Diabetes drugs may help older adults slow frailty

A new study shows that older adults with type 2 diabetes who start treatment with sodium–glucose cotransporter-2 (SGLT-2) inhibitors—such as empagliflozin (Jardiance) and dapagliflozin (Farxiga)—or glucagon-like peptide-1 (GLP-1) receptor agonists—such as semaglutide (Ozempic) and liraglutide (Victoza)—experience slower progression of frailty over one year compared with those starting other diabetes medications. The findings suggest these therapies could help older adults maintain strength, mobility, and independence beyond their well-known effects on blood sugar and heart health.

The study, titled “Sodium-Glucose Cotransporter-2 Inhibitors, Glucagon-Like Peptide-1 Receptor Agonists, and Frailty Progression in Older Adults With Type 2 Diabetes,” and published in Diabetes Care, looked at older adults who had just started different types of diabetes medications and followed them for one year. They found that people taking SGLT-2 inhibitors or GLP-1 drugs were less likely to show signs of frailty, such as weakness, slowed movement, or fatigue, compared with those starting other diabetes medications. In other words, these treatments appeared to help patients with diabetes maintain strength and function as they aged. The benefit could not be fully explained by heart benefits, suggesting the medications may directly help protect against frailty.

Analyzing a national 7% sample of U.S. Medicare claims, researchers tracked one-year changes in a validated claims-based frailty index (CFI; range 0–1, with higher scores indicating greater frailty). Compared with new users of DPP-4 inhibitors, those starting GLP-1 receptor agonists saw a mean CFI change of –0.007 (95% CI: –0.011 to –0.004) and those starting SGLT-2 inhibitors saw a mean change of –0.005 (95% CI: –0.008 to –0.002), indicating slower frailty progression. Users of sulfonylureas showed no significant difference. Additional analyses found that cardiovascular or other safety events accounted for only a small portion of the effect, suggesting a potential direct benefit of these medications on frailty itself.

According to prior research, roughly 10–15% of adults over age 65 experience frailty, with higher rates in those with type 2 diabetes. People with diabetes are particularly at risk due to chronic inflammation, muscle loss, cardiovascular disease, and the cumulative burden of managing a complex condition. Frailty is associated with falls, disability, hospitalization, and reduced lifespan. Because it is difficult to reverse once established, slowing frailty progression has emerged as an important goal in geriatric care, making the findings of this study especially significant for older adults with diabetes.

“While SGLT-2 inhibitors and GLP-1 receptor agonists are primarily prescribed for blood sugar control and heart protection, our findings show they may also help older adults with diabetes stay stronger and less vulnerable to health setbacks,” said lead author of the study, Chanmi Park, MD, MPH, Assistant Scientist I, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife. “Because frailty is common, serious, and hard to reverse, this could meaningfully change how clinicians think about medication choices for aging patients.”

In addition to Park, the other researchers were Saran Thanapluetiwong, MD, Visiting Research Fellow, Marcus Institute for Aging Research, Hebrew SeniorLife; Xiecheng Chen, PhD, Data Scientist I, Marcus Institute for Aging Research, Hebrew SeniorLife; Gahee Oh, MD, MPH, Daa Scientist II, Marcus Institute for Aging Research, Hebrew SeniorLife; Darae Ko, MD, MSc, Associate Scientist, Marcus Institute for Aging Research, Hebrew SeniorLife; and Dae Hyun Kim, MD, MOH, ScD, Associate Director & Senior Scientist, Marcus Institute for Aging Research, Hebrew SeniorLife.