167 – Type 2 Diabetes: Best & Safest Medications for Older Adults
Update: 2025-10-06
Description
In This Episode:
Dr. K talks with diabetes researcher and UCSF geriatrician Sei Lee, MD MAS, about how to choose the best medications to treat diabetes in older adults. They explain the pros and cons of today’s main diabetes treatments — metformin, SGLT2 inhibitors, GLP-1 receptor agonists, DPP-4 inhibitors, sulfonylureas, pioglitazone, and insulin — and how to balance benefits with risks depending on health, frailty, and life expectancy.
They cover:
- Introduction to Diabetes
- Why diabetes care is different in aging
- Time to benefit & diminishing returns
- Individualizing A1C targets
- First-line: lifestyle & metformin
- Older drugs: sulfonylureas, and pioglitazone
- SGLT2 inhibitors: who benefits, who should avoid
- GLP-1s in older adults: benefits, appetite & muscle considerations
- Why DPP-4s are less useful
- Insulin in geriatrics: basal vs mealtime strategies
- Preventing hypoglycemia
- What to know about continuous glucose monitors (CGMs)
- Questions to ask your doctor
Related episode: 166 – Diabetes in Aging: Signs, Symptoms & What to Do
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