Managing diabetes in patients with diabetes of long duration.

PURPOSE: The purpose of this article is to review clinical issues related to the management of hyperglycemia in older patients with diabetes of long duration. CONCLUSION: Older adults represent an extensive proportion of patients with type 2 diabetes. Treatment goals need to be individualized to take into account comorbid conditions, life expectancy, diabetes complications, and the benefits of glycemic control. For both older patients and especially those with chronic renal insufficiency, the most important drug-related adverse effect to avoid is hypoglycemia, and avoidance of any severe hypoglycemia should be paramount. Patients with long duration of diabetes are often treated with insulin. Recent data show that glucagon-like peptide-1 receptor agonists may be used in combination with insulin for patients not achieving glycemic goals, with reductions in the doses of insulin used and with a low risk of hypoglycemia and possible weight loss.