SGLT-2 inhibitors in elderly patients with diabetes

Dr Chantal Mathieu is a professor of medicine at KU Leuven (Belgium) and chair in the Division of Endocrinology at UZ Leuven.

Sodium-glucose cotransporter 2 (SGLT-2) inhibitors increase renal glucose excretion. Can they be used in older patients with diabetes who often have bacterial colonization but no urinary tract infections?

Chantal Mathieu, MD, PhD: SGLT-2 inhibitors increase the risk of genital infections—so mycotic infections, like vulvitis, vaginitis, and balanitis (in men). It is not the risk of urinary tract infections that is increased. It is not cystitis or pyelonephritis. So can you use SGLT-2 inhibitors in elderly individuals? Does it increase the risk of urinary tract infections? It does not increase the risk of urinary tract infections.

Another question when using them in elderly individuals is the somewhat increased risk of complaints of hypovolemia, or lower blood pressure, in individuals of a higher age, especially in frail individuals.

SGLT-2 inhibitors work in elderly frail individuals. When we look at the big cardiovascular outcome trials and renal outcome trials, they also protect the heart. They protect against hospitalization for heart failure, particularly in elderly individuals, but in that group you need to be a little bit cautious when looking at blood pressure and symptoms of hypovolemia. You might have to adapt, for instance, the doses of diuretics that are used in these individuals.