Antipsychotic  drugs are widely used for many psychiatric disorders, such as schizophrenia, bipolar affective disorder, delusions and hallucinations  due to neurological  disorders, depression with severe psychotic  symptoms. Metabolic disorders including  weight gain, dyslipidemia and hyperglycemia  are one of the most common side effects of antipsychotic therapy. Psychiatric patients have higher risk of cardiovascular disease, so that the development of metabolic side effects is an important clinical problem that should be solved. Antipsychotic-induced weight gain may cause distress that leads to antipsychotics withdraw and repeated hospitalizations.Lifestyle changes, correction of the antipsychotic treatment, additional medications and their combination are the possible solutions of antipsychotic metabolic side effects. Lifestyle modification is a first-line therapy that should complement other options, when it feasible. At the same time, it can be extremely difficult for patients receiving antipsychotic to adhere dietary and physical activity recommendations. Replacing an antipsychotic with a milder drug is not always possible and may not be enough effective. Metformin seems to be the most well-studied, safe and effective agent that is prescribed to deal with antipsychotic-induced weight gain and associated metabolic disorders. Glucagon-like peptide type 1 receptor agonists and thiazolidinediones  are mentioned as alternative medications, but clinical data on their efficacy and safety in this patient group are extremely limited. Dyslipidemia can develop as an independent antipsychotic side effect even without an increase in body weight. The most effective treatment, as in the general population, is statin therapy. However, the joint appointment of statins and antipsychotic significantly  increases the risk of adverse reactions, such as myalgia, myopathy, increased creatine kinase levels, due to the competition of drugs for the cytochrome system.It is still unknown what scales should be used for cardiovascular risk stratification in patients taking antipsychotic and whether it is possible to use metformin to prevent antipsychotic-induced weight gain, and if so, how to select patients for whom such therapy can be indicated. Finally, more clinical trials are needed to evaluate the efficacy and safety of other classes of hypoglycemic and lipid-lowering drugs in patients on antipsychotics.

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Elderly patients with diabetes type 2 represent complex and heterogeneous group with different diabetes complications and comorbidity, polypharmacy, functional and cognitive state. Each of those factors should be taken into account to choose the best glycemic targets as well as the most tailored treatment so that it is necessary for endocrinologist to perform geriatric assessment. The most favorable antidiabetic drugs for elderly are safe in terms of hypoglycemia and cardiovascular risks, can be used irrespective of kidney function, do not affect weight or bone mineral density, and are available in fixed combinations with other drugs. Dipeptidyl pepti-dase-4 (DPP-4) inhibitors meet all these requirements with low adverse events rate. Interdisciplinary approach, close interaction with patient and his relatives and considerations for both intensification and deprescribing are keys to successful treatment in this patient subgroup. Cardiovascular events are the most common cause of death and hypoglycemia is highly unfavorable in elderly because it can lead to falls, life-threatening arrhythmias, and cognitive impairment. So deprescribing in elderly with diabetes should be primarily aimed at minimizing of cardiovascular events and severe hypoglycemia risks. For this purpose, it is considered to the reject use of sulfonylureas, glinides, insulins in favor of safer ones (metformin, GLP-1 receptor agonists, SGLT-2 inhibitors, DPP-4 inhibitors).