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Assessing 1-year sodium-glucose co-transporter-2 inhibitor tolerance in older adults

Stephanie M Schafer1,2, Marcia C Zeithamel2, Nancee V Waterbury2

  • 1Louis Stokes VA Medical Center - Pharmacy, 10701 East Boulevard, Cleveland, IA 44106-1702, USA.

Age and Ageing
|October 29, 2024
PubMed
Abstract

Insights

Sodium-glucose co-transporter-2 (SGLT2) inhibitor intolerance did not significantly increase with age until 85 years. Older adults aged 85 and above showed a higher risk of discontinuation, warranting closer monitoring.

Area of Science:

  • Pharmacology
  • Geriatrics
  • Clinical Medicine

Background:

  • Limited evidence exists on sodium-glucose co-transporter-2 (SGLT2) inhibitor tolerability in older adults due to trial underrepresentation.
  • This study investigates age-related SGLT2 inhibitor intolerance and associated risk factors.

Purpose of the Study:

  • To determine the relationship between age and SGLT2 inhibitor intolerance.
  • To identify additional factors contributing to SGLT2 inhibitor intolerance in older populations.

Main Methods:

  • Retrospective observational study of Veterans Health Administration patients initiating SGLT2 inhibitors (2013-2021).
  • One-year discontinuation was used as a proxy for intolerance.
  • Log-binomial regression analyzed relative risk across age groups, adjusting for confounders.

Main Results:

  • Overall, 26.1% of 232,495 patients discontinued SGLT2 inhibitors within one year.
  • Discontinuation rates increased with age, notably in those ≥85 years (34.9%).
  • Patients 75-84 years had an 8% increased risk, and those ≥85 years had a 21% increased risk of discontinuation compared to <65 years.

Conclusions:

  • No clinically significant differences in SGLT2 inhibitor intolerance were found in patients up to 84 years old.
  • Initiating SGLT2 inhibitors in patients 85 years and older requires closer follow-up.
  • Female sex, advanced kidney disease, underweight status, and history of infections were associated with increased discontinuation risk.
Keywords:
agedolder peoplerisk factorssodium-glucose transporter 2 inhibitors

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