Pharmacological management of glycemic control in the geriatric patient with type 2 diabetes mellitus

Objective: Discuss geriatric considerations in the treatment of diabetes mellitus and review the advantages and disadvantages of the various pharmacologic agents, including oral medications and insulin, currently available for the treatment of type 2 diabetes mellitus (T2DM). Data Sources: Literature identified within MEDLINE and PubMED, with an emphasis on material published since 2000, were reviewed. Study Selection: Overall, 67 primary study manuscripts, clinical reviews, and dosing guidelines were identified and reviewed based on their clinical relevance to the geriatric population. Data Extraction: Literature searches were performed for studies and reviews that included information on the use of antidiabetic medications in the geriatric population. Information was gathered from the available literature base for each medication class included in the review. Data Synthesis: The literature identified provided guidelines and considerations for the treatment of the older patient with diabetes mellitus to optimize patient outcomes while minimizing the risk for adverse events. This review provides a systematic outline of these considerations and suggests treatment pearls. Conclusion: The approach to managing T2DM in the elderly should be conservative and methodical in nature, with careful consideration of side effects, drug-disease and drug-drug interactions, and the risk of inducing hypoglycemia in this at-risk population.