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SGLT2 Inhibitors and Safety in Older Patients

Rena Pollack1, Avivit Cahn2

  • 1The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; Department of Endocrinology and Metabolism, Hadassah-Hebrew University Medical Center, PO Box 12000, Jerusalem 91120, Israel.

Heart Failure Clinics
|October 10, 2022
PubMed

Insights

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) effectively manage diabetes and improve cardiovascular and renal outcomes. Careful patient evaluation is crucial to minimize potential adverse effects in older adults.

Area of Science:

  • Endocrinology
  • Cardiology
  • Nephrology

Background:

  • Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are established treatments for diabetes.
  • These agents offer significant benefits in reducing cardiovascular and renal adverse outcomes.

Purpose of the Study:

  • To evaluate the safety and tolerability of SGLT2 inhibitors in older adults.
  • To identify and mitigate risks associated with SGLT2i initiation in this population.

Main Methods:

  • Review of randomized clinical trials focusing on SGLT2i use in elderly populations.
  • Analysis of factors influencing adverse event profiles, including frailty, comorbidities, and polypharmacy.

Main Results:

  • SGLT2i demonstrated safety and tolerability in older adults.
  • Key risks include volume depletion, hypoglycemia, genital infections, and diabetic ketoacidosis, manageable through careful selection and education.
  • Limited data exists on urinary tract infections, fractures, and amputations, warranting routine monitoring.

Conclusions:

  • SGLT2i are safe and effective for older adults with diabetes when risks are proactively managed.
  • Individualized assessment and patient education are paramount for optimizing SGLT2i therapy in the elderly.
  • Further research and monitoring are recommended for specific adverse events in this demographic.
Keywords:
Diabetic ketoacidosisElderlyFracturesGenital infectionsHypoglycemiaSGLT-2 inhibitorsSafetyVolume depletion

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