Safety and effectiveness of SGLT2 inhibitors in a UK population with type 2 diabetes and aged over 70 years: an instrumental variable approach – published online 05/06/2024

Laura M. Güdemann, Katie G. Young, Nicholas J. M. Thomas, Rhian Hopkins, Robert Challen, Angus G. Jones, Andrew T. Hattersley, Ewan R. Pearson, Beverley M. Shields, Jack Bowden, John M. Dennis, Andrew P. McGovern, on behalf of the MASTERMIND consortium

Real-world use of sodium−glucose cotransporter 2 (SGLT2) inhibitors in older adults with type 2 diabetes is increasing, but these individuals are typically excluded from clinical trials. In this issue, Güdemann et al (https://doi.org/10.1007/s00125-024-06190-9) use a large UK primary care database over 2013–2020 to compare the safety and effectiveness of SGLT2 inhibitors to dipeptidyl peptidase-4 inhibitors in people with type 2 diabetes aged 70 or over. The authors use an instrumental variable approach to allow causal estimation of treatment effects. The study provides evidence that SGLT2 inhibitors effectively reduce HbA_1c levels and weight in this older age group. SGLT2 inhibitor use was associated with an increased risk of genital infections and diabetic ketoacidosis (DKA), although the incidence of DKA was low in absolute terms. Importantly, no increased risks for falls, selected osmotic symptoms or lower limb amputation were observed. The authors conclude that SGLT2 inhibitors can be an effective treatment for older adults with type 2 diabetes, although clinicians should be mindful of the heightened risks for certain adverse events.