Benefits and risks of new antidiabetic drugs for the treatment of elderly diabetics
Authors:
Kvapil Milan
Authors‘ workplace:
Geriatrická interní klinika 2. lékařské fakulty Univerzity Karlovy a Fakultní nemocnice v Motole, Praha
Published in:
Geriatrie a Gerontologie 2024, 13, č. 2: 81-85
Category:
Review Article
Overview
The basic goal of antidiabetic treatment is to reduce hyperglycemia. New classes of antidiabetics using the effect of GLP-1 (DPP 4 inhibitors and GLP-1 receptor agonists /GLP1RA/) and inhibition of sodium-glucose transport /SGLT2i/ in the proximal tubule of the nephron are effective and safe. In relation to the treatment of diabetes in the elderly, a minimal risk of hypoglycemia is a major benefit. In addition, GLP1RA and SGLT2i reduce the risk of the manifestation of heart failure, they positively influence cardiovascular mortality in secondary prevention, SGLT2i slow down the rate of decline in glomerular filtration. In the case of seniors, when using them, it is necessary to take into account the specifics of older age, which often interfere with the desired and unwanted effects of antidiabetic treatment. Anorexigenic effects of GLP1RAs, polyuria, hypovolemia and lowering of blood pressure during SGLT2i treatment may be a notable adverse effect.
Keywords:
diabetes mellitus of the elderly, gliptins, DPP-4 inhibitors, gliflozins, SGLT2 inhibitors, GLP-1 receptor agonists
Sources
1. Ahrén B. Gut peptides and type 2 diabetes mellitus treatment. Curr Diab Rep 2003; 3: 365–372.
2. Demuth H, et al. Type 2 diabetes – therapy with dipeptidyl peptidase IV inhibitors. Biochim Biophys Acta 2005; 1751: 3–44.
3. Subrahmanyan NA, Koshy RM, Jacob K, et al. Efficacy and cardiovascular safety of DPP-4 inhibitors. Curr Drug Saf 2021; 16(2): 154–164.
4. Yao H, Zhang A, Li D, et al. Comparative effectiveness of GLP-1 receptor agonists on glycaemic control, body weight, and lipid profile for type 2 diabetes: systematic review and network meta-analysis. BMJ 2024; 384: e076410.
5. Nauck MA, Quast DR, Wefers J, et al. GLP-1 receptor agonists in the treatment of type 2 diabetes – state-of-the-art. Mol Metab 2021; 46: 101102.
6. Kristensen SL, Rørth R, Jhund PS, et al. Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials. Lancet Diabetes Endocrinol 2019; 7(10): 776–785.
7. Strain WD, Frenkel O, James MA, et al. Effects of semaglutide on stroke subtypes in type 2 diabetes: Post hoc analysis of the randomized SUSTAIN 6 and PIONEER 6. Stroke 2022; 53(9): 2749–2757.
8. Mikulecká V, Kvapil M. Mysleli jsme to dobře, a málem to dopadlo trochu jinak. Běžná příčina manifestace syndromu „frailty“ s dobrým koncem. Kazuistiky v diabetologii 2022; 20(4): 20–24.
9. Lee YJ, Lee YJ, Han HJ. Regulatory mechanisms of Na(+)/glucose cotransporters in renal proximal tubule cells. Kidney Int Suppl 2007; 106: S27–35.
10. Wright EM. SGLT2 inhibitors: Physiology and pharmacology. Kidney 2021; 2(12): 2027–2037.
11. Nuffield Department of Population Health Renal Studies Group; SGLT2 inhibitor Meta-Analysis Cardio-Renal Trialists’ Consortium. Impact of diabetes on the effects of sodium glucose co-transporter-2 inhibitors on kidney outcomes: collaborative meta-analysis of large placebo-controlled trials. Lancet 2022; 400(10365): 1788–1801.
12. Marilly E, Cottin J, Cabrera N, et al. SGLT2 inhibitors in type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials balancing their risks and benefits. Diabetologia 2022; 65(12): 2000–2010.
13. van Poelgeest EP, Handoko ML, Muller M, et al.; EUGMS Task & Finish group on Fall-risk-increasing drugs. Diuretics, SGLT2 inhibitors and falls in older heart failure patients: to prescribe or to deprescribe? A clinical review. Eur Geriatr Med 2023; 14(4): 659–674.
14. Scheen AJ, Bonnet F. Efficacy and safety profile of SGLT2 inhibitors in the elderly: How is the benefit/risk balance? Diabetes Metab 2023; 49(2): 101419.
15. Aldafas R, Crabtree T, Alkharaiji M, et al. Sodium-glucose cotransporter-2 inhibitors (SGLT2) in frail or older people with type 2 diabetes and heart failure: a systematic review and meta-analysis. Age Ageing 2024; 53(1): afad254.
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Geriatrics General practitioner for adults Orthopaedic prostheticsArticle was published in
Geriatrics and Gerontology
2024 Issue 2
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