- In a United States Medicare study, older adults with type 2 diabetes who started SGLT 2 inhibitors or GLP 1 receptor agonists had slower frailty progression over one year than those starting DPP 4 inhibitors or other
- Compared with DPP 4 inhibitor users, people on GLP 1 drugs had a slightly lower increase in a claims based frailty index, and those on SGLT 2 drugs showed a similar benefit.
- The effect was only weakly explained by heart and safety events, suggesting these medicines might directly help protect against frailty, although trials are needed to confirm this.
Frailty is common in older adults with type 2 diabetes and is linked to falls, disability, hospital admission and death.
It is hard to reverse once established, so slowing its progression is an important goal.
Researchers analysed a national 7 per cent sample of United States Medicare claims, focusing on older adults who were just starting a new diabetes medicine.
They compared people who began GLP 1 receptor agonists such as semaglutide or liraglutide, SGLT 2 inhibitors such as empagliflozin or dapagliflozin, DPP 4 inhibitors or sulfonylureas.
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Frailty was measured using a validated claims based frailty index, which ranges from 0 to 1, with higher scores indicating greater frailty.
The team looked at how this index changed over one year.
What they found
Compared with new users of DPP 4 inhibitors, those starting GLP 1 drugs had a mean change in frailty index of about minus 0.007 and those starting SGLT 2 drugs had a mean change of about minus 0.005.
In other words, frailty still tended to worsen with age, but it progressed more slowly in those groups. There was no meaningful difference for people starting sulfonylureas.
When the researchers accounted for cardiovascular events and other safety issues, these factors explained only a small part of the benefit.
This suggests that GLP 1 and SGLT 2 medicines may have direct effects on pathways linked to frailty, beyond their known heart and kidney benefits.
What this means for treatment choices
This study is observational and based on claims, not clinical examination.
It cannot prove that the medicines themselves slow frailty, and the size of the effect is modest at individual level.
Even so, it adds to the growing sense that when choosing diabetes medicines for older adults, we should think beyond blood glucose alone.
For an older person with type 2 diabetes, especially someone already at risk of frailty, a GLP 1 or SGLT 2 medicine, where suitable and affordable, may help preserve strength, mobility and independence as part of a broader plan that includes activity, nutrition and social support.
