Table.

The table summarizes properties of currently available glucose lowering agents in elderly patients affected by type 2 diabetes mellitus.

Sulfonylureas (1st generation: glibenclamide 2nd generation: glipizide, glimepiride, gliclazide	Increased release of insulin by glucose independent closure of the ATP-sensitive K-channels	Proven glucose lowering efficacy Long term clinical experience Relatively low cost	Risk of hypoglycaemia Weight gain	Caution in renal impairment, hepatic dysfunction, concomitant insulin therapy, recent hospitalization, poor nutrition, cognitive decline and polypharmacy Cardiovascular profile is an important concern
Glinides (repaglinide)	Increased release of insulin with a mechanism partially glucose dependent	Rapid onset of action and short duration Improved post-prandial hyperglycaemia	Risk of hypoglycaemia Weight gain Frequent dosing schedule Relatively high cost	Caution in hepatic dysfunction, concomitant insulin therapy, recent hospitalization, poor nutrition, cognitive decline and polypharmacy Cardiovascular profile is an important concern
Dipeptidyl peptidase-4 inhibitors (alogliptin, linagliptin, saxagliptin, sitagliptin, vildagliptin)	Stimulation of insulin secretion Suppression of glucagon secretion	Low risk of hypoglycaemia	Increased respiratory infections Angio-edema Relatively high cost	Limited long term data Pancreatitis (?)	Potential cardio-protective and neuro-protective effects
Glucagon-like peptide 1 analogues (exenatide, liraglutide, lixisenatide)	Stimulation of insulin secretion Suppression of glucagon secretion Slow gastric emptying	Low risk of hypoglycaemia Weight loss	Gastro-intestinal effects (nausea/vomiting) Injectable Relatively high cost	Limited data on elderly patients Pancreatitis (?)	Potential cardio-protective and neuro-protective effects
Sodium-glucose cotransporter 2 inhibitors (canaglifozin)	Target Inhibition of renal reabsorption of glucose	Low risk of hypoglycaemia Systolic blood pressure reduction	Genitourinary infections, especially in women Pollakiuria Unintended weight loss	Cancer risk (?) Dose adjustment may be recommended in the elderly on loop diuretics and in those with an estimated GFR<60 mL/min or suffering from orthostatic hypotension
Insulin Fast-acting: insulin lispro Insulin aspart Insulin glulisine Long acting: Insulin glargine Insulin detemir Ultra long acting: insulin degludec	Replacement of endogenous insulin	Mimics physiology Rapidly effective Theoretically unlimited efficacy	Risk of hypoglycaemia Injectable Weight gain	Require patient's ability or caregiver involvement Glucose monitoring and dose adjustment