Diabetes medication management recommendations for older adults: A systematic review of the Western Pacific region.

The Western Pacific region has the fastest aging population and 38% of the world's diabetes population. It is unknown to what extent medication management recommendations are included for older adults in type 2 diabetes (T2D) clinical practice guidelines (CPGs). MEDLINE, Embase, Scopus, guideline-specific registries and gray literature searches were performed in November 2024. Data were extracted on guideline characteristics and recommendations relevant to older adults, dementia, frailty, co-morbidities associated with aging or end-of-life. Quality appraisal was performed using the AGREE II (Appraisal of Guidelines, Research and Evaluation) tool. From the 37 countries and areas of the Western Pacific region, 16 CPGs were identified, of which 15 included 1-29 relevant recommendations. Thirteen CPGs recommended less stringent and/or individualized glycemic targets focused on reducing hypoglycemia for older adults. Five CPGs recommended individualized antihyperglycemic treatment choices. Seven CPGs included recommendations about de-intensification/simplification of complex regimens. The quality of CPGs varied, with scope and purpose rated the highest. There was heterogeneity in the number of recommendations within CPGs; however, none comprehensively addressed the T2D medication management needs of older adults or those living with dementia, frailty or receiving end-of-life care. Collaboration between diabetes and geriatric societies as well as the assistance of higher-income countries in helping those with less resource availability could provide a way forward to improving future CPGs. Geriatr Gerontol Int 2025; ••: ••-••.