SGLT2 Inhibitors for Diabetes Safe, Effective in Older Adults

Miriam E. Tucker

December 19, 2019

BUSAN, SOUTH KOREA — Sodium glucose cotransporter 2 (SGLT2) inhibitors for the treatment of type 2 diabetes appear to be as safe and effective in people aged 65 years and older as in younger individuals, new research suggests. 

Findings from a real-world observational study of 50 older adults with type 2 diabetes were recently presented here at the International Diabetes Federation (IDF) Congress 2019 by Carlos Trescoli-Serrano, MD, of Hospital Universitario de la Ribera, Valencia, Spain.

"The results are quite similar to those of younger people…In a selected population they are safe. It doesn't matter if patients are older or younger. You have to review the patients for complications," Trescoli-Serrano told Medscape Medical News.

Asked to comment, session moderator Samuel Dagogo-Jack, MD, told Medscape Medical News: "We need more and more studies in older people for reassurance. The elderly have impaired kidneys, and these drugs depend on kidney filtration. It's good to have data on elderly patients in the real world."

Most Patients Had Comorbidities

The 50 adults were a mean age of 67 years, and the oldest was 81 years. They had a mean diabetes duration of 12.5 years, and 40% were women. They had all been taking SGLT2 inhibitors for more than 3 years (mean 43.9 months) during 2015-2019.

At baseline, most (75%) were also taking metformin, 45% also took sulfonylureas, 37% dipeptidyl peptidase-4 (DPP-4) inhibitors, and 36% insulin.

Most (81%) also had hypertension, half (51%) had hypercholesterolemia, a third (33%) had obesity, and 32% had a previous cardiovascular event.

With SGLT2 inhibitor treatment, average A1c level dropped from 8.5% to 7.3% (P < .01), body weight was reduced from 91.0 kg to 84.7 kg (P < .01), systolic blood pressure from 134.5 mmHg to 130.4 mmHg (P = .02), and diastolic blood pressure from 76.2 mmHg to 73.3 mmHg (P = .04).

This effect on blood pressure "should be considered" because it means that "antihypertensive treatment might need to be reviewed," Trescoli-Serrano commented.

There were no significant changes in estimated glomerular filtration rate (eGFR), microalbuminuria, lipid profile, hematocrit, or heart rate, although there were positive trends in both renal function and lipid profiles.

No patient had a fall, volume depletion symptoms, or diabetic ketoacidosis.

However, 38% of patients were treated for urinary-genital infections and 8% had to stop taking the SGLT2 inhibitor because of such infections.

That percentage seemed unusually high and was "an outlier, not the general experience," commented Dagogo-Jack, chief of the Division of Endocrinology, Diabetes and Metabolism at the University of Tennessee Health Science Center, Memphis. Dagogo-Jack is a consultant for Merck, Janssen, and Sanofi and owns stock in Dance Pharma and Jana Care.

He noted that infections with SGLT2 inhibitors are more often genital fungal than urinary tract infections, but the latter are more common in people with diabetes overall, and the study wasn't randomized, so this might explain the finding.

New nonfatal cardiovascular events occurred in 22% of the patients, mainly cerebrovascular disease during the treatment period. Of those, 66% had had a previous cardiovascular event prior to starting on SGLT2 inhibitors.

Severe hypoglycemia was recorded in one patient, who was also taking insulin. Overall 10% died, mainly because of neoplastic causes.

"Long-term treatment with SGLT2 inhibitors are safe and effective when added to not well-controlled elderly type 2 diabetes patients in a real-world experience," Trescoli-Serrano concluded.

International Diabetes Federation 2019 Congress. December 4, 2019.

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