Risks associated with hypoglycemic pharmacotherapy in elderly patients with neurological and psychiatric disorders

Type 2 diabetes mellitus is characterized by its high prevalence among the elderly and senile populations. It is estimated that approximately one in five individuals aged 65 or more live with diagnosed or undiagnosed type 2 diabetes mellitus. These estimates support the reasonable hypothesis that the disease is associated with advanced age. Of particular relevance is the observation that type 2 diabetes mellitus in geriatric practice often co-occurs with neurological and psychiatric disorders. A comprehensive analysis of the scientific studies published over the past 5 years by Russian and international authors offers a detailed description and discussion of the potential risks associated with hypoglycemic pharmacotherapy for type 2 diabetes mellitus in elderly and senile patients with neurological and psychiatric disorders. This study provides an overview of the pharmacodynamic characteristics of the main classes of hypoglycemic agents, thereby facilitating an assessment of their safety in geriatric populations. The following discussion addresses the requirements and principles of hypoglycemic pharmacotherapy in elderly patients, with the aim of reducing the risks of adverse reactions. Metformin has been identified as the hypoglycemic agent with the lowest risk of adverse reactions for elderly and senile patients with impaired central nervous system function who are treated for type 2 diabetes mellitus. Novel groups of antidiabetic medications, such as incretin mimetics and gliflozines, have emerged as promising candidates for treatment. Sulfonylureas, glitazones, and glinides are not recommended for elderly individuals.