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SGLT2 Inhibitors in Elderly Patients: Clinical Perspectives from Metabolic and Cardiorenal Protection to
Iris Parrini1, Roberto Ceravolo2, Carmelo Massimiliano Rao3
1Cardiology Unit, Koelliker Hospital, 10134 Torino, Italy.
Journal of Clinical Medicine
|June 26, 2026
Summary
Sodium-glucose co-transporter-2 inhibitors (SGLT2i) offer significant cardio-renal protection, particularly reducing heart failure hospitalizations in older adults. Real-world use in the elderly is limited by tolerability and cost concerns.
Area of Science:
- Geriatric Medicine
- Cardiology
- Endocrinology
Background:
- Diabetes and heart failure prevalence increase with age, exacerbating cardiovascular and renal risks.
- Elderly patients present unique challenges like frailty and multimorbidity, complicating treatment.
- Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are vital for cardio-renal-metabolic protection.
Purpose of the Study:
- To review the pharmacological basis and evidence for SGLT2i use in older adults.
- To explore SGLT2i mechanisms beyond glucose lowering.
- To address practical challenges of SGLT2i implementation in geriatrics.
Main Methods:
- Analysis of pharmacological rationale for SGLT2i in the elderly.
- Review of pivotal trial data focusing on geriatric populations.
- Assessment of real-world usage barriers and benefits.
Main Results:
- SGLT2i consistently reduce heart failure hospitalizations.
- Cardiovascular death and MACE benefits vary based on patient risk and trial design.
- Limited real-world SGLT2i use in elderly due to tolerability, polypharmacy, and cost.
Conclusions:
- SGLT2i demonstrate significant cardio-renal benefits in older adults, extending beyond glycemic control.
- Further research and practical strategies are needed to optimize SGLT2i use in geriatric patients.
- Addressing tolerability and cost barriers is crucial for wider geriatric implementation.
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