ECE2021 Audio Eposter Presentations Diabetes, Obesity, Metabolism and Nutrition (223 abstracts)
Could we use SGLT2 inhibitors without serious concern in the elderly?
Ihintza Larrañaga 1 , Cristina Goena Vives 2 , Maria Magdalena Arteaga Ossa 1 , Jorge Rojo Alvaro 3 , Laura Mañas Alonso 2 , Laura Quintas Ovejero 2 , Begoña Maíz Alcorta 4 , Ana Moreno Rodrigo 5 , Nerea Andrés Imaz 5 , Irene Larrañaga Gomez 6 , Ruth Agirrezabalaga Villar 7 , Amaia Aspiazu Abasolo 4 , Teresa Arana Suarez 8 , Naroa Rico Dadebat 8 , Amaia Cristina Armentia Del Pozo 9 , Sara Diez Irizar 6 , Naroa Gomez Tijero 10 & Jose Francisco Egido Arroyo 8
1Osakidetza Basque Health Service- Mendaro Hospital, Endocrinology and Nutrition, Spain; 2Osakidetza Basque Health Service- Mendaro Hospital, Cardiology, Spain; 3Osakidetza Basque Health Service- Donostia Hospital, Endocrinology and Nutrition, Spain; 4Osakidetza Basque Health Service-Mutriku Health Centre, Primary Care, Spain; 5Osakidetza Basque Health Service- Mendaro Hospital, Internal Medicine, Spain; 6Osakidetza Basque Health Service, Torrekua Health Centre, Primary Care, Spain; 7Osakidetza Basque Health Service, Soraluze Health Centre, Primary Care, Spain; 8Osakidetza Basque Health Service, Ermua Health Centre, Primary Care, Spain; 9Osakidetza Basque Health Service, Eibar Health Centre, Primary Care, Spain; 10Osakidetza Basque Health Service- Mendaro Hospital, Pharmacy
Background
Therapeutic experience with SGLT2i is limited in the elderly. Its initiation is not recommended in patients over 85 years based on volume depletion risk. The aim of this study is to analyze clinical efficacy and safety of SGLT2i in elder T2DM patients.
Methods
This observational retrospective study included 544 T2DM subjects who initiated SGLT2i as add-on treatment between February 2018–2019 and were monitored until February 2020. Two groups were performed: youngest-old = aged 60–74 years (N = 282) and old = 75 years and older (N = 111), patients < 60 were excluded. Clinical and biochemical outcomes were studied at baseline and at the end of monitoring.
Results
Mean age for the youngest-old was 62.3 and 79.7 for the old (maximum age 92 and N = 55 were ≥ 80). Most used SGLT2i was Empagliflozin (75.5% vs 79.28%, p 0.483). In 15.95% of the youngest SGLT2i adjustment was made facing 6.3% of the old (p 0.011). Both groups were fairly homogeneous in male percentage, renal function, HbA1c, stablished CVE, preexisting heart failure (HF) and use of loop diuretics (see table1). In the old group, patients had longer duration of T2DM, more concomitant insulin users and lower BMI.
| Youngest-old 60–75 (N = 282) | Old≥75 (N = 111) | p | |
| Male (N;%) | 176 (62.4) | 57 (51.3) | NS |
| BMI (kg/m2 ± SD) | 31.3 ± 6.27 | 29.57 ± 4.05 | 0.002 |
| eGFR (ml/min ± SD) | 83.3 ± 19.6 | 74.15 ± 17.90 | NS |
| HbA1c (mean% ± SD) | 7.85 ± 1.20 | 8.16 ± 1.27 | NS |
| DM duration (years ± SD) | 13.28 ± 7.46 | 16.97 ± 7.56 | < 0.001 |
| Insulin treatm ent (N;%) | 83 (29.43) | 49 (44.14) | 0.005 |
| Loop diuretic (N:%) | 34 (12) | 17 (15.31) | NS |
| Stablished CV disease (N;%) | 77 (27.3) | 33 (29.7) | NS |
| Pre-existing HF (N:%) | 33 (11.7) | 16(14.4) | NS |
| CVE follow-up (N:%) | 12 (4.2) | 6 (5.4) | NS |
| SGLT2i discontinuation (N;%) | 45 (15.9) | 27 (24.32) | NS |
| HF follow-up (N;%) | 13 (4.6) | 9 (8.10) | NS |
| Death | 7 (2.4) | 5 (4.5) | NS |
Final %HBA1c was lower in the youngest: 6.9% (–0.88) vs 7.5% (–0.67), (p 0.136). CVE were infrequent: peripheral vascular disease was the main event in the youngest (6/12) whereas stroke prevailed in the elderly (4/6). There was a tendency to more SGLT2i discontinuation, HF in follow-up and death in the elderly although it was not statistically significant. The most frequent side effects in youngest and oldest were eGFR drops < 30, genital and urinary tract infection (31.8 vs 37%, 28.8% vs 22%; and 15.5% vs 25%). Oncological disease (6/7) was the main death cause in the youngest group while CVE and HF were in old group.
Conclusions
Initiation of SGLT2i seems to be safe and effective regardless of age.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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