Demographic Mix of Care Homes and Personalised Use of SGLT-2 Inhibitors and GLP-1RAs in Residents with Type 2 Diabetes Mellitus

TL;DR

This paper explores how SGLT-2 inhibitors and GLP-1RAs can be personalized for older care home residents with diabetes based on their body composition and health status.

Contribution

The paper proposes a personalized approach to using SGLT-2 inhibitors and GLP-1RAs in care home residents with diabetes, considering their demographic and health heterogeneity.

Findings

SGLT-2 inhibitors and GLP-1RAs have low hypoglycaemia risk and cardiovascular benefits, making them suitable for many care home residents.

Residents with normal or higher body weight may benefit more from these therapies compared to frail or malnourished individuals.

Current guidelines lack personalization and do not clearly define which care home residents are suitable for these therapies.

Abstract

Diabetes prevalence in older people residing in care homes is rising. This cohort of patients is characterised by multiple morbidities, polypharmacy, and frailty. As a result, they are exposed to an increasing burden of hypoglycaemia, which leads to unnecessary hospital visits and negative consequences. In addition, due to their high baseline morbidities, the risk of cardiovascular events increases. The newly introduced therapy of SGLT-2 inhibitors and GLP-1RA has a very low risk of hypoglycaemia and a significant cardiovascular protective effect. This makes it an appealing choice to be used in older people with complex morbidities, such as care home residents. So far, the current use of these agents is suboptimal in these settings because clinicians are cautious of side effects and tolerability, and also, clinical studies have not included this population. Furthermore, the guidelines in this area lack a personalised approach and are too general, with no clear specific description of which patients are suitable for such therapy. The currently available little evidence is indirect, which confirms the superior benefits of such therapy in frail compared with robust subjects, especially in those who are overweight or obese. The demographic mix of care homes is largely heterogeneous in terms of variations in body composition. In addition to malnourished, frail phenotype subjects, the prevalence of individuals with obesity living in these settings is increasing. Therefore, there is scope for increased use of these new agents in residents who have at least a normal or higher body weight. Because of the high baseline cardiovascular risk, these patients will benefit most from such therapy. Otherwise, these agents are better when less used for frail patients who are anorexic and malnourished because of the risk of inducing further weight loss, volume loss, low blood pressure, falls, and fractures.

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