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Introduction and Objective: Type 2 Diabetes (T2D) is a highly prevalent health condition in people older than 70 yrs, but they are still underrepresented in RCTs evaluating medications for T2D, as the combined SGLT2i/GLP1-RA therapy. The aim of this real-world, observational, prospective study was to compare the efficacy of combined SGLT2i/GLP1-RA therapy with that of SGLT2i and GLP1-RA monotherapy in improving glycaemic compensation and body weight (BW), in patients aged ≥70 yrs with T2D and obesity. Methods: Patients aged ≥ 70 yrs, with T2D, BMI ≥ 30 kg/m2 and suboptimal glycaemic control, treated with SGLT2i (Group 1), GLP1-RA (Group 2) and combined SGLT2i/GLP1-RA (Group 3) were considered for the study. Data were analysed at baseline (T0), 6 months (T1) and 12 months (T2) after the start of treatment. Results: Out of 94 patients, 25 patients (9 F/16 M, 76.5±3.9 yrs, BMI 31.7±4.3 Kg/m2) in the Group 1, 38 patients (11 F/27 M, 75.8±4.1 yrs, BMI 32.9±4.6 Kg/m2) in the Group 2, 31 patients (10 F/21 M, 77.1±4.9 yrs, BMI 32.9±2.9 Kg/m2) in the Group 3 were included in the study. In all 3 groups, a significant reduction in BMI was observed after 1 year of treatment compared to baseline, with no significant differences in efficacy between the 3 types of intervention [ΔBMI: -1.44±0.26 (Group 1) vs -1.33±0.28 (Group 2) vs -1.33±0.27 (Group 3)]. GLP1-RA treatment was more effective than SGLT2i in reducing HbA1c in this population [ΔHbA1c: -9.8±2.2 (group 2) vs -2.2±1.8 (group 1), p=0.026]. Although not significant, an overlapping trend was observed for the combined SGLT2i and GLP1-RA therapy [ΔHbA1c: -9.5±3.9 (group 3)]. Conclusion: Combined SGLT2i/GLP1-RA therapy was not shown to be superior to monotherapy in improving glycaemic control, likely due to lower efficacy of SGLT2i in the elderly population, as previously described. One possible explanation could be a physiological reduction in GFR in elderly population. All 3 interventions were effective in controlling BW for up to 1 year. Disclosure A. Ferrulli: None. P. Senesi: None. L. Luzi: Speaker's Bureau; A. Menarini Diagnostics, Amgen Inc. Research Support; Boehringer-Ingelheim. Advisory Panel; Eli Lilly and Company. Speaker's Bureau; Eli Lilly and Company. Research Support; Medtronic. Speaker's Bureau; Novartis AG, Novo Nordisk. Funding Ricerca Corrente - IRCCS MultiMedica