Management of Type 2 Diabetes in Elderly Patients on Atypical Antipsychotics

Medication Selection

The American Diabetes Association recommends SGLT2 inhibitors as a preferred option for glycemic control, with HbA1c reductions of approximately 0.5-0.7% 1
SGLT2 inhibitors provide cardiovascular and renal protection, with a low risk of hypoglycemia, and are safe with GFR >30 mL/min/1.73m² 1, 2
GLP-1 receptor agonists are an alternative option, offering effective glycemic control with low hypoglycemia risk, weight loss benefits, and improved lipid profiles, as well as cardiovascular benefits in high-risk patients 2
The American College of Cardiology recommends avoiding thiazolidinediones due to the risk of fluid retention and heart failure, particularly in patients on atypical antipsychotics 2

The American Association of Clinical Endocrinologists recommends checking HbA1c after 3 months of therapy and monitoring fasting and postprandial glucose levels 3
Patients on SGLT2 inhibitors should be educated on the importance of adequate hydration, genital hygiene to prevent infections, and the need to temporarily discontinue medication during acute illness or prior to surgical procedures 1
Patients should be instructed to recognize symptoms of ketoacidosis that require immediate medical attention, such as severe abdominal pain, vomiting, and rapid breathing 1

Dapagliflozin 10 mg daily, canagliflozin 100 mg daily, and empagliflozin 10 mg daily are appropriate for patients with a GFR of 72 mL/min/1.73m² 1