What adverse effects are associated with SGLT2 inhibitors in older adults, requiring caution and monitoring?

• A. Urogenital infections and euglycemic diabetic ketoacidosis
• B. Severe hypoglycemia in all patients
• C. Hyperkalemia only
• D. Seizures in patients with CKD.

Answer: (B)

SGLT2 inhibitors increase glucose in the urine, which creates a breeding ground for genitourinary infections. This is a common adverse effect in older adults and is a key reason for caution and monitoring. They also carry a risk of euglycemic diabetic ketoacidosis, a situation where ketones rise without the high blood sugar typical of DKA, which can be harder to recognize in older patients who may have altered appetite or illness. These risks are especially important in the elderly who may have reduced renal function or be volume-depleted, increasing the chance of dehydration and kidney stress. While severe hypoglycemia can occur, it is not a universal outcome with SGLT2 inhibitors and is more likely when these drugs are combined with insulin or sulfonylureas. So the adverse effects that most consistently require careful monitoring in older adults are genitourinary infections and euglycemic DKA, with attention to hydration and kidney function to reduce risk.