Sodium-glucose cotransporter 2 inhibitors were associated with higher rates of treatment discontinuation in adults over 80 years with type 2 diabetes. Findings were presented at the European Association for the Study of Diabetes (EASD) 2025.

This retrospective real-world study included 207 adults with type 2 diabetes who initiated either sodium-glucose cotransporter 2 inhibitors or glucagon-like peptide-1 receptor agonists after age 75. Among 156 individuals receiving sodium-glucose cotransporter 2 inhibitors and 51 receiving glucagon-like peptide-1 receptor agonists, mortality was 12.6% during follow-up. 

Baseline characteristics showed older age, lower body mass index, and lower triglycerides in the sodium-glucose cotransporter 2 inhibitor group. Overall mortality and therapy persistence were similar between groups. However, stratified analysis revealed that adults older than 80 had higher therapy discontinuation with sodium-glucose cotransporter 2 inhibitors compared with glucagon-like peptide-1 receptor agonists (hazard ratio 3.61, 95% confidence interval 1.09–12.00; P=0.036).

These findings suggest that reduced persistence with sodium-glucose cotransporter 2 inhibitors in the very elderly may influence long-term outcomes, highlighting the importance of individualized therapy selection and monitoring.