Table 2: Non-Insulin
pharmacotherapy options for Type 2 Diabetes Mellitus in the elderly. Listed
medications are limited to those commercially available in the U.S. at time of
manuscript submission.
Type of Medication (Generic names) |
Primary Mechanism of Action |
Benefits in the Elderly |
Concerns in the Elderly |
Biguanide
(metformin) |
Reduce
Hepatic Glucose Production |
·
High
Efficacy ·
Low
cost ·
Modest
Weight Loss ·
Low
Risk of Hypoglycemia |
Caution
with Renal Disease, Heart Failure, Liver Disease Due to Risk of Lactic
Acidosis |
Sulfonylureas (glimepiride, glyburide, glipizide) |
Insulin
Secretagogue |
·
High
efficacy ·
Low
cost |
·
Hypoglycemic
risk with Advancing Age ·
Caution
in Liver Disease |
Meglitinides
(nateglinide,
repaglinide) |
Insulin
Secretagogue |
·
Lower
Risk of Hypoglycemia Compared to Sulfonylureas |
·
Hypoglycemic
risk with advancing age ·
Frequent
administration ·
Caution
in Liver Disease |
Glucagon-like peptide-1 Agonists (liraglutide,
exenatide, exenatide XR, albiglutide, dulaglutide) |
Insulin
Secretagogue Increase
Incretin Effect |
·
Low
risk for Hypoglycemia ·
Weight
loss |
·
Gastroparesis ·
Pancreatitis ·
Injectable
therapy |
Dipeptidyl-peptidase
IV Inhibitors (sitagliptin,
linagliptin, alogliptin, saxagliptin) |
Insulin
Secretagogue Increase
Incretin Effect |
·
Low
Risk for Hypoglycemia; Weight neutral |
·
Pancreatitis ·
Modest
Reduction in HgBA1c ·
Expensive |
Thiazolidinediones
(pioglitazone, rosiglitazone) |
Increase
Insulin Sensitivity |
·
Low
risk of hypoglycemia |
·
Lower
BMD and increase fracture risk [249] ·
Caution
in Renal and Liver disease, Heart Failure ·
Weight
gain and Fluid retention |
Alpha-glucosidase
inhibitors (acarbose,
miglitol) |
Reduce
Carbohydrate Absorption |
·
Possible
reduction in cardiovascular events [237]. |
·
Caution
in Renal, Liver Disease and Malabsorptive Syndromes ·
Gastrointestinal
side effects common |
Sodium-glucose co-transporter-2
Inhibitors (empagliflozin,
canagliflozin, dapagliflozin) |
Increase
Urinary Glucose Excretion |
·
Possible
Cardiovascular Benefit [238]. ·
Reduction
in blood pressure |
·
Increased
risk of UTI and yeast infection ·
Dehydration
common side effect ·
Increased
urinary frequency ·
Limited
efficacy with chronic kidney disease ·
Expensive |
Amylin replacement (pramlintide)
|
Amylin
Replacement |
·
Weight
Loss |
·
Gastro
paresis ·
Multiple
daily injections ·
Modest
HgBA1c reduction |