Table 1.

Advantages and disadvantages of newer antihyperglycemic agents in older patients

DRUG CLASS AND MECHANISM OF ACTIONNAME OF DRUGADVANTAGES IN OLDER ADULTSDISADVANTAGES IN OLDER ADULTS
Incretin agents (GLP1-RAs and DPP4Is): increase glucose-dependent insulin release, slow gastric emptying, inhibit glucagon releaseGLP1-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 pemphigoid4,5

  • 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.