Glycaemic and Cardiometabolic Effects of Oral Semaglutide in Patients Aged ≥65 Years with Type 2 Diabetes

Background: Older patients with type 2 diabetes mellitus (T2DM) are often undertreated because of concerns regarding hypoglycaemia and clinical heterogeneity. Although the evidence base for oral semaglutide is growing, data specifically in older adults remain relatively limited, particularly regarding long-term effectiveness and tolerability in routine practice. Methods: This observational study included 81 patients aged ≥65 years with T2DM treated with oral semaglutide for 12 months. Changes in glycaemic, anthropometric and cardiometabolic parameters were evaluated. The primary endpoint was the achievement of HbA1c < 7% at 12 months. Multivariable logistic regression was performed to identify baseline predictors of response. Results: HbA1c decreased from 7.75 ± 1.01% to 6.80 ± 0.88% after 12 months (p < 0.00001). Significant reductions were observed in body weight (−4.09 ± 4.42 kg, p < 0.00001), BMI (−1.50 ± 1.55 kg/m2, p < 0.00001) and waist circumference (−5.83 ± 4.71 cm, p < 0.00001). Improvements were also detected in lipid profile, blood pressure and visceral adiposity indices. No hypoglycaemic events were reported during follow-up. In multivariable analysis, baseline age, diabetes duration, baseline HbA1c and baseline VAI were not independently associated with the achievement of HbA1c < 7%; therefore, these baseline factors did not discriminate responders within our cohort (hypothesis-generating). Greater absolute HbA1c reductions were observed in patients with higher baseline HbA1c. Conclusions: In older patients with T2DM, oral semaglutide is associated with effective glycaemic control without hypoglycaemia and with a response largely independent of baseline clinical characteristics, supporting its use in elderly and clinically heterogeneous populations.