The role of sodium-glucose co-transporter-2 inhibitors in frail older adults with or without type 2 diabetes mellitus

Abstract

Sodium-glucose co-transporter-2 (SGLT2) inhibitors offer significant outcome benefits beyond glucose lowering, including reduced risk of cardiovascular death, all-cause mortality, major adverse cardiovascular events, hospitalisations for heart failure and progression of renal disease. Considering these therapeutic effects, minimal incremental risk for hypoglycaemia and simplicity of administration, this drug class appears to be an attractive therapeutic option for older adults, and post hoc analysis of trial data provides support for the use of SGLT2 inhibitors in this population. Nevertheless, despite favourable clinical trial data, there has been some hesitance in clinical practice prescribing these drugs to older frail adults due to the limited therapeutic experience in this population and insufficient long-term safety data. In this review article, we evaluate the risk-benefit profile for the use of SGLT2 inhibitors in this population and suggest that rather than being a treatment to avoid, SGLT2 inhibitors should be considered a valid therapeutic option for older frail adults with or without diabetes.

Keywords: frail; older people; sodium-glucose co-transporter-2; type 2 diabetes mellitus.

Figure 1

Benefit–risk profile of SGLT2 inhibitors in older frail adults. CV, cardiovascular; ESKD, end-stage kidney disease; UTI, urinary tract infection.