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Safer diabetes drugs identified for older adults, large study finds

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GLP-1 receptor agonists and SGLT2 inhibitors may be the best options

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Mark Huffman
Reporter

Mark Huffman has covered consumer issues since 2004, with a special focus on protecting and empowering older adults. A former news correspondent for the Associated Press Radio Network, Westwood One, and ConsumerAffairs, Mark brings decades of journalistic experience to RetirementLiving.com. He is passionate about giving consumers a voice and helping them make informed decisions. Mark has also created educational content, including Senior Scam Alert, a video resource designed to help seniors recognize and avoid fraud. He holds a B.A. from the University of Kentucky and lives with his family in Richmond, Virginia.

Updated:

key insights:

  • New research analyzing 1.8 million older adults finds significant safety differences among common diabetes drugs.
  • GLP-1 receptor agonists and SGLT2 inhibitors are linked to lower risks of dangerous side effects like hypoglycemia.
  • Findings could reshape prescribing decisions for seniors, a group especially vulnerable to medication complications.

A large international study is shedding new light on which diabetes medications may be safest for older adults, a population at heightened risk for drug-related complications.

The research analyzed real-world data from roughly 1.8 million patients aged 65 and older across the United States and Europe. Researchers compared the safety of several widely used second-line treatments for type 2 diabetes, focusing on outcomes such as hypoglycemia, electrolyte imbalances, and other adverse events.

The findings point to two newer classes of drugs — GLP-1 receptor agonists and SGLT2 inhibitors — as safer options in many cases. Both were associated with significantly lower risks of hypoglycemia and hyperkalemia compared with older medications such as sulfonylureas. 

Hypoglycemia, or dangerously low blood sugar, is a particular concern for seniors because it can trigger falls, hospitalizations, and cardiovascular complications.

GLP-1 receptor agonists had the best results

The study also found that GLP-1 receptor agonists may offer an additional advantage over another class of drugs, DPP-4 inhibitors, by reducing the risk of peripheral edema — fluid buildup that can be especially problematic in older patients.

GLP-1 receptor agonists are a class of injectable (and some oral) medications used to treat type 2 diabetes and, in some cases, obesity. Common examples include:

  • Semaglutide (brand names: Ozempic, Rybelsus [oral], Wegovy)
  • Liraglutide (Victoza, Saxenda)
  • Dulaglutide (Trulicity)
  • Exenatide (Byetta, Bydureon)
  • Lixisenatide (Adlyxin)
  • Tirzepatide (Mounjaro, Zepbound) — technically a dual GIP/GLP-1 agonist, but often grouped with GLP-1 drugs

These medications work by mimicking the GLP-1 hormone, which helps regulate blood sugar by increasing insulin release, slowing digestion, and reducing appetite.

SGLT2 inhibitors showed higher risks

However, the results were not entirely one-sided. SGLT2 inhibitors were linked to a higher risk of diabetic ketoacidosis, a rare but potentially life-threatening condition, highlighting the need for careful patient selection and monitoring. 

Researchers say the findings underscore the importance of tailoring diabetes treatment for older adults, who are often underrepresented in clinical trials, yet more susceptible to adverse drug events due to factors such as frailty, multiple chronic conditions, and polypharmacy. 

The study adds to a growing body of evidence suggesting that medication choice should prioritize safety alongside blood sugar control, particularly in aging populations. Experts say the results could help clinicians make more informed prescribing decisions and improve outcomes for millions of older adults living with diabetes.