Management of type 2 diabetes mellitus in the elderly population with cardiovascular diseases

Abstract

Addressing the glycemic control of the elderly patients with type 2 diabetes mellitus (T2DM) requires creating an individualized plan for each patient due to the heterogeneity among this population. The personalized plan should address topics such as comorbidities, polypharmacy, and cost of medications. One of the major comorbidities that necessitate consideration is cardiovascular disease (CVD), which makes it essential for clinicians to stay updated with literature on cardiovascular safety of diabetes medications. Metformin, along with dietary changes and adequate exercise, should be the first line treatment for patients with T2DM. Glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors should be considered for add-on therapy for elderly patients with CVD whom do not reach their hemoglobin A1c goal on metformin alone. All drugs in these two categories have been shown to be safe in patients with CVD and most of them have shown to reduce adverse cardiovascular events. Sulfonylureas should be used cautiously in elderly due to their high risk of hypoglycemia. Thiazolidinediones, saxagliptin and alogliptin should be avoided in patients with heart failure. With the high rate of major adverse cardiovascular events in elderly population, it is imperative to consider cardiovascular safety and efficacy of non-insulin diabetes medications in formulating management plan for elderly patients with concurrent T2DM and CVD.