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BACKGROUND: Sodium-glucose cotransporter-2 (SGLT2) inhibitors provide cardiorenal benefits in type 2 diabetes mellitus (T2DM), but concerns persist regarding potential exacerbation of geriatric syndromes through osmotic diuresis, volume depletion, and catabolic weight loss in older adults. This study evaluated the association between SGLT2 inhibitors and geriatric syndromes, all-cause hospitalization, and all-cause mortality. METHODS: A cohort study was conducted using data from TriNetX global health research network between January 1, 2014 to December 31, 2020. Adults aged ≥65 years with T2DM newly initiated on SGLT2 inhibitors or dipeptidyl peptidase-4 (DPP-4) inhibitors were included. Propensity score matching (1:1) was performed to minimize confounding and reduce bias from unequal distribution of baseline characteristics and treatment effects. Primary outcomes were incident geriatric syndromes; secondary outcomes were all-cause hospitalization and mortality at 6 months, 1 year, and 5 years. RESULTS: After matching, 42,440 individuals were included in each group (mean age 71.4 years, 60% male). SGLT2 inhibitor initiation was associated with lower risks of multiple geriatric syndromes, including delirium, cognitive impairment, and pressure injuries. Five-year hazard ratios were 0.81 (95% CI: 0.78-0.83) for all-cause hospitalization and 0.65 (95% CI: 0.62-0.69) for all-cause mortality. Findings remained consistent across subgroups stratified by age, sex, glycated hemoglobin (HbA1c) control, heart disease, and renal function. CONCLUSION: In older adults with T2DM, SGLT2 inhibitor use was not associated with increased geriatric syndromes but rather with lower risks of geriatric outcomes, all-cause hospitalization, and all-cause mortality, supporting their use within comprehensive geriatric assessment frameworks.
Lee et al. (2026) studied this question.