Type 2 diabetes continues to challenge global health, affecting more than 10% of the adult population worldwide. Over 90% of those diagnosed with diabetes have type 2 diabetes, a condition characterized by the body's inability to manage blood glucose levels effectively. This chronic health issue necessitates effective treatment strategies to mitigate its widespread impact. The most commonly prescribed oral medication is metformin, which helps regulate glucose production and absorption while enhancing insulin sensitivity.
Metformin works by decreasing the amount of glucose produced by the liver and reducing glucose absorption in the intestines. Additionally, it increases the body's response to insulin, which is crucial for maintaining normal blood sugar levels. However, as type 2 diabetes progresses, additional medications may be required. DPP-4 inhibitors offer another option by promoting insulin production and reducing glucagon levels from the pancreas. Meanwhile, GLP-1 receptor agonists stimulate insulin secretion, inhibit glucagon production, slow gastric emptying, and encourage weight loss.
SGLT2 inhibitors represent a newer class of medications that function by reducing the reabsorption of glucose by the kidneys, thus promoting its excretion through urine. Researchers recently reviewed 601 published trials focusing on the efficacy of various medications for older adults with type 2 diabetes. They examined the impact of these drugs on hemoglobin A1c (HbA1c) levels and the occurrence of major adverse cardiovascular events.
"It is well established that all three medications are effective at lowering blood glucose, but only SGLT2 inhibitors and GLP-1 agonists have established additional benefits at reducing cardiovascular and kidney outcomes," – Peter Hanlon, PhD
The study revealed that SGLT2 inhibitors are notably effective in reducing cardiovascular events among older individuals. However, their efficacy in improving blood sugar control may diminish in this demographic due to age-related decline in kidney function. This decline can affect how well SGLT2 inhibitors lower HbA1c levels in patients with compromised kidney function.
"The decrease in blood sugar control efficacy with SGLT2 inhibitors in older patients may be related to age-related decrease in kidney function. Previous studies have found that SGLT2 inhibitors appear to lower HbA1c less in patients with worse kidney function." – Chen
Importantly, the study highlighted that while glucose-lowering effects may be less pronounced in older adults using SGLT2 inhibitors, their cardiovascular benefits are significantly greater compared to younger populations.
"Our findings confirm this (already established) knowledge, but also show that the cardiovascular benefits of SGLT2 inhibitors are even greater in older compared to younger people, despite the glucose lowering effects being less in older people," – Peter Hanlon, PhD
Type 1 diabetes differs from type 2 as it involves an immune system malfunction that halts insulin production entirely. In contrast, type 2 diabetes involves cells becoming resistant to insulin. As researchers continue to explore treatments for type 2 diabetes, newer medications like SGLT2 inhibitors and GLP-1 receptor agonists promise not only better blood sugar management but also a reduction in complications such as cardiovascular disease.
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