Diabetes in older adults

In which GLP1 agonist do you want to avoid if the CrCl is less than 30

exenatide

In which GLP1 agonist do you want to avoid if the eGFR is <15

lixisenatide

Which GLP1 agonists are dosed once daily?

• liraglutide

• rybelsus

• lixisenatide

Which GLP1 agonist are dosed once weekly?

• dulaglutide

• ozempic

Which GLP1 agonist are dosed twice daily?

exenatide

Which GLP1 agonists are FDA approved for ASCVD benefit?

• liraglutide

• dulaglutide

• semaglutide

Which SGLT2 inhibitors reduces MACE?

canagliflozin

Which SGLT2i (s) are indicated for CV death if risk and HF death

• empagliflozin

• dapaglifzon

Which SGLT2i is indicated for HF admission

dapagliflozin

Which SGLT2i (s) are indicated for CKD progression?

• Canagliflozin

• empagliflozin

• dapagliflozin

What are 3 main points we look at when treating diabetes in elderly?

1. avoid hypoglycemia

2. adjust glycemic target

3. assess need for deintensifying therpay

For older adults with T1D, what is recommended to reduce hypoglycemia and for older adults with T2D on multiple daily doses of insulin, what should be implemented to improve glycemic outcomes

cgm

What are some ways to simplify insulin regimen for older patients with T2D?

• change timing of basal insulin from bedtime to morning

• titrate dose of basal insulin based on fasting finger-stick glucose test results over a week

What are some reasons to initiate someone on insulin?

1. diagnosed with hyperglycemic crisis

2. diagnosed and A1c is >10%

3. patient fails multiple oral/ GLP-1 RA or combo with GIR

For basal insulin therapy what does the ADA recommend?

• long acting insulin 10 units daily

• weight based insulin (0.1-0.2 units/kg/day)

  • usually at bedtime

What do you monitor in basal insulin therapy?

Fasting glucose and any signs/symptoms of hypo

How do you dose adjust basal insulin therapy?

10-20% of the existing dose q2-3 days until fasting glucose is at goal