# Evidence on SGLT2 Inhibitors’ Efficacy in Older and Frail Patients

## TL;DR

This review examines how well SGLT2 inhibitors work in older and frail patients, focusing on outcomes like cognitive function and sarcopenia.

## Contribution

The paper provides a critical appraisal of SGLT2 inhibitors' efficacy in older and frail adults, highlighting age-specific outcomes and evidence gaps.

## Key findings

- SGLT2 inhibitors show cardiovascular and nephroprotective benefits in older adults.
- Frailty and functional outcomes remain understudied in clinical trials involving SGLT2 inhibitors.
- Current evidence lacks sufficient data on cognitive and sarcopenia-related effects in this population.

## Abstract

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.