Achieving glycemic control in elderly patients with type 2 diabetes: a critical comparison of current options

Abstract

The prevalence of type 2 diabetes mellitus (T2DM) is increasing in the elderly. Because of the unique characteristics of elderly people with T2DM, therapeutic strategy and focus should be tailored to suit this population. This article reviews the guidelines and studies related to older people with T2DM worldwide. A few important themes are generalized: 1) the functional and cognitive status is critical for older people with T2DM considering their life expectancy compared to younger counterparts; 2) both severe hypoglycemia and persistent hyperglycemia are deleterious to older adults with T2DM, and both conditions should be avoided when determining therapeutic goals; 3) recently developed guidelines emphasize the avoidance of hypoglycemic episodes in older people, even in the absence of symptoms. In addition, we raise the concern of glycemic variability, and discuss the rationale for the selection of current options in managing this patient population.

Keywords: blood glucose; frailty; glycemic target; glycemic variability.

Figure 1

Comparison of combination therapies, studies including two drugs combination, and three drugs combination. Abbreviations: AGI, alpha glucosidase inhibitors; DPP4-i, dipeptidyl peptidase-4 inhibitors; SU, sulfonylurea; TZD, thiazolidinediones; SGLT2i, sodium glucose co-transporter 2 inhibitor; MET, metformin.