Safety and effectiveness of SGLT2 inhibitors in a UK population with type 2 diabetes and aged over 70 years: an instrumental variable approach
Authors' conclusion
Causal analysis suggests SGLT2i are effective in adults aged ≥70 years, but increase risk for genital infections and diabetic ketoacidosis. Our study extends RCT evidence to older adults with type 2 diabetes.
Study context
- Population
- People with T2D initiating SGLT2i or DPP4i, UK Clinical Practice Research Datalink, 2013–2020; stratified <70 and ≥70 yearsage-stratified
- Exposure
- SGLT2i initiation vs DPP4i initiation
- Outcome
- HbA1c reduction, aged ≥70
Methodological detailsinstrumental variable analysis (prescriber preference as instrument), age-stratified, hospital-linked UK primary care data (Clinical Practice Research Datalink)
- Instrumental variable analysis (prescriber preference as instrument)
- Age-stratified
- Hospital-linked UK primary care data (Clinical Practice Research Datalink)
Main finding
As reported in the abstract
Difference, mmol/mol (CI)
SGLT2ivs DPP4i
−0.3(−1.6 to 1.1)
- Between SGLT2i and DPP4i
- difference −0.02 % (CI 0.1–0.1)
Observational data: associations, not effects.
Further findings
| Outcome | Difference (%) (CI) | |
|---|---|---|
| HbA1c reduction, aged <70SGLT2ivs DPP4iSGLT2i more effective | −0.4 (−0.4 to −0.3) | |
| −0.6−0.4−0.200.2Difference, % (linear scale) |
| Outcome | Difference (mmol/mol) (CI) |
|---|---|
| HbA1c reduction, aged <70Between SGLT2i and DPP4i · SGLT2i more effective | −4 (4.8,–3.1) |
Safety
| Outcome | SGLT2i | IRR | |
|---|---|---|---|
| DKAAged ≥70; increased risk | 29.6 per 10,000 person-years (CI 29.5–29.7) | 3.82 (95% CI 1.12–13.03) | |
| DKAAged <70; not increased | 1.12 (95% CI 0.41–3.04) | ||
| Genital infectionAged <70 | 2.27 (CI 2.03–2.53) | ||
| Genital infectionAged ≥70 | 2.16 (CI 1.77–2.63) | ||
| 0.050.21520Incidence rate ratio (log scale) |
- DKA: incidence rate with SGLT2i is for those aged ≥70
Volume depletion, poor micturition control, urinary frequency, falls, amputation
- No evidence of increased risk with SGLT2i in either age group
Original publication
Safety and effectiveness of SGLT2 inhibitors in a UK population with type 2 diabetes and aged over 70 years: an instrumental variable approach. Diabetologia. Published 5 June 2024. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →