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This study sought to examine the impact of sodium-glucose cotransporter-2 (SGLT2) inhibitors in frail or older people suffering from type 2 diabetes (T2D) and heart failure (HF).
SGLT2 inhibitors lower mortality and heart failure hospitalizations in older or frail adults with type 2 diabetes and heart failure, while having minimal impact on HbA1c or renal outcomes.
This study sought to examine the impact of sodium-glucose cotransporter-2 (SGLT2) inhibitors in frail or older people suffering from type 2 diabetes (T2D) and heart failure (HF).
Researchers explored Google Scholar, PubMed, Scopus, Cochrane CENTRAL, and Web of Science. Those randomized controlled trials (RCTs) and observational studies that compared SGLT2 inhibitors with placebo or other glucose-lowering therapies in adults over 65 years or frail individuals with T2D and HF were included. In this systematic review and meta-analysis, the data on glycated hemoglobin (HbA1c) changes and safety outcomes were pooled via a random-effects meta-analysis.
A total of 20 studies (22 reports; N = 77,083) were incorporated. SGLT2 inhibitors did not markedly reduce HbA1c (mean difference -0.13). However, they were linked with noticeable reductions in all-cause mortality (risk ratio [RR] 0.81), cardiac death (RR 0.80), and hospitalization for HF (RR 0.69). No vital benefits were observed for macrovascular events, renal outcomes, acute kidney injury, worsening HF, diabetic ketoacidosis, or atrial fibrillation. While adverse event data were limited, there was no considerable rise in the risk of diabetic ketoacidosis or acute kidney impairment.
In older or frail patients with T2D and HF, SGLT2 inhibitors reduce overall mortality and cardiovascular events, including HF-related hospitalizations and cardiac death, but do not appear to protect against macrovascular or renal complications.
Age and Ageing
Sodium-glucose cotransporter-2 inhibitors (SGLT2) in frail or older people with type 2 diabetes and heart failure: a systematic review and meta-analysis
Rami Aldafas et al.
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