The use of SGLT2 inhibitors in older people: What is important?

Gliflozins, or sodium-glucose co-transporter 2 (SGLT2) inhibitors are synthetic derivatives of phlorizin. Phlorizin (phloretin-2-’O-β-glucopyranoside) is an O-glucoside of phloretin, a member of the dihydrochalcone family that is, in turn, a subclass of flavonoids. Isolated from the bark of the apple tree was initially used for its antipyretic and antimalarial effect. Many years later von Mering discovered its glycosuric properties.

SGLT2i, originally developed as oral hypoglycemic agents, have emerged as particularly valuable therapeutic options for older adults due to their efficacy and favourable safety profile, enabling glycaemic control without necessitating aggressive intervention strategies. Contemporary evidence demonstrates that SGLT2i maintains remarkable glycaemic efficacy across age stratifications, dispelling earlier concerns regarding diminished therapeutic response in older populations. The mechanism of action of SGLT2i, which involves inhibition of glucose reabsorption in the proximal renal tubules, remains functionally intact despite age-related physiological changes, including modest reductions in glomerular filtration rate commonly observed in geriatric patients. In this review the use of sglt2i in older patients will be analysed in detail.