Treatment
Other Considerations
Age: Older adults
• Reduced life expectancy
• Higher atherosclerotic disease burden
• Reduced renal function
• At risk for adverse events from polypharmacy
• More likely to be compromised by hypoglycemia
▶▶ Less ambitious targets
▶▶ HbA1c < 7.5-8.0% if lower targets cannot be achieved with simple interventions
▶▶ Focus on drug safety
Weight
• Majority of T2DM patients are overweight or obese
• Intensive lifestyle intervention can improve fitness, glycemic control, and
cardiovascular risk factors
• Metformin
• GLP-1 receptor agonists
• ? Bariatric surgery
• Consider LADA (latent autoimmune diabetes in adults) in lean patients
Sex/ethnic/racial/genetic differences
• Little is known
• MODY (maturity-onset diabetes of the young) and other monogenic forms
of diabetes
• Latinos: more insulin resistance
• East Asians: more β-cell dysfunction
• Gender may drive concerns about adverse effects (eg, bone loss with TZDs)
Comorbidities
• Coronary artery disease
• Heart failure
• Chronic kidney disease
• Liver dysfunction
• Hypoglycemia
12
