In the Lancet recently Bellary et al, 2023 has stressed the benefits of SGLT2 inhibitors in the elderly.
Sodium glucose co-transporter 2 (SGLT2) inhibitors were initially licensed as glucose lowering agents for the treatment of type 2 diabetes. Subsequent studies, aimed primarily at showing cardiovascular and renal safety, reported other benefits, including reductions in hospitalisation for heart failure, and improved renal outcomes.
Because of these characteristics, SGLT2 inhibitors are now recommended as important treatment options in patients with type 2 diabetes, proteinuric chronic kidney disease (due to diabetes or not), or heart failure.
However, despite their expanding indications, SGLT2 inhibitor uptake has not been consistent across all age groups. Concerns relating to potential adverse effects and insufficient safety data due to poor representation of older adults in clinical trials are probably major contributors to the relatively low prescription rates in older adults,
Recently in The Lancet Healthy Longevity, Pratley et al report on a further analysis of data from the VERTIS-CV study. The authors assessed cardiorenal outcomes, kidney function, and other safety measures with the SGLT2 inhibitor ertugliflozin versus placebo, in adults aged 65 years and older compared with those younger than 65 years.
A separate post-hoc analysis of 903 patients aged 75 years and older was also included. Pratley and colleagues report that overall cardiovascular and renal outcomes in patients treated with ertugliflozin, including reduction in hospitalisation for heart failure and exploratory composite kidney outcomes, were similar across all age groups. The study provides much needed safety data on the use of SGLT2 inhibitors in older adults.
In older adults in particular, the use of SGLT2 inhibitors (and GLP-1 receptor agonists) is still outweighed by sulfonylurea and insulin prescriptions (in the study above, almost half of all older adults were on insulin and more than 40% were on sulfonylureas at baseline) despite the obvious risk of hypoglycaemia. High sulfonylurea use presumably relates to cost in low-income countries, but this is less of an argument in high income countries. Tackling existing gaps in knowledge and addressing clinical inertia is paramount to resolve this discrepancy.
