Endocrinology · General Practice · 2 h ago
SGLT2 Inhibitors and Safety in Adults Aged 75 Years or Older
A population-based, active-comparator new-user cohort study in British Columbia compared SGLT2 inhibitor and DPP-4 inhibitor initiation in 6,286 adults aged 75 years or older with type 2 diabetes. SGLT2 inhibitor use was associated with lower risks of acute kidney injury and all-cause hospitalization; several other safety estimates were imprecise.
- Cohort included 6,286 adults aged 75 years or older.
- SGLT2 inhibitor use was associated with less acute kidney injury.
- Hospitalization risk was also lower than with DPP-4 inhibitors.
- Several safety estimates remained compatible with benefit or harm.
Researchers used administrative health databases in British Columbia, Canada, to conduct a population-based, active-comparator, new-user cohort study. The analysis included adults aged 75 years or older with type 2 diabetes who initiated an SGLT2 inhibitor or DPP-4 inhibitor between January 2021 and December 2023. Outcomes included infections, diabetic ketoacidosis, acute kidney injury, falls, fractures and all-cause hospitalization. The study compared 4,997 SGLT2 inhibitor initiators (median age 79; 37% women) with 1,289 DPP-4 inhibitor initiators (median age 82; 50% women), using propensity score weighting and Cox regression.
Compared with DPP-4 inhibitor initiation, SGLT2 inhibitor initiation was associated with lower risk of acute kidney injury (hazard ratio 0.76, 95% CI 0.60–0.95) and all-cause hospitalization (0.87, 0.77–0.98). There was no observed difference in infection risk. The study also found no difference in diabetic ketoacidosis, falls or fractures, but confidence intervals for these outcomes were compatible with both benefit and harm.
The findings provide real-world safety data for older adults, but the observational design cannot establish causality. The authors conclude that SGLT2 inhibitors may be considered as a treatment option in this age group; estimates for some outcomes remain imprecise.
In practice
For adults aged 75 years or older with type 2 diabetes, this cohort found no observed increase in the measured safety outcomes with SGLT2 inhibitor initiation compared with DPP-4 inhibitor initiation; acute kidney injury and all-cause hospitalization were less frequent in the SGLT2 inhibitor group. These observational findings may inform treatment discussions but do not establish that SGLT2 inhibitors caused the lower risks. Estimates for diabetic ketoacidosis, falls and fractures were imprecise, and the results do not remove the need to consider individual patient factors.
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Diabetes Care: Safety of Sodium–Glucose Cotransporter 2 Inhibitors in Older Adults With Type 2 Diabetes: A Cohort Study ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.