SGLT2 Inhibitors and Safety in Older Patients

Heart Fail Clin. 2022 Oct;18(4):635-643. doi: 10.1016/j.hfc.2022.03.002.

Abstract

SGLT2 inhibitors (SGLT2i) are effective in the management of diabetes and in reducing adverse cardiovascular and renal outcomes. Randomized clinical trials demonstrated safety and tolerability in older adults. Adverse effects associated with SGLT2i are impacted by patient frailty, comorbidities, and concomitant medication use and, therefore, must be thoroughly evaluated before initiating treatment. The risk of volume depletion, hypoglycemia, genital infections, and diabetic ketoacidosis can be minimized by appropriate patient selection, patient education, and early symptom recognition. Limited data exists regarding the risk of urinary tract infections, fractures, and amputations in the elderly treated with SGLT2i and routine monitoring is recommended.

Keywords: Diabetic ketoacidosis; Elderly; Fractures; Genital infections; Hypoglycemia; SGLT-2 inhibitors; Safety; Volume depletion.

Publication types

  • Review

MeSH terms

  • Aged
  • Diabetes Mellitus, Type 2* / drug therapy
  • Diabetic Ketoacidosis* / chemically induced
  • Diabetic Ketoacidosis* / complications
  • Diabetic Ketoacidosis* / drug therapy
  • Humans
  • Hypoglycemia* / chemically induced
  • Hypoglycemia* / complications
  • Hypoglycemia* / drug therapy
  • Hypoglycemic Agents / adverse effects
  • Sodium-Glucose Transporter 2 Inhibitors* / adverse effects

Substances

  • Hypoglycemic Agents
  • Sodium-Glucose Transporter 2 Inhibitors