Metformin as first-line treatment, second-line options include GLP-1 receptor agonists, SGLT-2 inhibitors and DPP-4 inhibitorsAvoid long acting sulphonylureas and other insulin secretagogues If insulin is necessary, use long-acting basal insulin analogues as a single morning doseStop/reduce medications if suitableOpportunistically educate patients, caregivers and healthcare providersAdditional research is required to examine the effects of pharmacological treatments in frail older patients with diabetes and whether benefits are sustained across the spectrum of frailty. Here, DPP4 is linked to diabetes mellitus.