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. Data on the effectiveness of oral semaglutide in this population remain limited. 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 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, no baseline clinical or metabolic variable independently predicted achievement of HbA1c <7%, indicating a homogeneous glycaemic response across the study population. 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.