Cardiometabolic drugs such as SGLT2 inhibitors and GLP-1 receptor agonists offer substantial benefits for older adults, but clinicians should base prescribing decisions on a patient’s frailty and comorbidities rather than age alone, experts said at the American Geriatrics Society (AGS) 2026 Annual Scientific Meeting. 

SGLT2 inhibitors are linked to side effects such as genital infections, dehydration, and dizziness, which may increase the risk for falls in older adults. GLP-1 drugs often cause nausea and weight loss, which may be harmful in patients already at risk for frailty or muscle loss. 

“The key thing is that risk is vulnerability dependent, not age dependent,” said Chintan Dave, PhD, associate professor of pharmacy and epidemiology at Rutgers University School of Public Health in New Brunswick, New Jersey. 

To better understand these risks, Dave presented preliminary findings from a Medicare claims-based study of about 120,000 older adults (mean age, 75 years). The analysis compared patients starting SGLT2 inhibitors with those taking another class of diabetes drugs and examined rates of genital infections across levels of frailty and multimorbidity. 

Risk for genital infections were higher in more clinically complex older adults with the highest burden of multimorbidity or frailty. 

Older adults are often excluded from clinical trials, which makes predicting how these drugs will affect real-world patients with complex health needs harder. 

“If you think about the patient that you see in a clinical setting, a lot of times they’re probably not even going to make it to the trial,” Dave said. 

That gap means clinicians must carefully weigh benefits and risks for each individual to guide treatment decisions in this population. 

A Framework for Personalized Care 

Onica Washington, MD, PhD, a geriatric fellow and renal attending at UMass Chan Medical School in Worcester, Massachusetts, said clinicians should use the 5Ms framework — what matters most, medications, mentation, mobility, and multicomplexity — to guide prescribing decisions in these patients. 

Washington described a 74-year-old patient with stable kidney disease who questioned adding an SGLT2 inhibitor or GLP-1 drug to their regiment. 

“Why add an extra medication when I’m doing pretty well?” the patient asked. 

That question prompted a broader discussion about his goals, daily life, and concerns, including medication burden and cost. 

After reviewing options, the patient chose a GLP-1 drug, in part because he was interested in weight loss and could access financial support, she said. 

Daniel Forman, MD, chair of the Section of Geriatric Cardiology at the University of Pittsburgh in Pennsylvania, said the growing use of these cardiometabolic drugs reflects a shift in medicine. 

Rather than focusing only on disease-specific outcomes, clinicians should consider how treatments affect function, independence, and quality of life. 

“A shift from disease endpoints to trajectories of function, resilience, and independence — that’s where we are,” Forman said. 

Dave said clinicians should balance risks like dehydration with the benefits of GLP-1 or SGLT2 inhibitors on heart and kidney health. 

“Most [adverse events] are predictable and potentially manageable,” Dave said. 

Dave reported funding, salary support, and consulting fees from agencies within the National Institutes of Health, Breakthrough T1D, the FDA, Takeda, SpineBioPharma, and Priovant, among others. Washington and Forman reported no relevant disclosures. 

Lara Salahi is a health journalist based in Boston.