Differential effects of dapagliflozin and empagliflozin on skeletal muscle mass in older adults with type 2 diabetes.

PURPOSE: Sodium-glucose cotransporter-2 inhibitors are widely used in older adults with type 2 diabetes mellitus; however, their effects on geriatric syndromes remain incompletely understood. This study evaluated the longitudinal effects of dapagliflozin and empagliflozin on older adults using a comprehensive geriatric assessment (CGA).

METHODS

This study included 42 adults aged ≥ 65 years with type 2 diabetes mellitus (dapagliflozin, n = 22; empagliflozin, n = 20). Assessments were performed at baseline and after approximately six months. CGA was a core component of the study and included the FRAIL scale, Mini-Mental State Examination, Timed Up and Go test, gait speed, Tinetti gait and balance assessment, handgrip strength, and the Pittsburgh Sleep Quality Index.

RESULTS

In the dapagliflozin group, body mass index decreased from 31.0 ± 4.9 to 27.8 ± 4.7 kg/m² (p = 0.018), accompanied by reductions in fat-free mass (FFM) (52.75 ± 7.41 to 51.05 ± 6.95 kg, p = 0.020) and skeletal muscle mass index (SMMI) (11.68 ± 1.01 to 11.38 ± 0.88 kg/m², p = 0.039). In the empagliflozin group, body mass index (BMI) also decreased (32.8 ± 5.5 to 31.6 ± 4.8 kg/m², p = 0.013), while SMMI remained stable. A significant time × group interaction was observed for SMMI (p = 0.023). No significant changes were detected in frailty, physical performance, cognitive function, muscle strength, sleep quality, or fall frequency.

CONCLUSION

While dapagliflozin was associated with slight muscle mass loss, empagliflozin preserved muscle. Neither drug negatively affected frailty, cognition, physical performance, or sleep. These findings support their safe use in older adults, with attention to individual patient needs.