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Cited by 8Diabetes Treatment and ManagementHealth Systems, Economic Evaluations, Quality of LifeHeart Failure Treatment and Management

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Expected Health Benefits of SGLT-2 Inhibitors and GLP-1 Receptor Agonists in Older Adults

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Dadwani, Rahul S., Wan, Wen, Skandari, M. Reza, Huang, Elbert S.·2023·MDM Policy & Practice
DOI 10.1177/23814683231187566PMC PMC10363885
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Abstract

Background. Older and sicker adults with type 2 diabetes (T2D) were underrepresented in randomized trials of glucagon-like peptide 1 receptor-agonist (GLP1RA) and sodium-glucose cotransporter 2 inhibitors (SGLT2I), and thus, health benefits are uncertain in this population. Objective. To assess the impact of age, health status, and life expectancy in older adults with T2D on health benefits of GLP1RA and SGLT2I. Design. We used the United Kingdom Prospective Diabetes Study (UKPDS) model to simulate lifetime health outcomes. We calibrated the UKPDS model to improve mortality prediction in older adults using a common geriatric prognostic index. Participants. National Health and Nutrition Examination Survey 2013–2018 participants 65 y and older with T2D, eligible for GLP1RA or SGLT2I according to American Diabetes Association guidelines. Interventions. GLP1RA or SGLT2I use versus no additional medication. Main Measures. Lifetime complications and weighted life-years (LYs) and quality-adjusted life-years (QALYs) across overall treatment arms and life expectancies. Key Results. The overall older adult population was predicted to experience significant health benefits from GLP1RA (+0.29 LY [95% confidence interval: 0.27, 0.31], +0.15 QALYs [0.14, 0.16]) and SGLT2I (+0.26 LY [0.24, 0.28], +0.13 QALYs [0.12, 0.14]) as compared with no added medication. However, expected benefits declined in subgroups with shorter life expectancies. Participants with <4 y of life expectancy had minimal gains of <0.05 LY and <0.03 QALYs from added medication. Accounting for injection-related disutility, GLP1RA use reduced QALYs (−0.03 QALYs [−0.04, −0.02]). Conclusions. While GLP1RA and SGLT2I have substantial health benefits for many older adults with type 2 diabetes, benefits are not clinically significant in patients with <4 y of life expectancy. Life expectancy and patient preferences are important considerations when prescribing newer diabetes medications. Highlights: On average, older adults benefit significantly from SGLT2I and GLP1RA use. However, the benefits of these drugs are not clinically significant among older patients with life expectancy less than 4 y. There is potential harm in injectable GLP1RA use in the oldest categories of adults with type 2 diabetes. Heterogeneity in life expectancy and patient preferences for injectable versus oral medications are important to consider when prescribing newer diabetes medications

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  • GLP-1 receptor agonists have been demonstrated to exert a protective effect on the microvascular compartment of the myocardium.

    “Furthermore, GLP-1 receptor agonists have been demonstrated to exert a protective effect on the microvascular compartment of the myocardium [46,47].”

    From New Developments in Pharmacological Treatment of Obesity and Type 2 Diabetes—Beyond and within GLP-1 Receptor Agonists (2024) · cites this paper as [46]

    The Introduction (page unavailable) says cardiovascular outcome trials found cardiovascular benefits from GLP-1 receptor agonists in selected adults with type 2 diabetes. It does not say those benefits arise from protection of the myocardium’s microvascular compartment; the Results’ microvascular outcomes concern other diabetes complications, not myocardial microvasculature. (LLM, conf=0.82)

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Metadata

Authors
Dadwani, R. S., Wan, W., Skandari, M. R., & Huang, E. S.
Affiliations
  • University of Chicago (US)
  • Imperial College London (GB)
Corresponding author
Dadwani, Rahul S.
ORCID
Venue
MDM Policy & Practice
Publisher
SAGE Publications
Published
2023-07
Volume
8
Issue
2
Pages
23814683231187566-23814683231187566
ISSN
2381-4683 (ISSN-L)
DOI
10.1177/23814683231187566
PMC
PMC10363885
OpenAlex
W4384936639
Cited by
8
References
10
Citations by year
2026: 2 · 2025: 3 · 2024: 3
FWCI
1.64
Type
journal article
Language
en
Open access
Licence
Locations
  • MDM Policy & Practice (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Knowledge@UChicago (University of Chicago) (submittedVersion, cc-by-nc-nd)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Spiral (Imperial College London) (submittedVersion, cc-by-nc)
  • University of Chicago
Funders
Pritzker School of Medicine
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
Keywords
type 2 diabetes, older adults, SGLT2 inhibitors, GLP-1 receptor agonists, life expectancy, quality-adjusted life years, quality of life, patient preferences

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