Diabetes Patients with Frailty more vulnerable to Adverse Effects related to SGLT-2 Inhibitors

The prevalence of type 2 diabetes mellitus (T2DM) is increasing globally, with the highest increases anticipated to be in older populations.

Examining benefits and risk of SGLT-2 inhibitors in older diabetes patients with frailty, researchers have found in a new study that SGLT-2 inhibitors were associated with significantly higher complication rates in the patients with frailty (40%) than in the non-frail patients (9.5%). Therefore SGLT-2 Inhibitors should be used with caution in older frail adults, suggested researchers. 

Based on glycemic needs of patients, Sodium-glucose transporter-2 (SGLT-2) inhibitors are used as a second-line therapy in type 2 diabetes mellitus (DM) either with or without metformin. But there is uncertainty on the safety and efficacy of SGLT-2 inhibitors in older adults, and there is no sufficient evidence on it's in the use of older adults with DM. 

By reviewing patients records retrospectively, forty-one patients with DM, who started a new SGLT-2 inhibitor between 2019 and 2021, were included in the study. 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.       

It was found that the he 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).

The researchers therefore concluded that 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.

For further reference log on to

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 (2023). https://doi.org/10.1007/s13410-023-01175-7