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Expected Health Benefits of SGLT-2 Inhibitors and GLP-1 Receptor Agonists in Older Adults

Rahul S Dadwani1, Wen Wan2, M Reza Skandari3

  • 1Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.

MDM Policy & Practice
|July 26, 2023
PubMed

Insights

Older adults with type 2 diabetes (T2D) generally benefit from glucagon-like peptide 1 receptor-agonists (GLP1RA) and sodium-glucose cotransporter 2 inhibitors (SGLT2I). However, benefits are not significant for those with less than four years of life expectancy.

Area of Science:

  • Gerontology
  • Endocrinology
  • Pharmacology

Background:

  • Older adults with type 2 diabetes (T2D) were underrepresented in trials for GLP1RA and SGLT2I.
  • Health benefits of GLP1RA and SGLT2I are uncertain in this population.

Purpose of the Study:

  • To assess the impact of age, health status, and life expectancy on T2D medication benefits.
  • Evaluate GLP1RA and SGLT2I effectiveness in older adults with T2D.

Main Methods:

  • Utilized the UKPDS model, calibrated with a geriatric prognostic index for improved mortality prediction.
  • Simulated lifetime health outcomes for adults aged 65+ with T2D using NHANES data.
  • Compared GLP1RA/SGLT2I use against no additional medication, measuring complications, life-years (LYs), and quality-adjusted life-years (QALYs).

Main Results:

  • GLP1RA and SGLT2I use predicted significant health benefits (0.29 LY and 0.26 LY, respectively) for the general older adult population.
  • Benefits diminished in subgroups with shorter life expectancies; gains were minimal (<0.05 LY) for those with <4 years.
  • Injectable GLP1RA use showed a slight reduction in QALYs (-0.03) due to disutility.

Conclusions:

  • GLP1RA and SGLT2I offer substantial benefits for many older adults with T2D.
  • Benefits are not clinically significant for patients with less than four years of life expectancy.
  • Life expectancy and patient preferences (e.g., injectable vs. oral) are crucial for prescribing decisions.
Keywords:
GLP-1 receptor agonistsolder adultssimulation modeling SGLT-2 inhibitorstype 2 Diabetes

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