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SGLT2 inhibitors and geriatric syndromes in older adults with type 2 diabetes: A real-world cohort study

Chun-Ying Lee1, Tzu-Jung Fang2, Chun-Hao Jen3

  • 1Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Center for Metabolic Disorder and Obesity, Kaohsiung Medical University, Kaohsiung, Taiwan; Precision Sports Medicine and Health Promotion Center, Kaohsiung Medical University, Kaohsiung, Taiwan; Research Center for Precision Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.

Journal of the Formosan Medical Association = Taiwan Yi Zhi
|May 22, 2026
PubMed
Abstract

Insights

Sodium-glucose cotransporter-2 (SGLT2) inhibitors are safe for older adults with type 2 diabetes mellitus (T2DM). These medications reduce risks of geriatric syndromes, hospitalization, and mortality in this population.

Area of Science:

  • Geriatric Medicine
  • Endocrinology
  • Cardiology

Background:

  • Concerns exist regarding SGLT2 inhibitors exacerbating geriatric syndromes in older adults with T2DM.
  • This study investigated the association between SGLT2 inhibitors and geriatric syndromes, hospitalization, and mortality.

Purpose of the Study:

  • To evaluate the safety and efficacy of SGLT2 inhibitors in older adults with T2DM.
  • To assess the impact of SGLT2 inhibitors on geriatric syndromes, all-cause hospitalization, and all-cause mortality.

Main Methods:

  • A 1:1 propensity score-matched cohort study using TriNetX data (2014-2020).
  • Included adults aged ≥65 years with T2DM, comparing SGLT2 inhibitors to DPP-4 inhibitors.
  • Primary outcomes: incident geriatric syndromes; secondary outcomes: hospitalization and mortality at 6 months, 1 year, and 5 years.

Main Results:

  • SGLT2 inhibitor use was linked to reduced risks of delirium, cognitive impairment, and pressure injuries.
  • Five-year hazard ratios showed decreased all-cause hospitalization (0.81) and mortality (0.65).
  • Consistent findings across subgroups based on age, sex, HbA1c, heart disease, and renal function.

Conclusions:

  • SGLT2 inhibitors are not associated with increased geriatric syndromes in older adults with T2DM.
  • SGLT2 inhibitors demonstrate reduced risks of geriatric outcomes, hospitalization, and mortality.
  • Supports SGLT2 inhibitor use within geriatric assessment frameworks for T2DM patients.
Keywords:
DPP-4 inhibitorGeriatric syndromeHospitalizationMortalityOlder adultsSGLT2 inhibitorsType 2 diabetes

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