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
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