ABSTRACT
Elderly persons with diabetes have been an undertreated subset of diabetic patients. The goals of physicians and other providers caring for the elderly diabetic patient should be to optimize glycemic control and reduce associated cardiovascular risk factors in an effort to maximize long-term quality of life. Meglitinides are nonsulfonylurea drugs that have a distinct ß-cell binding profile and stimulate insulin secretion from the ß-cell by a mechanism similar to that of sulfonylureas. Metformin is currently the only biguanide available in North America. Its mechanism of action is to improve insulin sensitivity, chiefly by reducing insulin resistance in the liver, thereby decreasing hepatic glucose production. Thiazolidinediones improve insulin sensitivity primarily in muscles and adipocytes, thereby increasing peripheral uptake and utilization of the glucose. The accuracy of insulin injections may be improved in older patients when they are treated with premixed insulin.
