Table 2.

Geriatric syndromes and additional factors that contribute to hypoglycemia in the elderly [5, 17, 21–25]

Contributing factors	Considerations
Poor cognitive function	Increases risk of severe hypoglycemia in patients with T2DM Severity of deficits increases the risk Greater rate of decline increases the risk
Impaired metabolic and clearance processes	Higher risk (vs. younger patients) for hypoglycemia-associated compromised renal function Altered drug elimination compared with younger patients Rate of insulin clearance from the circulation may decline with age Hypoglycemia counter-regulation is impaired; less efficient compensatory mechanisms to avoid hypoglycemia
Polypharmacy	Receiving ≥5 medication classes is associated with severe hypoglycemia In addition to sulfonylureas, angiotensin-converting enzyme inhibitors and non-selective beta-adrenoceptor antagonists can predispose to hypoglycemia
Comorbidity	Heart failure and clinically relevant depression are predictors of hypoglycemia in elderly patients with T2DM

Elderly patients with diabetes are at increased risk for geriatric syndromes such as polypharmacy, urinary incontinence, depression, falls, chronic pain, and cognitive impairment

T2DM type 2 diabetes mellitus