5 Things You Need to Know About SGLT2-I Use in the Elderly

In May 2013 the FDA approved canagliflozin, the first sodium glucose cotransport 2 (SGLT2) inhibitor on the market, for use in mono- or combined therapy in patients with T2DM. SGLT2 inhibitors block the reabsorption of glucose through the proximal renal tubule, leading to decreased HbA1c levels and modest reductions in weight and blood pressure.Canagliflozin has been shown to be well tolerated in the elderly,1 with minimal tendency to cause hypoglycemia-a primary challenge in treating diabetes in this population. Because it acts independently of insulin levels and is not affected by beta cell function or insulin sensitivity, it can be used at all stages of diabetes.There are important cautions to be observed , however. The slides above offer snapshots of the specific issues about using canagliflozin in the elderly. Links to additional information can be found in the reference list below. ReferencesElmore LK, Baggett S, Kyle JA, Skelley JW. A review of the efficacy and safety of canagliflozin in elderly patients with type 2 diabetes. Consult Pharm. 2014;29:335-346.  Yale JF, Bakris G, Cariou B, et al. Efficacy and safety of canagliflozin in subjects with type 2 diabetes and chronic kidney disease. Diabetes Obes Metab. 2013;15:463–473.Sehgal V, Sukhminder JSB, Sehgal R.  Management of diabetes in the elderly with canagliflozin:  A newer hypoglycemic drug on the horizon.  J Pharmacother.  2014;5:227-231.Weir MR, Januszewicz A, Gilbert RE, et al. Effect of canagliflozin on blood pressure and adverse events related to osmotic diuresis and reduced intravascular volume in patients with type 2 diabetes mellitus. J Clin Hypertens (Greenwich). 2014;16:875-882. Bode B, Stenlof K, Harris S.  Long-term efficacy and safety of canagliflozin over 104 weeks in patients aged 55 to 80 years with type 2 diabetes. Diabetes Obes Metab. 2014 Dec 13. doi: 10.1111/dom.12428. [Epub ahead of print]