Abdelhafiz Ahmed H, Sinclair Alan J
Department of Geriatric Medicine, Rotherham General Hospital, Moorgate Road, Rotherham S60 2UD, UK.
Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, Droitwich Spa WR9 0QH, UK; Kings College, London SE1 9NH, UK.
J Diabetes Complications. 2020 Sep;34(9):107639. doi: 10.1016/j.jdiacomp.2020.107639. Epub 2020 May 26.
The prevalence of diabetes is increasing particularly in the older age group due to the increased life expectancy. Ageing is associated with vascular and renal changes that predispose older people with diabetes to an increased risk of cardio-renal complications. This manuscript is set to review the use of the sodium glucose transporter-2 (SGLT-2) inhibitors and the glucagon like peptide-1 receptor agonists (GLP1-RA) in older population with diabetes especially in those with comorbidities and frailty. The recently introduced (SGLT-2) inhibitors and the GLP1-RA have shown promising cardio-renal protective outcomes. In addition to the favourable effect of glycaemic control on cardio-renal complications, these new agents seem to add additional benefits independent of their hypoglycaemic properties. The favourable outcomes have been shown in the older age group (>65 years) who were reasonably represented in the randomised controlled clinical trials. However, the evidence for those ≥75 years old is limited due to the small number of the included participants and the few clinical events. Data from both real world and post-hoc analyses of clinical trials is assuring about the use of these new agents in older people. However, it remains reasonable to express caution in using these agents in frail older people with diabetes due to high risk of adverse events in this group.
由于预期寿命增加，糖尿病的患病率正在上升，尤其是在老年人群体中。衰老与血管和肾脏变化相关，这使老年糖尿病患者发生心肾并发症的风险增加。本手稿旨在综述钠-葡萄糖协同转运蛋白2（SGLT-2）抑制剂和胰高血糖素样肽-1受体激动剂（GLP1-RA）在老年糖尿病患者中的应用，特别是在那些患有合并症和身体虚弱的患者中。最近引入的SGLT-2抑制剂和GLP1-RA已显示出有前景的心肾保护效果。除了血糖控制对心肾并发症的有利影响外，这些新药似乎还具有独立于其降糖特性的额外益处。在随机对照临床试验中有合理代表性的老年人群体（>65岁）中已显示出这些有利结果。然而，对于那些≥75岁的患者，由于纳入的参与者数量较少且临床事件较少，证据有限。来自真实世界和临床试验事后分析的数据都证实了这些新药在老年人中的应用。然而，由于该群体发生不良事件的风险较高，在身体虚弱的老年糖尿病患者中使用这些药物时仍需谨慎。
