Management of type 2 diabetes in patients with frailty

Article Figures & Data

Table 1.

Advantages and disadvantages of newer antihyperglycemic agents in older patients

DRUG CLASS AND MECHANISM OF ACTION	NAME OF DRUG	ADVANTAGES IN OLDER ADULTS	DISADVANTAGES IN OLDER ADULTS
Incretin agents (GLP1-RAs and DPP4Is): increase glucose-dependent insulin release, slow gastric emptying, inhibit glucagon release	GLP1-RAs: Dulaglutide Exenatide Liraglutide Lixisenatide Semaglutide	Low risk of hypoglycemia Cardiorenal benefits Weekly administration available	Mostly injectable therapies Increased probability of GI adverse events² Potential to induce substantial weight loss High cost
	DPP4Is: Alogliptin Linagliptin Saxagliptin Sitagliptin	RCTs demonstrate efficacy and safety in elderly patients CV and renal safety Improved sarcopenic parameters³ Good tolerability	Increased risk of bullous pemphigoid^4,5 Risks of pancreatitis and pancreatic cancer debatable⁶ Specific agents contraindicated in patients with HF²
SGLT2Is: reduce renal glucose reabsorption causing increased glucosuria	Canagliflozin Dapagliflozin Empagliflozin	Phase III studies show safety in elderly patients⁷ Low risk of hypoglycemia Cardiorenal benefits	Concerns regarding increased risk of euglycemic DKA, genitourinary infections, dehydration, and fractures High cost

CV—cardiovascular, DDP4I—dipeptidyl peptidase 4 inhibitor, DKA—diabetic ketoacidosis, GI—gastrointestinal, GLP1-RA—glucagonlike peptide-1 receptor agonist, HF—heart failure, RCT—randomized controlled trial, SGLT2I—sodium-glucose cotransporter-2 inhibitor.
Adapted from Hawker and Akter⁸ with permission from the Canadian Geriatrics Society. Copyright 2023.