J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://jocmr.elmerjournals.com

Original Article

Volume 18, Number 5, May 2026, pages 292-300

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

↓ Figure 1. Flow diagram of patient selection and classification by GLP-1RA use. eGFR: estimated glomerular filtration rate; ESRD: end-stage renal disease; GIP/GLP-1RA: glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 receptor agonist; GLP-1RA: glucagon-like peptide-1 receptor agonist; T2D: type 2 diabetes; HbA1c: glycated hemoglobin A1c.

↓ Figure 2. Prescribing frequency and type of GLP-1RAs by age group. (a) Percentages were calculated among all participants within each age group. (b) Percentages were calculated among GLP-1RA users within each age group. GLP-1RAs: glucagon-like peptide-1 receptor agonist and glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 receptor agonist.

↓ Figure 3. Concomitant use of glucose-lowering and cardiometabolic drugs by age group and GLP-1RAs treatment status. GLP-1RAs: glucagon-like peptide-1 receptor agonist and glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 receptor agonist; SGLT2i: sodium-glucose cotransporter 2 inhibitor; SU: sulfonylurea.

↓ **Table 1.** Characteristics of Elderly People With T2D, Stratified by Use of GLP-1RAs
	All (n = 214)	GLP-1RAs (n = 50)	Non-GLP-1RAs (n = 164)
Data are presented as mean ± standard deviation or n (%) referring to the population within each group. The numbers shown on the left side of each variable indicate the number of participants with available data for that variable; therefore, denominators may vary due to missing values. Percentages for BMI and eGFR were calculated using the number of people with available measurements as the denominator. T2D: type 2 diabetes; BMI: body mass index; SBP: systolic blood pressure; DBP: diastolic blood pressure; HDL: high-density lipoprotein; LDL: low-density lipoprotein; eGFR: estimated glomerular filtration rate; GLD: glucose-lowering drug; GLP-1RAs: glucagon-like peptide-1 receptor agonist and glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 receptor agonist; SGLT2i: sodium-glucose cotransporter 2 inhibitor; SU: sulfonylurea; DPP-4i: dipeptidyl peptidase-4 inhibitor; GIP/GLP-1RA: glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 receptor agonist.
Age, years	214	76.0 ± 6.5	50	75.5 ± 6.5	164	76.2 ± 6.5
65 to < 75 years	87	(40.7)	20	(40.0)	67	(40.9)
≥ 75 years	127	(59.3)	30	(60.0)	97	(59.1)
Male	127	(59.3)	35	(16.3)	92	(43.0)
BMI, kg/m²	110	24.9 ± 4.0	27	25.6 ± 4.5	83	24.6 ± 3.8
< 25.0	60	(54.5)	10	(37.0)	50	(60.2)
≥ 25.0	50	(45.5)	17	(63.0)	33	(39.8)
HbA1c, %	214	7.0 ± 0.9	50	7.0 ± 0.7	164	7.0 ± 0.9
< 7.0%	109	(50.9)	24	(48.0)	85	(51.8)
7.0 to < 8.0%	86	(40.2)	23	(46.0)	63	(38.4)
≥ 8.0%	19	(8.9)	3	(6.0)	16	(9.8)
SBP, mm Hg	198	134.0 ± 16.0	46	132 ± 15.0	152	134.6 ± 16.3
DBP, mm Hg	197	74.7 ± 10.2	46	75.9 ± 8.7	151	74.3 ± 10.6
Total cholesterol, mg/dL	204	174.9 ± 28.3	47	169.1 ± 30.8	157	176.6 ± 27.3
Triglyceride, mg/dL	196	141.2 ± 79.3	46	137.2 ± 68.4	150	142.5 ± 82.5
HDL cholesterol, mg/dL	207	56.9 ± 15.5	49	52.7 ± 15.8	158	58.2 ± 15.3
LDL cholesterol, mg/dL	198	89.8 ± 25.5	46	88.0 ± 26.2	152	90.3 ± 15.8
eGFR, mL/min/1.73m²	202	66.5 ± 17.2	46	69.2 ± 17.6	156	65.7 ± 17.0
G1 + G2 (≥ 60)	27	(63.4)	31	(67.4)	97	(62.2)
G3a (45–59)	53	(26.2)	12	(26.1)	41	(26.3)
G3b (30–44)	19	(9.4)	3	(6.5)	16	(10.3)
G4 (15–29)	2	(1.0)	0	(0.0)	2	(1.3)
Number of GLDs	214	2.2 ± 1.1	50	3.2 ± 0.8	164	1.9 ± 0.9
GLP-1 and GIP/GLP-1RA	50	(23.4)	50	(23.4)	164	(76.6)
Oral semaglutide	23	(46.0)	23	(46.0)	–	–
Dulaglutide	12	(24.0)	12	(24.0)	–	–
Injectable semaglutide	9	(18.0)	9	(18.0)	–	–
Tirzepatide	5	(10.0)	5	(10.0)	–	–
Lixisenatide	1	(2.0)	1	(2.0)	–	–
Metformin	106	(49.5)	30	(60.0)	76	(46.3)
Metformin dosage, mg/day	106	809 ± 465	30	1,025 ± 539	76	724 ± 405
SGLT2i	105	(49.1)	38	(76.0)	67	(40.9)
SU	52	(24.3)	17	(34.0)	35	(21.3)
Insulin	43	(20.1)	19	(38.0)	24	(14.6)
DPP-4i	107	(50.0)	0	(0.0)	107	(65.2)
Antihypertensive drug	129	(60.3)	33	(66.0)	96	(58.5)
Dyslipidemia drug	131	(61.2)	25	(50.0)	106	(64.6)

