Weighing the Potential Benefits and Risks of Antidiabetic Agents in Older Adults

Abstract

R.W. was referred by her case manager to the clinic pharmacist for a medication management consultation. She is an 81-year-old woman who recently presented to the emergency department (ED) after a fall in her kitchen and was subsequently hospitalized with a hip fracture. When asked about the circumstances surrounding her recent hypoglycemia event, she reports rushing to the kitchen to answer the phone and slipping on the tile floor. In the ED, her blood glucose was 58 mg/dl, which was considered contributory to her fall. She reports not experiencing any hypoglycemia symptoms before falling. R.W.'s medical history includes type 2 diabetes diagnosed 12 years ago, hypertension, dyslipidemia, osteoporosis, and depression. In addition, she experienced a transient ischemic attack (TIA) 3 years ago and reports chronic back pain from several osteoporotic vertebral fractures. R.W.'s parents both had type 2 diabetes, and her father died at the age of 63 years after a myocardial infarction (MI). R.W. lives alone in a single-bedroom apartment. Her husband died of bladder cancer 2 years ago, and her son lives 90 miles away. She reports that she eats sporadically throughout the day, and her diet primarily consists of processed foods, although she reports having a good appetite. Her weight has increased by ~ 5 lb since the addition of glyburide to her medication regimen 1 year ago. She recently implemented a walking routine 3 days per week at the mall with a group of friends in hope of losing some weight. Her antidiabetic regimen consists of metformin, 500 mg twice daily, and glyburide, 5 mg twice daily. She reports never taking more than 500 mg twice daily of metformin, which was confirmed by a review of her medical history. She has experienced about six hypoglycemia events (blood glucose level < 70 mg/dl) confirmed by fingerstick glucose …