The A–G Mnemonic: A Practical Framework for Deprescribing in Older Adults With Type 2 Diabetes

What is it about?

Managing diabetes in older adults can be challenging, especially when patients are on many medications. As people age, they may develop other health issues like memory problems, kidney disease, or frailty, which can increase the risk of side effects from diabetes medicines—particularly those that lower blood sugar too much, like sulfonylureas or strong insulins. This article presents a real-life case of an 84-year-old woman with Type 2 diabetes who was taking 11 different medications, including drugs that increased her risk of low blood sugar and confusion. She experienced two fainting episodes, which led doctors to review her medications. The result was a careful reduction and replacement of high-risk drugs with safer alternatives. To help make these kinds of decisions easier, the authors introduced the A–G mnemonic, a simple memory tool to guide doctors in reviewing and reducing unnecessary diabetes medicines in older patients. Each letter—from A (Age) to G (Glycemic goals)—represents a factor to consider when tailoring treatment to the patient’s health, priorities, and risks. After the medication changes, the patient’s blood sugar remained in a safe range, and her overall alertness and appetite improved. The A–G framework is now being used in clinics in India and may help doctors around the world reduce medication-related harm in older adults with diabetes. This patient-centered approach focuses on safety, reducing medication burden, and improving quality of life—rather than chasing overly tight blood sugar numbers that may no longer benefit older, frailer patients.

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