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Use of SGLT2 Inhibitors in Older Adults: Scientific Evidence and Practical Aspects

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Abstract

Diabetes mellitus (DM) is an increasingly prevalent condition that has a significant impact on health systems worldwide, particularly in older people. It is estimated that 30% of people aged > 65 years fulfil the diagnostic criteria for DM, with 90% having type 2 DM (T2DM). Generally, specific guidelines for the treatment of T2DM in older people address in a very limited manner the use of more recent therapies, such as sodium–glucose co-transporter-2 inhibitors (SGLT2i), which have important benefits for older people, such as a low risk of hypoglycemia, reduction of cardiovascular and renal risk, and an insulin-independent mechanism, allowing its use in disease of any duration. The SGLT2i class is well-tolerated, though some caution is also suggested, including adjustment of concomitant therapies, such as insulin and antihypertensives, especially loop diuretics. This review discusses the pathophysiological characteristics of the older patient with T2DM and evaluates the main benefits of and cautions for the use of SGLT2i in this population.

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Fig. 1

Adapted from Custódio Jr et al. [34]

Fig. 2

Adapted from Verma et al. [44]

Fig. 3

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Authors and Affiliations

  1. Department of Family Health, Medical School of Bahia, Federal University of Bahia, Salvador, BA, Brazil

    Joaquim Silva Custódio Jr

  2. Hospital Português, Salvador, BA, Brazil

    Joaquim Silva Custódio Jr

  3. Department of Clinical Medicine, Federal University of Ceará, Fortaleza, CE, Brazil

    Jarbas Roriz-Filho

  4. AstraZeneca Brazil, Cotia, SP, Brazil

    Catarina Addobbati Jordão Cavalcanti & Amanda Martins

  5. Clinic Endocrinology Unit, Department of Internal Medicine, Santa Casa de São Paulo School of Medical Sciences, São Paulo, SP, Brazil

    João Eduardo Nunes Salles

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  1. Joaquim Silva Custódio Jr
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Correspondence to Catarina Addobbati Jordão Cavalcanti.

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Funding for the preparation of this manuscript was received from AstraZeneca.

Conflict of interest

Joaquim Custódio has served as a speaker for AstraZeneca, Boehringer Ingelheim, and Eli Lilly. João Eduardo Nunes Salles has served as a speaker and has received consulting fees from Abbot, AstraZeneca, Boehringer Ingelheim, Eli Lilly, MSD, and Novo Nordisk. Jarbas Roriz has served as a speaker for AstraZeneca. Catarina Cavalcanti is an employee of AstraZeneca. Amanda Martins was a previous employee of AstraZeneca.

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Custódio, J.S., Roriz-Filho, J., Cavalcanti, C.A.J. et al. Use of SGLT2 Inhibitors in Older Adults: Scientific Evidence and Practical Aspects. Drugs Aging 37, 399–409 (2020). https://doi.org/10.1007/s40266-020-00757-y

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