JAMA

Efficacy of diabetes treatments varies by age

February 5, 2025

Study design: This network meta-analysis included 601 randomized trials comparing the efficacy of SGLT2 inhibitors, GLP-1 receptor agonists, and DPP4 inhibitors in adults with T2DM. The analysis utilized both individual participant data and aggregate data to estimate age and sex interactions with treatment efficacy, focusing on HbA1c and major adverse cardiovascular events (MACEs).

Results: The efficacy of SGLT2 inhibitors in lowering HbA1c decreased with age, while GLP-1 receptor agonists showed increased efficacy with age. DPP4 inhibitors had a slight improvement in HbA1c lowering in older adults. SGLT2 inhibitors were more effective in reducing MACEs in older adults, whereas GLP-1 receptor agonists were more effective in younger adults. No consistent sex-based differences in treatment efficacy were observed.

Clinical impact: Findings suggest that age should be considered when selecting antihyperglycemic treatments for T2DM. SGLT2 inhibitors may be preferred for older adults due to their greater cardiovascular benefits, despite smaller reductions in HbA1c. Conversely, GLP-1 receptor agonists may be more beneficial for younger patients. This age-specific approach could optimize treatment outcomes and reduce cardiovascular risks in patients with T2DM.

Source:

Hanlon P, et al. (2025, February 3). JAMA. Age and Sex Differences in Efficacy of Treatments for Type 2 Diabetes: A Network Meta-Analysis. https://pubmed.ncbi.nlm.nih.gov/39899304/