Incretin-based therapy compared with non-insulin alternatives in elderly patients with type 2 diabetes

Type 2 diabetes mellitus is an increasingly common threat to the health of elderly Americans. There are a variety of treatment options, each with a unique set of advantages and disadvantages in this population. Discriminating factors between non-insulin drug classes include glucose-lowering effectiveness, weight effects, propensity for hypoglycemia or other adverse events, route of administration, and cost. Metformin offers substantial glucose lowering without weight gain or hypoglycemia at a low cost, but there are several contraindications or warnings for its use. Sulfonylureas offer substantial glucose lowering at low cost, but can cause weight gain and hypoglycemia. Thiazolidinediones provide meaningful glucose lowering, but with weight gain and concern of cardiovascular toxicity and bladder cancer. Incretin agents lower glucose without weight gain and rarely cause hypoglycemia, but are expensive and lower glucose less than alternatives. A patient-specific approach is critical in identification of the optimal medication regimen for elderly patients with diabetes.