SGLT2 inhibitors more cardioprotective in older versus younger people despite smaller reduction in HbA1c with older age
By Elana Gotkine HealthDay Reporter
TUESDAY, Feb. 11, 2025 (HealthDay News) — Age differences are seen in the efficacy of treatments for type 2 diabetes, according to a study published online Feb. 3 in the Journal of the American Medical Association.
Peter Hanlon, Ph.D., from the University of Glasgow in the United Kingdom, and colleagues reviewed the literature to examine whether age or sex is associated with differences in the efficacy of sodium-glucose cotransporter 2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and dipeptidyl peptidase 4 (DPP4) inhibitors. Individual participant data were obtained for 103 trials: 103 reported hemoglobin A1c (HbA1c), and six reported major adverse cardiovascular events (MACEs).
The researchers found that compared with placebo, SGLT2 inhibitor use was associated with less HbA1c lowering with increasing age for monotherapy, dual therapy, and triple therapy (absolute reductions, 0.24, 0.17, and 0.25 percent, respectively, per 30-year increment in age). GLP-1 receptor agonist use was associated with greater HbA1c lowering with increasing age for monotherapy and dual therapy (absolute reductions, –0.18 and –0.24 percent) but not for triple therapy. Slightly better HbA1c lowering was seen in association with DPP4 inhibitor use in older people for dual therapy (absolute reduction, –0.09 percent) but not for monotherapy or triple therapy. The relative reduction in MACEs with SGLT2 use was greater in older versus younger participants, while the relative reduction with GLP-1 receptor agonist use was less in older versus younger participants. Sex was not associated with differences in efficacy for any of the diabetes treatments studied.
“For hemoglobin A1c, use of SGLT2 inhibitors showed modestly reduced efficacy with increasing age,” the authors write. “In contrast, the reduction in major adverse cardiovascular events with SGLT2 inhibitors was greater in older people compared with younger people.”
Several authors disclosed ties to the pharmaceutical industry.
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