Type 2 diabetes presents a significant public health challenge, especially among the elderly population. With the global number of individuals over 65 with diabetes expected to rise dramatically, the need for effective and safe treatment options is critical. Older adults with type 2 diabetes face higher risks of cardiovascular disease (CVD) and adverse drug reactions, making the choice of pharmacological therapy crucial.
Sodium-glucose co-transporter-2 (SGLT2) inhibitors, a class of oral antidiabetic drugs, have gained attention for their ability to lower blood glucose levels and reduce CVD events with minimal risk of hypoglycemia. However, concerns about side effects such as diabetic ketoacidosis, genital infections, urinary tract infections, and bone fractures persist. Despite these concerns, post hoc analyses of randomized controlled trials (RCTs) have shown SGLT2 inhibitors to be beneficial in reducing CVD events in older adults with type 2 diabetes.
This study compared the cardiovascular outcomes and adverse drug reactions between older adults initiating SGLT2 inhibitors or DPP-4 inhibitors. The findings revealed that SGLT2 inhibitors were associated with significantly lower risks of heart failure hospitalization (HHF), all-cause death, and stroke compared to DPP-4 inhibitors. However, the risks of genital infection and UTI were higher with SGLT2 inhibitors.
The study also noted that the protective effects of SGLT2 inhibitors against CVD may be diminished in very elderly patients (aged 75 years or older), possibly due to combined comorbidities and polypharmacy. Despite these findings, SGLT2 inhibitors were deemed tolerable therapeutic agents for older adults with type 2 diabetes.
This research underscores the importance of personalized treatment plans for elderly patients with type 2 diabetes, considering the potential benefits and risks associated with SGLT2 inhibitors. Further studies are needed to explore the long-term effects and safety of these drugs, especially in very elderly populations.
