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Benefits vs risks: SGLT-2 inhibitors in older adults living with frailty: a retrospective study from a university hospital

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Abstract

Purpose

Sodium-glucose transporter-2 (SGLT-2) inhibitors are second-line therapy in type 2 diabetes mellitus (DM) with or without metformin based on glycemic needs. However, the safety and efficacy of SGLT-2 inhibitors in older adults are controversial, and not sufficient evidence is present in the use of older adults with DM.

Methods

Forty-one patients with DM, who were started on a new SGLT-2 inhibitor between 2019 and 2021, were included in the study. Patients’ records were reviewed retrospectively. Demographic features, components of comprehensive geriatric assessment, laboratory values including glycosylated hemoglobin (HbA1c), renal functions, and urinary analysis were recorded. Complications regarding dehydration, genitourinary infections, acute renal failure, and emergency department admission with euglycemic ketoacidosis or serious infection related to SGLT-2 inhibitors were also documented.

Results

The mean age of participants was 69 ± 5.3 years, and 20 patients were living with frailty via the clinical frailty scale. The median follow-up time was 5.0 (3.0–7.0) months. The mean ± SD HbA1c before SGLT-2 inhibitors was 8.56 ± 2.12%, and after treatment, it was 8.13 ± 1.25% in patients living with frailty (p > 0.05). HbA1c level before SGLT-2 inhibitor treatment was observed as 8.87 ± 2.08%, and it was 7.44 ± 0.87% after the treatment among non-frail patients (p < 0.05). Complication rates related to SGLT-2 inhibitors were significantly higher in the patients living with frailty than in the non-frail patients (40% vs 9.5%, respectively p < 0.05).

Conclusion

Patients living with frailty are more vulnerable to adverse effects of SGLT-2 inhibitors, and their benefits are limited. Therefore, it should be used with caution in older adults with frailty. Longitudinal prospective studies should be conducted to support our findings.

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Data Availability

The data that support the findings of this study are available from the corresponding author, [M.G.O], upon reasonable request.

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Authors and Affiliations

  1. Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, 06230, Sıhhıye, Ankara, Turkey

    Merve Güner Oytun, Serdar Ceylan, Meltem Koca, Yelda Öztürk, Arzu Okyar Baş, Cafer Balcı, Burcu Balam Doğu, Meltem Gülhan Halil & Mustafa Cankurtaran

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  1. Merve Güner Oytun
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  2. Serdar Ceylan
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  3. Meltem Koca
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  6. Cafer Balcı
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Correspondence to Merve Güner Oytun.

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Ethical approval

The study was approved by the local ethics committee of our university. The study protocol followed the Declaration of Helsinki.

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Informed consent was not applicable since the study design was retrospective.

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The authors declare no competing interests.

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Oytun, M.G., Ceylan, S., Koca, M. et al. Benefits vs risks: SGLT-2 inhibitors in older adults living with frailty: a retrospective study from a university hospital. Int J Diabetes Dev Ctries 43, 758–764 (2023). https://doi.org/10.1007/s13410-023-01175-7

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