Impact of Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors on Frailty and Physical Function in Older Adults with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis

Frailty is a serious health issue that affects many older adults. It is a health state of increased vulnerability due to age-related dysfunction in multiple body systems. It decreases reserves and resilience to illness and injury, and increases the risk of falls, hospitalization, and death. Frailty can happen when people lose weight, muscle, and become less active. This can also increase the chances of falling. However, with proper exercise, good nutrition, vitamin D, and managing multiple medications, frailty can be improved. Early intervention is important for better health, fewer medical costs, and a better quality of life.

Sodium-glucose co-transporter 2 (SGLT2) inhibitors are a type of medication that has been used to treat type 2 diabetes because they help with heart and kidney health. While these medications can be helpful, they also come with risks, especially for older adults. Side effects such as dehydration, fractures, and urinary infections are more common in this age group. These side effects can lead to less physical activity, falls, and frailty. Because of this, some experts recommend using SGLT2 inhibitors carefully in older adults.

Previous studies have explored how SGLT2 inhibitors might affect muscle mass, particularly in relation to sarcopenia (a condition that causes muscle loss). Some studies show that SGLT2 inhibitors help reduce fat and body weight, but they may also cause a decrease in muscle mass, which could lead to a higher risk of frailty. However, the research on how SGLT2 inhibitors affect frailty in older adults is still unclear, especially because most participants in earlier studies were younger. Additionally, the effects of these drugs on muscle strength and frailty, beyond just physical frailty, remain unknown. Major studies on cardiovascular disease benefits of SGLT2 inhibitors have also focused on younger patients, leaving the risks and benefits unclear for those over 65 years old.

The goal of this study is to better understand how SGLT2 inhibitors impact frailty in older adults and to identify which patients should be more cautious when using these drugs. This research will help reduce the negative effects of SGLT2 inhibitors while maximizing their benefits for patients, particularly those at risk of frailty. The results are expected to have a significant impact on older adults, especially those with diabetes and other health conditions.

We have chosen to conduct a systematic review because there is limited research available that specifically looks at the relationship between Sodium-Glucose Co-Transporter 2 (SGLT2) inhibitors and frailty risk in older adults.