↓ Table 1. Characteristics of Elderly People With T2D, Stratified by Use of GLP-1RAs

All (n = 214)

GLP-1RAs (n = 50)

Non-GLP-1RAs (n = 164)

Data are presented as mean ± standard deviation or n (%) referring to the population within each group. The numbers shown on the left side of each variable indicate the number of participants with available data for that variable; therefore, denominators may vary due to missing values. Percentages for BMI and eGFR were calculated using the number of people with available measurements as the denominator. T2D: type 2 diabetes; BMI: body mass index; SBP: systolic blood pressure; DBP: diastolic blood pressure; HDL: high-density lipoprotein; LDL: low-density lipoprotein; eGFR: estimated glomerular filtration rate; GLD: glucose-lowering drug; GLP-1RAs: glucagon-like peptide-1 receptor agonist and glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 receptor agonist; SGLT2i: sodium-glucose cotransporter 2 inhibitor; SU: sulfonylurea; DPP-4i: dipeptidyl peptidase-4 inhibitor; GIP/GLP-1RA: glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 receptor agonist.

Age, years

214

76.0 ± 6.5

75.5 ± 6.5

164

76.2 ± 6.5

65 to < 75 years

(40.7)

(40.0)

(40.9)

≥ 75 years

127

(59.3)

(60.0)

(59.1)

Male

127

(59.3)

(16.3)

(43.0)

BMI, kg/m²

110

24.9 ± 4.0

25.6 ± 4.5

24.6 ± 3.8

< 25.0

(54.5)

(37.0)

(60.2)

≥ 25.0

(45.5)

(63.0)

(39.8)

HbA1c, %

214

7.0 ± 0.9

7.0 ± 0.7

164

7.0 ± 0.9

< 7.0%

109

(50.9)

(48.0)

(51.8)

7.0 to < 8.0%

(40.2)

(46.0)

(38.4)

≥ 8.0%

(8.9)

(6.0)

(9.8)

SBP, mm Hg

198

134.0 ± 16.0

132 ± 15.0

152

134.6 ± 16.3

DBP, mm Hg

197

74.7 ± 10.2

75.9 ± 8.7

151

74.3 ± 10.6

Total cholesterol, mg/dL

204

174.9 ± 28.3

169.1 ± 30.8

157

176.6 ± 27.3

Triglyceride, mg/dL

196

141.2 ± 79.3

137.2 ± 68.4

150

142.5 ± 82.5

HDL cholesterol, mg/dL

207

56.9 ± 15.5

52.7 ± 15.8

158

58.2 ± 15.3

LDL cholesterol, mg/dL

198

89.8 ± 25.5

88.0 ± 26.2

152

90.3 ± 15.8

eGFR, mL/min/1.73m²

202

66.5 ± 17.2

69.2 ± 17.6

156

65.7 ± 17.0

G1 + G2 (≥ 60)

(63.4)

(67.4)

(62.2)

G3a (45–59)

(26.2)

(26.1)

(26.3)

G3b (30–44)

(9.4)

(6.5)

(10.3)

G4 (15–29)

(1.0)

(0.0)

(1.3)

Number of GLDs

214

2.2 ± 1.1

3.2 ± 0.8

164

1.9 ± 0.9

GLP-1 and GIP/GLP-1RA

(23.4)

164

(76.6)

Oral semaglutide

(46.0)

–

Dulaglutide

(24.0)

–

Injectable semaglutide

(18.0)

–

Tirzepatide

(10.0)

–

Lixisenatide

(2.0)

–

Metformin

106

(49.5)

(60.0)

(46.3)

Metformin dosage, mg/day

106

809 ± 465

1,025 ± 539

724 ± 405

SGLT2i

105

(49.1)

(76.0)

(40.9)

(24.3)

(34.0)

(21.3)

Insulin

(20.1)

(38.0)

(14.6)

DPP-4i

107

(50.0)

(0.0)

107

(65.2)

Antihypertensive drug

129

(60.3)

(66.0)

(58.5)

Dyslipidemia drug

131

(61.2)

(50.0)

106

(64.6)

