Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Diabetes, Obesity and Dietetic Center, Garibaldi Hospital, Via Palermo 636, 95122, Catania, Italy.
Prim Care Diabetes. 2021 Apr;15(2):283-288. doi: 10.1016/j.pcd.2020.10.002. Epub 2020 Oct 28.
To evaluate efficacy, renal safety and tolerability of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in a cohort of patients with type 2 diabetes (T2DM) aged ≥65 years.
We retrospectively evaluated 364 elderly individuals with T2DM starting SGLT2i from June 2015 to June 2018. Patients were divided into 2 subgroups based on median age (70 years). Linear mixed effect models were used to estimate changes in glycated hemoglobin (HbA1c), body mass index (BMI), and glomerular filtration rate (eGFR). SGLT2i discontinuation rate and causes of treatment interruption were also recorded.
A significantly higher percentage of patients achieved HbA1c <7.5% (46.7% vs. 31.6%, p < 0.01) and <8.0% (68.9% vs. 47.2%, p < 0.01) compared to baseline. Each year of therapy was associated with an average HbA1c decrease of 0.34% (p < 0.01) and BMI loss of 0.71 kg/m (p < 0.01), without significant interaction across age classes. In the younger group eGFR increased by 1.02 ml/min/year, while in the older group it declined by 0.42 ml/min/year (p = 0.08). Overall discontinuation rate during the follow-up period was similar across age groups (34.2% vs. 36.1%, long-rank p = 0.26). Genitourinary infections were the most frequent cause of treatment interruption (15.8% vs. 17.2%, p = 0.69) in both study groups, while persistent eGFR decline (4.4%) and orthostatic hypotension (1.7%) were only present in older age class.
Efficacy, renal safety and tolerability of SGLT2i were similar in people >70 compared to 65-70 years of age, suggesting that a wider use should not be worried even in the elderly. However, some caution must be paid to the occurrence of persistent eGFR decline and orthostatic hypotension, especially in patients >70 years old.
评估钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2i）在年龄≥65 岁的 2 型糖尿病（T2DM）患者中的疗效、肾脏安全性和耐受性。
我们回顾性评估了 2015 年 6 月至 2018 年 6 月期间开始使用 SGLT2i 的 364 名老年 T2DM 患者。根据中位年龄（70 岁）将患者分为 2 个亚组。线性混合效应模型用于估计糖化血红蛋白（HbA1c）、体重指数（BMI）和肾小球滤过率（eGFR）的变化。还记录了 SGLT2i 的停药率和治疗中断的原因。
与基线相比，有更高比例的患者达到 HbA1c<7.5%（46.7% vs. 31.6%，p<0.01）和<8.0%（68.9% vs. 47.2%，p<0.01）。每年的治疗与 HbA1c 平均降低 0.34%（p<0.01）和 BMI 降低 0.71 kg/m（p<0.01）相关，且在年龄组之间无显著交互作用。在年轻组中，eGFR 每年增加 1.02 ml/min/year，而在老年组中则每年下降 0.42 ml/min/year（p=0.08）。在随访期间，两个年龄组的总体停药率相似（34.2% vs. 36.1%，长时间秩检验 p=0.26）。尿路感染是两组中最常见的治疗中断原因（15.8% vs. 17.2%，p=0.69），而持续性 eGFR 下降（4.4%）和直立性低血压（1.7%）仅见于老年组。
与 65-70 岁的患者相比，SGLT2i 在>70 岁的人群中的疗效、肾脏安全性和耐受性相似，这表明即使在老年人中，也不应担心更广泛的使用。然而，必须注意持续性 eGFR 下降和直立性低血压的发生，尤其是在>70 岁的患者中。
