SGLT2 Inhibitors After 75: The Kidney Fear Gets a Second Look

Key Takeaway

In a real-world study of 6,286 adults aged 75 and older with type 2 diabetes, starting an SGLT2 inhibitor instead of a DPP-4 inhibitor was linked to a 24% lower risk of acute kidney injury and a 13% lower risk of hospitalization. No increase in falls, fractures, infections or ketoacidosis was detected. For the rarer harms, though, the estimates remain too imprecise to rule out risk entirely.

The Prescription Left Unwritten

Picture Mrs. Alvarez, 81, sitting on the exam table with her cardigan buttoned to the collar. Her blood sugar has been creeping upward, and her cardiologist has suggested empagliflozin. Her internist hesitates. She lives alone and forgets to drink water in the summer. She fell on her icy front step last January. A drug that makes her urinate away sugar and salt feels like an invitation to dizziness, a broken hip, or the strange, sugar-normal form of ketoacidosis that keeps showing up in case reports. So the internist writes for sitagliptin, a gentler, weight-neutral DPP-4 inhibitor, and moves on.

That scene plays out in clinics every day. It rests on intuition, not data, because…