↓ **Table 2.** Age-Stratified Characteristics of GLP-1RAs users and Non-Users Among Elderly People With T2D
Variables	65 to < 75 years (n = 87)	≥ 75 years, (n = 127)
Data are presented as mean ± standard deviation. The numbers shown on the left side of each variable indicate the number of participants with available data for that variable; therefore, denominators may vary due to missing values. T2D: type 2 diabetes; BMI: body mass index; SBP: systolic blood pressure; DBP: diastolic blood pressure; HDL: high-density lipoprotein; LDL: low-density lipoprotein; eGFR: estimated glomerular filtration rate; CKD: chronic kidney disease; GLD: glucose-lowering drug; GLP-1RAs: glucagon-like peptide-1 receptor agonist and glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 receptor agonist; SGLT2i: sodium glucose co-transporter 2 inhibitor.
Age, years	20	69.0 ± 3.1	67	70.1 ± 3.2	30	79.8 ± 4.0	97	80.4 ± 4.6
BMI, kg/m²	8	27.1 ± 5.9	38	25.3 ± 3.9	19	24.9 ± 3.8	45	24.0 ± 3.6
HbA1c, %	20	6.9 ± 0.6	67	6.8 ± 0.8	30	7.1 ± 0.7	97	7.2 ± 1.0
SBP, mm Hg	19	132.2 ± 13.7	65	131.4 ± 16	27	131.9 ± 16.1	87	137.0 ± 16.2
DBP, mm Hg	19	76.3 ± 8.9	64	76.3 ± 9.8	27	75.7 ± 8.7	87	72.8 ± 11.0
Total-cholesterol, mg/dL	18	175.1 ± 30.2	61	174.8 ± 26.9	29	165.4 ± 31.1	96	177.7 ± 27.7
Triglyceride, mg/dL	18	140.1 ± 76.4	62	157.6 ± 94	28	135.3 ± 64.2	88	131.8 ± 72.0
HDL cholesterol, mg/dL	19	52.7 ± 14.7	63	55.2 ± 14.4	30	52.7 ± 16.7	95	60.2 ± 15.6
LDL cholesterol, mg/dL	18	88.3 ± 29.2	62	88.0 ± 26.5	28	87.9 ± 24.7	90	91.9 ± 24.6
eGFR, mL/min/1.73 m²	19	67.7 ± 18.5	64	70.1 ± 17.1	27	70.3 ± 17.2	92	62.6 ± 16.3
Number of GLDs	20	3.2 ± 0.7	67	2.0 ± 1.1	30	3.2 ± 0.8	97	1.9 ± 0.9
Metformin dosage, mg/day	16	1,141 ± 619	38	796 ± 475	14	893 ± 413	38	651 ± 311

↓ Table 2. Age-Stratified Characteristics of GLP-1RAs users and Non-Users Among Elderly People With T2D

Variables

65 to < 75 years (n = 87)

≥ 75 years, (n = 127)

GLP-1RAs (n = 20)

Non-GLP-1RAs (n = 67)

GLP-1RAs (n = 30)

Non-GLP-1RAs (n = 97)

Data are presented as mean ± standard deviation. The numbers shown on the left side of each variable indicate the number of participants with available data for that variable; therefore, denominators may vary due to missing values. T2D: type 2 diabetes; BMI: body mass index; SBP: systolic blood pressure; DBP: diastolic blood pressure; HDL: high-density lipoprotein; LDL: low-density lipoprotein; eGFR: estimated glomerular filtration rate; CKD: chronic kidney disease; GLD: glucose-lowering drug; GLP-1RAs: glucagon-like peptide-1 receptor agonist and glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 receptor agonist; SGLT2i: sodium glucose co-transporter 2 inhibitor.

Age, years

69.0 ± 3.1

70.1 ± 3.2

79.8 ± 4.0

80.4 ± 4.6

BMI, kg/m²

27.1 ± 5.9

25.3 ± 3.9

24.9 ± 3.8

24.0 ± 3.6

HbA1c, %

6.9 ± 0.6

6.8 ± 0.8

7.1 ± 0.7

7.2 ± 1.0

SBP, mm Hg

132.2 ± 13.7

131.4 ± 16

131.9 ± 16.1

137.0 ± 16.2

DBP, mm Hg

76.3 ± 8.9

76.3 ± 9.8

75.7 ± 8.7

72.8 ± 11.0

Total-cholesterol, mg/dL

175.1 ± 30.2

174.8 ± 26.9

165.4 ± 31.1

177.7 ± 27.7

Triglyceride, mg/dL

140.1 ± 76.4

157.6 ± 94

135.3 ± 64.2

131.8 ± 72.0

HDL cholesterol, mg/dL

52.7 ± 14.7

55.2 ± 14.4

52.7 ± 16.7

60.2 ± 15.6

LDL cholesterol, mg/dL

88.3 ± 29.2

88.0 ± 26.5

87.9 ± 24.7

91.9 ± 24.6

eGFR, mL/min/1.73 m²

67.7 ± 18.5

70.1 ± 17.1

70.3 ± 17.2

62.6 ± 16.3

Number of GLDs

3.2 ± 0.7

2.0 ± 1.1

3.2 ± 0.8

1.9 ± 0.9

Metformin dosage, mg/day

1,141 ± 619

796 ± 475

893 ± 413

651 ± 311