Applied Evidence

Diabetes in the elderly: Matching meds to needs

Author and Disclosure Information

 

From The Journal of Family Practice | 2018;67(7):408-410,412-415.

References

Combining antidiabetes agents

Combination therapy is often needed as T2DM progresses, even though strict glucose control is generally not recommended for the elderly.31 The American Geriatrics Society advises avoiding additional medications other than metformin to achieve an A1C level below 7.5% in most older adults.

However, for older patients already taking metformin who are not at their A1C goal, consider adding a second agent, if not contraindicated. Potential agents include a GLP-1 RA, SGLT-2 inhibitor, DDP-4 inhibitor, or short-acting sulfonylurea (glipizide). Alternatively, basal insulin may be added. However, avoid combining a sulfonylurea with insulin, which greatly increases the risk of hypoglycemia.32 Consider adding a GLP-1 RA or basal insulin if the patient is not at his/her target A1C on oral therapy with multiple agents.3

CORRESPONDENCE
Barbara Keber, MD, Glen Cove Hospital, 101 St. Andrews Lane, Glen Cove, NY; bkeber@northwell.edu.

Pages

Recommended Reading

Hormone therapy raises diabetes risk in breast cancer survivors
Clinician Reviews
Metabolic syndrome scoring system predicts CVD in type 2 diabetes
Clinician Reviews
Abstract: Coffee consumption and health: umbrella review of meta-analyses of multiple health outcomes
Clinician Reviews
Commentary: Shifting the care delivery paradigm to diabetes-depression collaborative care models
Clinician Reviews
Glyburide failed to show noninferiority in gestational diabetes
Clinician Reviews
CANVAS: Canagliflozin improved renal outcomes in diabetes
Clinician Reviews
SUSTAIN-7: GLP-1 receptor agonists effective in elderly
Clinician Reviews
GDM, subsequent diabetes predictive of later renal damage
Clinician Reviews
Patient adjustments needed for closed-loop insulin delivery
Clinician Reviews
Intensive treatment for T2D pays off in the long run
Clinician Reviews