Glucose control medications

Abstract

Elderly patients with diabetes are at risk of falls. Various neuropathies, nephropathy, orthostatic hypotension (OH), and retinopathy may contribute to fall risk in this population. The dosage of renally excreted oral hypoglycemic agents needs to be carefully adjusted to avoid hypoglycemia. Long-acting sulfonylureas such as glyburide and glimepiride should be avoided in older individuals. Metformin has a low risk of hypoglycemia, but when used in the situation of decreased renal function, there is an elevated risk of lactic acidosis. New dipeptidyl peptidase-4 (DPP4) inhibitors are excreted renally and their dosage should be adjusted. Patients with type 2 diabetes are 1.6 times more likely to have a fracture and 2.8 times more likely to have a hip fracture than patients without diabetes. The use of thiazolidinediones doubles the risk of fractures in women when compared to other oral hypoglycemia agents. Metformin can cause vitamin B12 deficiency which can be associated with neuropathy and increase the risk of falls. The literature studying the use of antidiabetic medications and the risk of falls is limited. Trials were not originally designed to evaluate the risk of falls or fractures, and some studies were done over short periods of time. Information on the risk of falls with the use of newer antidiabetic medications such as glucagon-like peptide 1 receptor agonists are lacking.