Iberoamerican Journal of Medicine
https://iberoamjmed.com/article/doi/10.53986/ibjm.2023.0023
Iberoamerican Journal of Medicine
Original article

Safety of SGLT2 inhibitors in very elderly diabetic type 2 patients in real life

Seguridad de los inhibidores de SGLT2 en pacientes diabéticos tipo 2 muy ancianos en la vida real

Ramón Baeza-Trinidad, José Daniel Mosquera-Lozano

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Abstract

Introduction: Sodium glucose cotransporter 2 inhibitors (SGLT2i) are the latest antidiabetic treatments that reduces mortality and cardiovascular outcomes. Its use in real life in very elderly patients is limited by its possible side effects.
Material and methods: We conducted a retrospective study of patients treated with SGLT2i in our community (La Rioja) since 2014. The safety (adverse effects) and prognosis (mortality, cardiac decompensation, and cardiovascular events) during the first 24 months of treatment were evaluated.
Results: We included 235 patients treated with SGLT2i, 114 of them were men (48.5%), and the mean age was 79.6 ± 3.9 years. The most used SGLT2i was empagliflozin (55.7%). The mean Hb1Ac at the time of inclusion was 7.9 ± 1.4, showing a decrease in 47.7% of the included patients during the follow up. The initial values of creatinine and glomerular filtration rate at the time of inclusion (0.94 ± 0.3 and 68.3 ± 16.4) presented an improvement at 24 months of treatment (0.94 ± 0.27 and 68.2 ± 15.8). During follow-up, 94 adverse events were described in 84 patients, and 53 treatment suspensions. This adverse events were related with sex (p 0.004), dapagliflozin (p < 0.001) and initial Hb1Ac values (p 0.04). The most common adverse event were genitourinary infections (63), followed by acute kidney injury (9), being the latter the most frequent cause of treatment interruption. Symptomatic hypoglycaemia during the follow-up was related with treatment of insulin, age and Hb1Ac (p <0.01).
Conclusions: Treatment with SGLT2i is a safe and well-tolerated treatment in very elderly patients in real life. Genitourinary infections are the most common adverse events, but those that less frequently cause treatment interruption.

Keywords

SGLT2 inhibitor; SGLT2i; Elderly; Adverse reaction

Resumen

Introducción: Los inhibidores del cotransportador de sodio y glucosa tipo 2 (SGLT2i) son los últimos tratamientos antidiabéticos que reducen la mortalidad y los resultados cardiovasculares. Su uso en la vida real en pacientes muy ancianos está limitado por sus posibles efectos secundarios.
Material y métodos: Realizamos un estudio retrospectivo de pacientes tratados con iSGLT2 en nuestra comunidad (La Rioja) desde 2014. La seguridad (efectos adversos) y el pronóstico (mortalidad, descompensación cardiaca y eventos cardiovasculares) durante los primeros 24 meses de tratamiento fueron evaluado.
Resultados: Se incluyeron 235 pacientes tratados con SGLT2i, 114 de ellos hombres (48,5%) y la edad media fue de 79,6 ± 3,9 años. El SGLT2i más utilizado fue la empagliflozina (55,7%). La Hb1Ac media en el momento de la inclusión fue de 7,9 ± 1,4, mostrando un descenso en el 47,7% de los pacientes incluidos durante el seguimiento. Los valores iniciales de creatinina y filtrado glomerular en el momento de la inclusión (0,94 ± 0,3 y 68,3 ± 16,4) presentaron una mejoría a los 24 meses de tratamiento (0,94 ± 0,27 y 68,2 ± 15,8). Durante el seguimiento se describieron 94 eventos adversos en 84 pacientes y 53 suspensiones del tratamiento. Estos eventos adversos se relacionaron con el sexo (p 0,004), dapagliflozina (p < 0,001) y valores iniciales de Hb1Ac (p 0,04). El evento adverso más frecuente fueron las infecciones genitourinarias (63), seguidas de la insuficiencia renal aguda (9), siendo esta última la causa más frecuente de interrupción del tratamiento. La hipoglucemia sintomática durante el seguimiento se relacionó con el tratamiento de insulina, la edad y la Hb1Ac (p <0,01).
Conclusiones: El tratamiento con SGLT2i es un tratamiento seguro y bien tolerado en pacientes muy ancianos en la vida real. Las infecciones genitourinarias son los eventos adversos más frecuentes, pero los que con menor frecuencia provocan la interrupción del tratamiento.

Palabras clave

Inhibidor SGLT2; SGLT2i; Ancianos; Reacción adversa

References

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Submitted date:
12/28/2022

Reviewed date:
02/01/2023

Accepted date:
06/30/2023

Publication date:
07/02/2023

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