The prevalence of diabetes mellitus (DM) is rising globally, especially among older adults, creating unique management challenges due to increased susceptibility to adverse drug reactions and multiple comorbidities. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have shown cardioprotective and renoprotective effects, but their safety and efficacy in aged populations, particularly those aged ≥ 75 years, remain under-explored. In this multi-center retrospective cohort study, we analyzed data from the Chang Gung Memorial Hospital Medical System in Taiwan, focusing on diabetic patients aged ≥ 75 years between 2012 and 2021. Initially, 33,964 patients were screened. After serial exclusions, a total of 3000 patients were included, with 1,000 in the SGLT2i group and 2,000 in the non-SGLT2i group, matched 1:2 by key variables. Clinical outcomes, including all-cause mortality, cardiovascular (CV) death, heart failure (HF) hospitalization, worsening renal function, and urinary tract infections (UTIs), were compared between groups over a maximum 5-year follow-up, with a minimum follow-up of one year. The final cohort had a mean age of 83.5 ± 4.2 years, with 78.7% of patients aged 75–85 and 6.6% aged > 90 years. After inverse probability of treatment weighting (IPTW), SGLT2i use was associated with a significant reduction in all-cause mortality (6.1% vs. 11.3%, p 85 years). SGLT2i treatment in DM patients aged ≥ 75 years seems associated with improved all-cause mortality and renal outcomes without increasing the risk of UTIs. The effectiveness of SGLT2i may decrease in very aged patients (> 85 years), suggesting careful patient selection is required in this subgroup.
Huang et al. (Sat,) studied this question.