Diabetes in the elderly: Matching meds to needs

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.