Eficacia y seguridad de inhibidores del cotransportador sodio glucosa tipo 2 versus biguanidas en el tratamiento de la diabetes mellitus Tipo 2 en adultos mayores: revisión sistemática

Abstract

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and biguanides are commonly prescribed pharmacological agents in the treatment of Type 2 Diabetes Mellitus (T2DM). Both aim to regulate blood glucose levels through different mechanisms of action. Objective: To evaluate the efficacy and safety of SGLT2 inhibitors compared to biguanides in the treatment of T2DM in the elderly population. Methods: A systematic review was conducted using databases such as PubMed, SpringerLink, and Elsevier. Medical subject headings and Boolean operators (AND/OR) were used to optimize the search. Open-access articles published in English or Spanish since 2020 were included. The selection process followed the PRISMA 2020 guidelines. The risk of bias was assessed using the RoB-2 tool, and methodological quality was evaluated with the National Institute of Health (NIH) assessment tool. Results: Dapagliflozin was the SGLT2 inhibitor that demonstrated the greatest efficacy, reflected in a greater reduction in glycated hemoglobin (HbA1c), and was associated with fewer adverse effects compared to other drugs. However, the studies did not show statistically significant differences between treatments, and the patient’s age influenced the results. Conclusions: Dapagliflozin emerged as the most effective and safest option among the evaluated medications. Nevertheless, further targeted research in the older adult population is necessary to validate these findings. Keywords: Type 2 diabetes mellitus, biguanides, adverse effects, metformin, glycated hemoglobin