medwireNews: Among older people with type 2 diabetes, use of sodium-glucose cotransporter (SGLT)2 inhibitors is associated with improved glycemic control and a favorable safety profile, suggests research reported at the virtual 57th EASD Annual Meeting.
The real-world study included 450 adults at least 70 years of age with type 2 diabetes who started on an SGLT2 inhibitor, most commonly empagliflozin (47.6%), followed by dapagliflozin (41.6%), canagliflozin (9.1%), and ertugliflozin (1.7%).
Maria Lunati (ASST FatebeneFratelli-Sacco, Milan, Italy) said that participants experienced a significant reduction in average glycated hemoglobin (HbA1c), from 7.7% (61 mmol/mol) at baseline to 7.4% (57 mmol/mol) at 1 year. There was also a significant reduction in average fasting plasma glucose (FPG) levels over this period, from 157.7 to 140.6 mg/dL (8.75 to 7.8 mmol/L).
Just 14.4% of participants (n=65) discontinued SGLT2 inhibitor treatment after 1 year, and 60% of these discontinuations took place during the first 6 months. The presenter reported that “as expected, the most important cause was genitourinary tract infections,” accounting for 30.8% of discontinuations during the first half of the follow-up period and 42.3% in the second half.
Symptoms of volume depletion, seen in 10 patients, only occurred in the first 6 months of follow-up, and other factors such as intolerance, acute kidney injury, weight loss, or inefficacy accounted for only a small proportion of discontinuations. There were no cases of diabetic ketoacidosis or amputation.
Lunati observed that patients who discontinued SGLT2 inhibitor treatment were significantly older than those who continued therapy.
Less than 4% of participants needed hospitalization during the follow-up period; the main reason for admission was cardiovascular events (CV), occurring in 1.3% of individuals during the first 6 months and in 2.3% between 6 and 12 months.
The presenter said that estimated glomerular filtration rate (eGFR) values remained approximately stable over time, with average values of 74.5 mL/min per 1.73 m2 at baseline and 72.4 mL/min per 1.73 m2 at 1 year. A total of 48 people experienced a reduction of at least 20% and these people had a significantly longer disease duration, higher creatinine and urinary albumin levels, and higher rates of prior CV disease, compared with those individuals whose eGFR levels remained stable.
She concluded that although the SGLT2 inhibitor class “appears a valid therapeutic option” in older people, “[s]ome caution is suggested in frailer patients, with an intermediate remaining life expectancy.”
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EASD Annual Meeting; Sept 27–Oct 1, 2021