney outcome trials find about non-White participants and SGLT2i therapy?

Answer 20

Non-White participants had higher rates of cardiovascular and other comorbidities than the White cohort but had significant reductions in the risk of cardiovascular death or HHF with SGLT2i therapy.

Question 21

What is the increased burden of complications in underrepresented populations with diabetes?

Answer 21

Underrepresented populations with diabetes have an increased burden of complications compared to the overall enrolled trial populations.

Question 22

What are the implications of the increased burden of complications in underrepresented populations with diabetes?

Answer 22

The implications are that interventions and therapies should be tailored to address the specific needs and risks of underrepresented populations with diabetes.