SGLT2 inhibitors in frailty: a review of current evidence, and clinical recommendations

There is a high prevalence of frailty in people with heart failure, chronic kidney disease, type 2 diabetes, and multiple long-term conditions. These groups are eligible for treatment with sodium-glucose cotransporter 2 inhibitors (SGLT2i), with numerous large-scale trials demonstrating favourable clinical outcomes spanning disease states. There are now increasing data that the benefits of these agents are consistent across all frailty severities and are well tolerated. However, real-world data suggest a hesitancy in SGLT2i use in those with frailty. As a result, SGLT2i are either not initiated or discontinued inappropriately in people with frailty who are likely to derive benefit from these agents. This review critically evaluates current evidence and clinical guidelines for SGLT2i use in people with frailty, addressing safety concerns and offering practical recommendations for clinical practice.