Certain diabetes medications may have additional health benefits for older adults, scientists from the University of Glasgow report.
In a recent study assessing the health benefits of diabetes medications in different age groups, researchers found that sodium-glucose cotransporter 2 (SGLT2) inhibitors reduced the risk of heart attacks or strokes more in older people than in younger people.
However, the same group of drugs was less effective at reducing blood sugar levels in older adults compared with younger adults. The authors say this highlights the need to better understand the impact and efficacy of medications in different age groups when prescribing to patients with type 2 diabetes.
The findings, which involve over 300,000 patients from more than 600 clinical trials worldwide, are published in JAMA.
Over the past two decades, new glucose-lowering medications have changed how type 2 diabetes is treated. However, little is known about how the new medications affect different groups of patients, such as older and younger patients and males and females. Current clinical guidelines do not recommend different diabetes drugs across various age groups, and the standard primary treatment aim is reducing blood sugar levels for all patients.
The researchers conducted a meta-analysis to determine whether three types of diabetes medications, SGLT2 inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and dipeptidyl peptidase 4 (DPP-4) inhibitors, differ in efficacy across age and sex in people with type 2 diabetes. By analysing 601 studies, the researchers collected data from 309,503 participants for HbA1c levels (to indicate blood sugar control) and 168,489 participants for major adverse cardiovascular events (MACEs).
All three classes of glucose-lowering drugs were effective for people of all ages and sexes. However, the treatments worked differently for different age groups. SGLT2 inhibitors lowered HbA1c less effectively in older adults than in younger ones, while GLP-1 receptor agonists lowered HbA1c more effectively in older adults than younger ones. DPP-4 inhibitors also reduced HbA1c slightly more in older adults, but the effect was inconsistent.
Despite the smaller effects on HbA1c in older adults, the researchers found that SGLT2 inhibitors provided greater heart protection in older adults than younger ones. Conversely, GLP-1 receptor agonists reduced the risk of MACEs more in younger than older people. There was no observed difference in medication efficacy between the sexes.
Dr Peter Hanlon from the School of Health and Wellbeing at the University of Glasgow said: ‘Deciding on the best treatments for older people always requires careful balancing of risks and benefits.
‘Our findings that older people experienced greater benefits from these drugs, in terms of reduced heart attacks and strokes, is very encouraging. Age alone should not be a barrier to treatments with proven benefit as long as they are well tolerated and align with patients’ priorities.’
