Table 5. Targets and specific recommendations in diabetic patients.^[41,43].

CV: cardiovascular: DPP4i: dipeptidyl peptidase-4 inhibitors; GFR: glomerular filtration rate; GLP-1: glucagon-like peptide-1; iSGLT-2: sodium-glucose cotransporter type 2 inhibitors
Non-pharmacological treatment	Nutritional advice avoiding very low-calorie diets (sarcopenia, increased risk of malnutrition).
	Prescription of adapted physical activity: aerobic, endurance, coordination and balance.
Pharmacological treatment	1stchoice• Metformin　It does not usually cause hypoglycaemia.　Monitoring of renal function (decrease dose if GFR < 45 mL/min and discontinue if GFR < 30 mL/min) and liver 　function (risk of lactic acidosis).　Vitamin B12 monitoring (especially if anaemia or peripheral neuropathy).　Gastrointestinal intolerance may be greater in the elderly.• iSGLT2　Do not induce hypoglycaemia.　Blood pressure control in concomitant use with diuretics. 　Educate on genital hygiene to avoid genital and urinary tract infections. 　CV and renal benefit.• GLP-1 receptor agonists　They do not induce hypoglycaemia.　Drug of choice in parenteral treatment* (ADA Guidelines). [41] 　Decreased appetite, weight loss and gastrointestinal discomfort, therefore use with caution in frail elderly people 　with hyporexia and malnutrition. 　Subcutaneous administration.　CV and renal benefit.
	In the event of not controlling with the Metformin + iSGLT2 + GLP1 receptor agonist combination or contraindication/intolerance to any of them. Insulin 　High hypoglycaemic power.　Important to monitor the possibility of hypoglycaemia.　Weight gain.　Insulin Glargine and Degludec, lower rate of hypoglycaemia.　Close monitoring in frail patients.
	Other
	• DDP4i 　Few side effects.　Low risk of hypoglycaemia.　No CV benefit.　Saxagliptin risk of heart failure.　Linagliptin and Sitagliptin are neutral in cardiovascular risk.[44,45]• Sulphonylureas, glinides:　Not recommended due to risk of hypoglycaemia.• Thiazolidinediones:　Not recommended due to side effects and risk of heart failure.