Vafeidou Kyriaki, Psoma Ourania, Dimakopoulos Georgios, Apostolidis Evangelos, Sarvani Anastasia, Gavriilaki Eleni, Doumas Michael, Tsimihodimos Vassilios, Kotsa Kalliopi, Koufakis Theocharis
Second Propaedeutic Department of Internal Medicine, Hippokration General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece.
Department of Internal Medicine, School of Medicine, University of Ioannina, 45110 Ioannina, Greece.
Pharmaceuticals (Basel). 2025 May 27;18(6):807. doi: 10.3390/ph18060807.
Current guidelines for the management of type 2 diabetes (T2D) strongly recommend the use of sodium-glucose cotransporter 2 inhibitors (SGLT2is) in patients with chronic kidney disease (CKD) to alleviate cardiorenal risk. However, the implementation of this guidance in daily practice remains limited. In a real-world setting, we evaluated the frequency of SGLT2i use in elderly people with T2D and CKD and compared patient profiles between SGLT2i users and non-users. We retrospectively analyzed the medical records of individuals over 65 years of age followed in outpatient internal medicine clinics in Greece. Demographic and laboratory parameters, comorbidity profiles, and medication use were recorded and compared between the SGLT2i and non-SGLT2i groups. The analysis included 135 patients with T2D and CKD, of whom the majority (57.8%) did not receive SGLT2i treatment. The patients in the SGLT2i group were younger ( = 0.006), had higher creatinine ( = 0.001) and hemoglobin ( = 0.001) values, and lower levels of uric acid ( = 0.025) than the participants not treated with SGLT2is. Heart failure rates were similar between the groups ( = 0.252). There was no difference in the use of renin-angiotensin-aldosterone system inhibitors ( = 0.210); in contrast, treatment with glucagon-like peptide 1 receptor agonists was more frequent in the group receiving SGLT2is compared to the group not treated with gliflozins ( = 0.002). Real-world data confirm the benefits of SGLT2i treatment for elderly people with T2D and CKD. However, our findings indicate that the use of gliflozins in this population of patients remains suboptimal, highlighting the need for greater vigilance among prescribers to align with existing guidelines.
2型糖尿病（T2D）管理的现行指南强烈建议，慢性肾脏病（CKD）患者使用钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）以减轻心肾风险。然而，该指南在日常实践中的实施情况仍然有限。在真实世界环境中，我们评估了老年T2D和CKD患者使用SGLT2i的频率，并比较了SGLT2i使用者和非使用者的患者资料。我们回顾性分析了希腊门诊内科诊所中65岁以上个体的病历。记录并比较了SGLT2i组和非SGLT2i组的人口统计学和实验室参数、合并症情况及用药情况。分析纳入了135例T2D和CKD患者，其中大多数（57.8%）未接受SGLT2i治疗。与未接受SGLT2i治疗的参与者相比，SGLT2i组患者年龄更小（P = 0.006），肌酐（P = 0.001）和血红蛋白（P = 0.001）值更高，尿酸水平更低（P = 0.025）。两组间心力衰竭发生率相似（P = 0.252）。肾素-血管紧张素-醛固酮系统抑制剂的使用情况无差异（P = 0.210）；相反，与未使用格列净类药物的组相比，接受SGLT2i治疗的组中胰高血糖素样肽1受体激动剂的治疗更为频繁（P = 0.002）。真实世界数据证实了SGLT2i治疗对老年T2D和CKD患者的益处。然而，我们的研究结果表明，在这类患者人群中格列净类药物的使用仍未达到最佳状态，这凸显了开处方者需要更加警惕以符合现有指南。
