Evidence on SGLT2 Inhibitors' Efficacy in Older and Frail Patients

Sodium-glucose cotransporter 2 (SGLT2) inhibitors have proven their favorable cardiovascular and nephroprotective benefits in large randomized-controlled trials (RCTs). Given that older adults constitute a substantial part of patients with type 2 diabetes mellitus (T2DM), heart failure (HF), and chronic kidney disease (CKD), they are the primary target population for SGLT2 inhibitor therapy. However, their representation in clinical trials remains low and it does not reflect the real-life heterogeneity of this group of patients. As chronological age alone does not adequately reflect the biological age, it is important to evaluate older adults using a multidimensional approach, particularly with regard to frailty. This review aims to summarize and critically appraise the available evidence regarding the efficacy of SGLT2 inhibitors in older and frail adults, with a focus on age-specific outcomes, such as cognitive outcomes, risk of sarcopenia, functional activity and current gaps in evidence related to frailty.