The effect of SGLT2 inhibitors on volume-related laboratory and metabolic parameters in older adults: a 6-month retrospective study

Aims: The aim of this study was to evaluate the effects of sodium-glucose cotransporter-2 (SGLT2) inhibitor therapy on volume-related laboratory parameters and vital signs, such as blood pressure and pulse rate, in geriatric patients with type 2 diabetes who have no comorbidities. Methods: This retrospective study included patients aged 65 years and over who had been diagnosed with Type 2 diabetes only and were starting SGLT2 inhibitor therapy for the first time. Patients with chronic conditions such as hypertension, cardiovascular disease, or chronic kidney disease, and those taking diuretics, were excluded from the study. Patients’ hemoglobin, hematocrit, blood urea nitrogen (BUN), creatinine, BUN/creatinine ratio, electrolyte and uric acid levels, as well as systolic and diastolic blood pressure and pulse rates, were recorded prior to SGLT2 inhibitor treatment and at 3 and 6 months into treatment. In the statistical analysis, appropriate parametric or non-parametric tests were used for repeated measurements. Results: Among 206 patients, 190 received dapagliflozin and 16 empagliflozin. Body weight, body-mass index (BMI), waist circumference, and blood pressure decreased significantly (p<0.001). Renal function markers (urea, creatinine, and blood urea nitrogen [BUN]/creatinine ratio) increased, whereas estimated glomerular filtration rate (eGFR) decreased. Sodium and albumin levels increased, while uric acid levels decreased (all p<0.001). Significant reductions were observed in glucose and HbA1c levels. Triglycerides (TG) decreased, whereas total cholesterol, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol increased. Hemoglobin, hematocrit, red blood cell (RBC), and platelet counts increased significantly (p<0.001). Most changes were more pronounced during the first 3 months and then approached a plateau. Conclusion: The use of SGLT2 inhibitors in geriatric patients without comorbidities has resulted in positive changes in body weight, blood pressure, and hematological parameters, as well as improved glycemic control. In particular, the effects on volume-related parameters highlight the need for close monitoring at the start of treatment in the geriatric population. These findings demonstrate that SGLT2 inhibitors are a safe and effective treatment option in the geriatric population, but that they must be supported by monitoring and follow-up.