TYPE-2 DIABETES - GLYCEMIC TARGETS AND ORAL THERAPIES FOR OLDER PATIENTS

In older patients with type 2 diabetes, life expectancy and the presen ce of microvascular complications determine the appropriate intensity of glucose control. The available antidiabetic agents offer many optio ns for achieving glycemic targets, based on the needs of the individua l patients. New stimulators of insulin secretion include glimepiride ( a sulfonylurea) and repaglinide (a meglitinide). The biguanide metform in is especially useful in obese, insulin-resistant patients. Alpha-gl ucosidase inhibitors such as acarbose and miglitol act locally in the GI tract to reduce postprandial excursion in glucose levels. The insul in-sensitizing drug troglitazone enhances insulin-mediated glucose dis posal. When troglitazone is used, careful monitoring of patients' live r function is required.