Efficacy and safety profile of SGLT2 inhibitors in the elderly: How is the benefit/risk balance?

Scheen, André; Bonnet, Fabrice

doi:10.1016/j.diabet.2023.101419

Cited by 17 publications

(4 citation statements)

References 107 publications

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“…In the present study, SGLT2i use resulted in a significantly deleterious effect against the incidence of ACS in users aged > 70 years relative to in users aged 65–70 years. The age-related differences in SGLT2i use can be attributed to differences in longevity, survival bias, and comorbidities (e.g., DM, hypertension, and chronic obstructive lung disease) between older and young patients [ 24 , 25 ]. Another reason is that the elderly are less likely to report having been offered SGLT2i therapy and more likely to decline compliance when offered [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

The association between SGLT2 inhibitors and new-onset acute coronary syndrome in the elderly: a population-based longitudinal cohort study

Lin,

Lee,

Cheng

et al. 2023

Diabetol Metab Syndr

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Background Several observational cohorts and meta-analytical studies on humans have shown that users of sodium-glucose cotransporter-2 inhibitors (SGLT2is) have a lower risk for new-onset acute coronary syndrome (ACS) than nonusers. However, some studies, including randomized clinical trials, reported the opposite results. This study aimed to investigate the impacts of a SGLT2i on new-onset ACS in a population. Methods We conducted a retrospective population-based cohort study involving 56,356 subjects who received SGLT2i therapy and 112,712 patients who did not receive SGLT2i therapy between May 1, 2016 and December 31, 2019. The outcome was the risk of new-onset ACS. Multivariable Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals for associations between SGLT2i use and ACS risk. Results A total of 670 and 1408 ACS events occurred in SGLT2i users and nonusers, respectively, during a follow-up of 3.7 years. SGLT2i use was associated with a nonsignificantly lower risk of ACS (adjusted HR 0.95, 95%confidence intervals (CI 0.87–1.04, P = 0.3218). We confirmed the robustness of these results through a propensity score 1:1 matching analysis. The results of the subgroup analysis of the subtype of the SGLT2i treatments were consistent with the main findings. An increased risk for the incidence of ACS in male and older (> 70 years) patients were also found. Conclusions In this population-based cohort study, we found that SGLT2i use is associated with a nonsignificantly decreased risk of ACS. No difference in the SGLT2i subtype was observed in subgroup analyses. However, the results of this study indicated an increased risk for the incidence of ACS in male and older (> 70 years) patients.

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Section: Discussionmentioning

confidence: 99%

The association between SGLT2 inhibitors and new-onset acute coronary syndrome in the elderly: a population-based longitudinal cohort study

Lin,

Lee,

Cheng

et al. 2023

Diabetol Metab Syndr

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“…SGLT2is can cause hypoglycemia, hypotension, volume depletion, lower-limb amputation, fractures, genital infection, urinary infections, and diabetic ketoacidosis with different frequencies of onset [ 145 ]. Several adverse events have been reported, whose incidence and severity might be increased in the elderly population [ 146 ]. The benefit/risk ratio of SGLT2is in older patients with type 2 diabetes was investigated.…”

Section: Safety Profile Of Sglt2ismentioning

confidence: 99%

“…Consistent results showed a similar relative risk reduction in CV mortality and HF with SGLT2is, independent of age. The safety profile of SGLT2is appeared comparable in older versus younger patients [ 146 ]. Caution may be required in very old frail patients, especially those exposed to an increased risk of volume depletion.…”

Section: Safety Profile Of Sglt2ismentioning

confidence: 99%

Significance of Endothelial Dysfunction Amelioration for Sodium–Glucose Cotransporter 2 Inhibitor-Induced Improvements in Heart Failure and Chronic Kidney Disease in Diabetic Patients

et al. 2023

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Beyond lowering plasma glucose levels, sodium–glucose cotransporter 2 inhibitors (SGLT2is) significantly reduce hospitalization for heart failure (HF) and retard the progression of chronic kidney disease (CKD) in patients with type 2 diabetes. Endothelial dysfunction is not only involved in the development and progression of cardiovascular disease (CVD), but is also associated with the progression of CKD. In patients with type 2 diabetes, hyperglycemia, insulin resistance, hyperinsulinemia and dyslipidemia induce the development of endothelial dysfunction. SGLT2is have been shown to improve endothelial dysfunction, as assessed by flow-mediated vasodilation, in individuals at high risk of CVD. Along with an improvement in endothelial dysfunction, SGLT2is have been shown to improve oxidative stress, inflammation, mitochondrial dysfunction, glucotoxicity, such as the advanced signaling of glycation end products, and nitric oxide bioavailability. The improvements in endothelial dysfunction and such endothelium-derived factors may play an important role in preventing the development of coronary artery disease, coronary microvascular dysfunction and diabetic cardiomyopathy, which cause HF, and play a role in retarding CKD. The suppression of the development of HF and the progression of CKD achieved by SGLT2is might have been largely induced by their capacity to improve vascular endothelial function.

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“…En conclusión, y siguiendo también las recomendaciones de otros expertos, en fragilidad leve, moderada y grave con IC y DM2, la biterapia metformina + iSGLT-2 se podría considerar como el primer escalón de tratamiento 96 , siempre con precaución en estados más avanzados de fragilidad por riesgo de hipotensión, CAD y fracturas 80 .…”

Section: Diabetes Práctica Actualización Y Habilidades En Atención Pr...unclassified

Recomendaciones en el manejo de la hiperglucemia en pacientes con diabetes mellitus según grado de fragilidad

Romera Liébana

2023

diabetpract

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El manejo de la fragilidad en la diabetes mellitus tipo 2 (DM2) emerge como un desafío para la atención sanitaria actual. La interacción de estos dos factores de riesgo complejos requiere un enfoque holístico y personalizado para garantizar resultados óptimos en la salud a medida que la población envejece y la prevalencia de ambas entidades cada vez está más presente. Por este motivo, el cribaje de fragilidad en personas con DM2 (PcDM) es imprescindible para identificar pacientes potencialmente frágiles, en los que evaluar el grado de fragilidad a través de una valoración geriátrica integral (VGI) para poder implementar estrategias terapéuticas, farmacológicas y no farmacológicas individualizadas, que aborden sus necesidades físicas, sociales y psicoemocionales para ofrecer la mayor calidad de vida.

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Efficacy and safety profile of SGLT2 inhibitors in the elderly: How is the benefit/risk balance?

Cited by 17 publications

References 107 publications

The association between SGLT2 inhibitors and new-onset acute coronary syndrome in the elderly: a population-based longitudinal cohort study

The association between SGLT2 inhibitors and new-onset acute coronary syndrome in the elderly: a population-based longitudinal cohort study

Significance of Endothelial Dysfunction Amelioration for Sodium–Glucose Cotransporter 2 Inhibitor-Induced Improvements in Heart Failure and Chronic Kidney Disease in Diabetic Patients

Recomendaciones en el manejo de la hiperglucemia en pacientes con diabetes mellitus según grado de fragilidad

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