SGLT2 inhibitors provide cardio-renal-metabolic protection in older adults, most consistently reducing heart failure hospitalizations, despite limited real-world implementation.
Does SGLT2i therapy improve clinical outcomes in elderly patients with diabetes and heart failure?
This review highlights the pharmacological rationale and evidence for SGLT2i therapy in older adults, emphasizing their role in reducing heart failure hospitalizations despite underutilization in real-world settings.
The prevalence of diabetes and heart failure rises sharply with age, and their coexistence amplifies cardiovascular and renal risk. Elderly patients display unique clinical and biological profiles characterised by frailty, multimorbidity, and pharmacodynamic variability that challenge conventional treatment strategies. Sodium–glucose co-transporter-2 inhibitors (SGLT2i) have emerged as a cornerstone of cardio–renal–metabolic protection, with the most consistent cardiovascular benefit being the reduction in heart failure hospitalisation, whereas effects on cardiovascular death and major adverse cardiovascular events vary according to baseline cardiovascular risk, heart failure phenotype, diabetic status, and trial design. However, real-world use among the elderly remains limited due to concerns about tolerability, polypharmacy, and cost. This review analyses the pharmacological rationale and evidence base for SGLT2i therapy in older adults, highlighting mechanisms beyond glucose control, quantitative data from pivotal trials, and practical issues for geriatric implementation.
Parrini et al. (Fri,) conducted a review in Diabetes and heart failure. Sodium-glucose co-transporter-2 inhibitors (SGLT2i) was evaluated. SGLT2 inhibitors provide cardio-renal-metabolic protection in older adults, most consistently reducing heart failure hospitalizations, despite limited real-world implementation.