Type 2 diabetes is a complex condition that requires tailored treatment approaches to ensure optimal health outcomes.
A new meta-analysis of over 600 studies has revealed that the effectiveness of different diabetes medications can vary depending on a person’s age. Specifically, SGLT2 inhibitors—such as Jardiance (empagliflozin)—appear to provide better protection against heart attack and stroke in older adults compared to younger individuals.
Surprisingly, researchers found that these medications were less effective at reducing blood sugar levels in older adults compared to newer drugs known as GLP-1s, which include Ozempic (semaglutide). This unexpected discovery was highlighted by lead author Peter Hanlon, PhD, a clinical senior research fellow at the School of Health and Wellbeing at the University of Glasgow in Scotland.
In contrast, younger adults responded better to SGLT2 inhibitors, which proved more effective at lowering blood sugar levels than GLP-1s in that age group.
These findings, drawn from extensive research and involving hundreds of thousands of diabetes patients, highlight the importance of personalized treatment plans. This study not only confirms prior knowledge about diabetes medications but also introduces new insights into how age plays a crucial role in determining treatment efficacy.
Key Findings of the Meta-Analysis
The meta-analysis was conducted by researchers who examined 601 randomized clinical trials, encompassing data from over 395,000 people with type 2 diabetes. The primary goal was to determine whether age or sex influenced the effectiveness of different diabetes medications.
According to Neda Rasouli, MD, professor of medicine and pharmacy at the University of Colorado School of Medicine, the study’s conclusions suggest that younger adults respond better to SGLT2 inhibitors for blood sugar control, while GLP-1 receptor agonists lower A1C levels more effectively in older adults.
However, when it comes to reducing cardiovascular risks, SGLT2 inhibitors demonstrate greater benefits for older adults, whereas GLP-1 receptor agonists have a stronger impact in younger populations.
How the Medications Work
SGLT2 Inhibitors
SGLT2 inhibitors (sodium-glucose cotransporter-2 inhibitors) function by increasing the excretion of glucose through urine. They are commonly prescribed for individuals with heart failure or chronic kidney disease, as they have been proven to offer significant heart and kidney health benefits.
Available SGLT2 inhibitors include:
- Brenzavvy (bexagliflozin)
- Invokana (canagliflozin)
- Farxiga (dapagliflozin)
- Jardiance (empagliflozin)
- Steglatro (ertugliflozin)
GLP-1 Receptor Agonists
GLP-1 receptor agonists mimic a hormone that stimulates insulin production, slows digestion, and reduces blood sugar levels. These medications are also associated with weight loss, making them highly popular for individuals who require additional metabolic benefits.
Available GLP-1 receptor agonists include:
- Ozempic, Rybelsus (semaglutide)
- Victoza (liraglutide)
- Mounjaro (tirzepatide)
- Trulicity (dulaglutide)
- Byetta (exenatide)
DPP4 Inhibitors
DPP4 inhibitors (dipeptidyl peptidase-4 inhibitors) work by regulating blood sugar levels through the prevention of incretin hormone breakdown. However, they have no significant impact on reducing cardiovascular risks.
Available DPP4 inhibitors include:
- Januvia (sitagliptin)
- Zituvio (sitagliptin)
- Onglyza (saxagliptin)
- Tradjenta (linagliptin)
- Nesina (alogliptin)
Detailed Study Insights
According to Susan Spratt, MD, professor of medicine at Duke Health, the meta-analysis confirmed that both SGLT2 inhibitors and GLP-1 receptor agonists effectively lower blood sugar and reduce the risk of cardiovascular events.
However, it also reinforced that DPP4 inhibitors do not provide the same level of cardiovascular protection. Additionally, the study found no differences in drug effectiveness between men and women.
One of the key takeaways from the research is that while blood sugar control is essential, it may not be the best measure of a diabetes medication’s ability to prevent heart attacks and strokes.
As lead researcher Dr. Peter Hanlon explains, “The findings suggest that age should not be a barrier to treatment with SGLT2 inhibitors. [Older adults] are likely to benefit from reduced cardiovascular risk.”
GLP-1 Drugs: A Growing Medical Marvel
GLP-1 receptor agonists have gained widespread attention in recent years due to their multiple benefits. Beyond lowering blood sugar, they also promote weight loss, making them a preferred choice for many patients. Dr. Spratt notes that these medications have additional advantages, including reducing sleep apnea and musculoskeletal pain.
However, SGLT2 inhibitors also provide critical health benefits. “We do need to remember that the SGLT2 inhibitors reduce heart failure risk, improve kidney outcomes, slow progression to dialysis and renal decline, and also lower the risk for major adverse cardiac events like heart attack and stroke,” says Spratt.
Dr. Rasouli further explains the key differences between the two drug classes, saying, “SGLT2 inhibitors lead to modest weight loss of around 5 percent, whereas GLP-1s typically result in more significant weight loss, often exceeding 10 percent. Additionally, GLP-1s are generally more effective at lowering A1C compared to SGLT2 inhibitors.”
With their proven effectiveness, it is no surprise that GLP-1 receptor agonists are receiving increasing attention.
“The growing attention around GLP-1s is well deserved, as they represent a breakthrough in achieving effective weight loss with a relatively good safety profile. Their added benefits of heart and kidney protection make them even more valuable,” Dr. Rasouli states.
Personalized Medicine: Choosing the Right Diabetes Treatment
Given these findings, it is crucial for individuals with type 2 diabetes to work closely with their healthcare providers to determine the most suitable medication. Dr. Spratt emphasizes that medication selection should be based on whether the priority is lowering blood sugar or reducing cardiovascular risks.
Dr. Rasouli supports the idea of personalized medicine, stating, “Precision medicine, or the individualization of care, is the future of healthcare.”
As researchers continue to explore the interactions between age, diabetes medications, and cardiovascular risks, these insights will help refine treatment approaches for millions of individuals worldwide.
A New Era in Diabetes Treatment
This groundbreaking meta-analysis provides compelling evidence that age plays a significant role in the effectiveness of diabetes medications. With SGLT2 inhibitors showing stronger cardiovascular benefits for older adults and GLP-1 receptor agonists proving more effective in lowering blood sugar levels in this population, treatment decisions should be increasingly tailored to individual needs.
As advancements in diabetes care continue, patients and healthcare providers must remain informed about the latest research findings. Whether the goal is improving blood sugar control, reducing cardiovascular risks, or achieving weight loss, there are now multiple effective options available, ensuring a more personalized and beneficial approach to diabetes management.