Key takeaways:
- Trials assessing DPP-IV inhibitors, SGLT2 inhibitors and GLP-1s discovered no elevated CV threat for older adults.
- Therapy steerage ought to embody suggestions tailor-made to older populations.
PHILADELPHIA — The worldwide populating is growing older, and roughly 29% of individuals with diabetes worldwide are aged 65 years and older, representing 123 million folks, in line with a speaker on the Coronary heart in Diabetes CME Convention.
Many adults on this age group have had diabetes for not less than 10 years and are in danger for cardiovascular issues akin to ischemic coronary heart illness, acute myocardial infarction and cerebrovascular accident, in line with Richard E. Pratley, MD, the Samuel E. Crockett Chair in Diabetes Analysis, medical director of AdventHealth Diabetes Institute and a Healio | Endocrine Right this moment Co-editor, stated right here. Nevertheless, most steerage for treating diabetes is targeted on assembly glycemic targets. Pratley advocated for an strategy that individualizes therapy and focuses on measures past glycemia for adults aged 65 years and older.
Customized remedy that focuses on “enhancing well being span” slightly than life span is essential for treating older adults with diabetes, in line with a speaker on the Coronary heart in Diabetes CME Convention.
“Our therapy tips must proceed to evolve to take into consideration the heterogeneity of older people in addition to accumulating information on advantages and dangers,” Pratley stated throughout a presentation. “We have to personalize remedy in our older adults with diabetes, much more so than different populations.”
No elevated CV threat for older adults
Broadly used drugs — DPP-IV inhibitors, SGLT2 inhibitors and GLP-1 receptor agonists — don’t increase CV threat for older adults. Nevertheless, well being care professionals ought to pay attention to different potential dangers when prescribing drugs, Pratley stated.
Richard E. Pratley
FDA-issued steerage to evaluate CV threat for diabetes therapies has led to twenty-eight CV final result trials, to this point, being carried out for eight lessons of medicine for sort 2 diabetes. Pratley stated these information have aided researchers in higher understanding how diabetes drugs have an effect on CV outcomes for adults aged 65 years and older in contrast with youthful adults.
A meta-analysis printed within the Journal of Diabetes and Its Issues in 2024 examined CV threat with a number of lessons of diabetes therapies by age group. In 5 trials that assessed DPP-IV inhibitors included within the meta-analysis, there was no distinction in CV threat for adults aged 65 years and older and people 75 years and older in contrast with youthful adults.
Some SGLT2 inhibitors could confer CV advantages for older adults. Within the EMPA-REG End result trial, adults aged 65 years and older who obtained empagliflozin (Jardiance, Boehringer Ingelheim) had decrease threat for CV outcomes and CV dying in contrast with those that obtained placebo. Equally, within the CANVAS trial, these aged 65 years and older who obtained canagliflozin (Invokana, Janssen) had decreased threat for CV outcomes in contrast with these within the placebo group.
CV advantages for older adults had been additionally noticed in some GLP-1 trials. In a post-hoc evaluation of the LEADER trial printed in Annals of Inner Medication, adults aged 75 years and older who obtained liraglutide (Victoza/Saxenda, Novo Nordisk) had decrease threat for CV outcomes and all-cause mortality than those that obtained placebo.
“We are able to use these medicine in sufferers who’re older and who’re at excessive threat for CVD safely.” Pratley stated. “However we’ve got to match advantages that we hope to attain with these drugs, which embody reductions in CVD, coronary heart failure, stroke and probably diabetic kidney illness, with the dangers of the remedy.”
Affect of lean mass loss
For older adults, a threat of therapy with a GLP-1 is a attainable discount in lean mass that might result in falls or antagonistic bone well being, in line with Pratley. He stated that is particularly a priority for older adults who’ve sarcopenia after they begin a GLP-1.
“Now we have to enter therapy with our eyes open,” Pratley stated. “What we need to be sure is that in our efforts to enhance CV outcomes, we’re not main down a path the place there’s accelerated lack of skeletal muscle and, consequently, operate.”
Pratley concluded that whereas beforehand printed trials confirmed older adults could confer further advantages from SGLT2s and GLP-1s, extra research are wanted so researchers can higher perceive which adults could confer essentially the most advantages from therapies.
Pratley stated the aim must be personalised remedy for older adults that focuses on “enhancing well being span” slightly than life span.
References:
Sources/Disclosures
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Pratley R. Diabetes Comorbidities. Offered at: Coronary heart in Diabetes CME Convention; June 6-8, 2025; Philadelphia.
Disclosures:
Pratley reviews talking for Eli Lilly and Novo Nordisk; consulting for AbbVie, Altanine, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Corcept Therapeutics, Eli Lilly, Endogenex, F. Hoffman-La Roche, Gasherbrum Bio, Genprex, Getz Pharma, Hanmi Pharmaceutical, Intas Prescription drugs, Lexicon, Novo Nordisk, Pfizer, Regeneron, Scholar Rock and Solar Prescription drugs; and receiving analysis grants from Biomea Fusion, Carmot Therapeutics, Dompe, Eli Lilly, Endogenex, Fractyl, Novo Nordisk and Sanofi.
