Prescribing of GLP-1 and GIP/GLP-1 Receptor Agonists and Other Glucose-Lowering Drugs Requiring Special Caution in Elderly Japanese People With Type 2 Diabetes: A Preliminary Report

Abstract

Background: Adverse drug events are more common in elderly people, prompting the Japan Geriatrics Society to update its “Guidelines for Safe Pharmacotherapy in the Elderly” in 2025. In this revision, glucagon-like peptide-1 receptor agonist (GLP-1RA) and glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 receptor agonist (GIP/GLP-1RA) were newly added to the list of drugs requiring special caution. This study aimed to descriptively investigate real-world prescribing patterns of GLP-1RAs and their concomitant use with other glucose-lowering drugs (GLDs) requiring special caution among elderly people with type 2 diabetes (T2D).

Methods: This single-center, retrospective, cross-sectional, exploratory descriptive study included outpatients aged ≥ 65 years with T2D who received antihyperglycemic therapy between September and December 2025. Clinical characteristics, laboratory data, and prescription records were extracted from electronic medical records. Descriptive analyses were conducted stratified by GLP-1RA use (users vs. non-users) and by age categories (65 to < 75 years and ≥ 75 years).

Results: Among 214 eligible people with T2D, 50 (23.4%) were prescribed GLP-1RAs. Among GLP-1RA users, 63.0% were classified as having obesity, and the mean number of concomitant GLDs was 3.2 ± 0.8. GLP-1RAs were often prescribed concomitantly with other GLDs requiring special caution in elderly people, including metformin, sodium-glucose cotransporter 2 inhibitor (SGLT2i), sulfonylureas, and insulin. In age-stratified analyses, oral semaglutide and dulaglutide were the most prescribed GLP-1RAs among people aged ≥ 75 years.

Conclusions: GLP-1RAs were prescribed to approximately one quarter of elderly people with T2D and were most commonly used in people with obesity and more complex glucose-lowering regimens. Their frequent concomitant use with other drugs requiring special caution underscores the complexity of pharmacological management in elderly people.