Medicines in older adults: a common diabetes pill held up well after 75
☕ Includes a question for the family ↓
Medicines in old agePart of a story we are following · 2 articles · See every update
If you or someone you love is 75 or older and takes diabetes medicine, here is welcome news about medicines in older adults. In a large study, a newer diabetes pill did not bring more harm than an older alternative. It also came with less sudden kidney injury and fewer hospital stays.
The pills are called SGLT2 inhibitors, and empagliflozin and dapagliflozin are two examples. They are known to protect the heart and kidneys. Doctors have sometimes been careful about using them in very old patients because of worries about infections, dehydration, falls and a rare but serious problem called ketoacidosis. This study looked at those worries head on.
How the study worked
Researchers used health records from British Columbia, Canada. They followed people 75 and older with type 2 diabetes who started either an SGLT2 inhibitor (4,997 people) or a DPP-4 inhibitor (1,289 people), another common diabetes pill, between 2021 and 2023. The results appeared on Oct. 27, 2026, in Diabetes Care. Because it tracked real patients rather than assigning pills by chance, the SGLT2 group was younger on average (79 vs. 82 years) and the numbers for ketoacidosis, falls and fractures were too imprecise to say more than that no difference showed up, though the researchers used statistical methods to make the two groups as comparable as possible.
What they found
People who started an SGLT2 inhibitor had a lower risk of acute kidney injury, which is a sudden drop in how well the kidneys work. The exact figure from the study is 0.76 compared with the other pill, and anything below 1 means less risk.
They also had a lower risk of being hospitalized for any reason. Here the exact figure is 0.87, again with lower meaning better.
Infections were no more common with SGLT2 inhibitors. Ketoacidosis, falls and fractures showed no differences either.
The researchers’ bottom line: in people 75 and older with type 2 diabetes, starting an SGLT2 inhibitor was not linked to more harm than starting a DPP-4 inhibitor. They say the findings support considering these pills as a treatment option for this age group.
Here is the summary in a small table.
| SGLT2 pill compared with DPP-4 pill | What the study saw |
|---|---|
| Acute kidney injury | Lower risk |
| Hospital stay for any reason | Lower risk |
| Infection | No difference |
| Ketoacidosis, falls, fractures | No difference |
What do these pills do?
SGLT2 inhibitors make the kidneys release extra sugar into the urine. That lowers blood sugar. Large trials have also shown benefits for the heart and kidneys.
Because the body passes more sugar and urine, doctors keep an eye on genital infections and dehydration. That is why a good plan for hydration and for days when you feel sick is part of taking them well.
Why does this matter for older adults?
Older adults are often left out of clinical trials. That means doctors sometimes have to decide with less information. Studies of real patients, like this one, help show whether a medicine that works well in younger people also fits someone much older.
The takeaway is encouraging. Age alone does not rule this medicine out.
What you can do today
If you or an older relative takes a diabetes pill, grab the pill bottle or the pharmacy label and write down the medicine name. Then add one question for the next doctor visit: “What should we do with this medicine on days of fever, vomiting or not eating?” Your pharmacist can also help you build a simple sick-day plan. Keep the note on the fridge so it is ready when you need it.
Talk about it at home
Some diabetes pills help your body get rid of extra sugar through pee. Doctors worried they might be risky for very old people. So researchers looked at thousands of real patients and found the pills did as well as another pill, and the kidneys did better.
Question for the table
Here is a question for the table: why do scientists need to study older people on their own, instead of just assuming what works for younger people works for them too?
Keep exploring
Copies this article and its questions so you can paste them into ChatGPT, Claude, Gemini or the AI you use, and keep the conversation going.
Questions and answers
- Are SGLT2 inhibitors safe for people over 75?
- In this study of people 75 and older with type 2 diabetes, they were not linked to more harm than DPP-4 inhibitors. Acute kidney injury and hospital stays were less likely.
- Do SGLT2 inhibitors cause more infections in older adults?
- In this study there was no difference in infection risk compared with DPP-4 inhibitors.
- What are SGLT2 inhibitors?
- They are diabetes pills, such as empagliflozin and dapagliflozin, that make the kidneys release extra sugar into the urine. They also protect the heart and kidneys.
- Should I switch my diabetes medicine?
- Do not change it on your own. Bring the question to your doctor, who knows your full health picture.
