Division of Clinical Pharmacology, Centre for Interdisciplinary Research on Medicines (CIRM), University of Liège, Liège, Belgium.
Division of Diabetes, Nutrition and Metabolic Disorders, Department of Medicine, CHU Liège, Liège, Belgium.
Expert Opin Pharmacother. 2021 Nov;22(16):2149-2165. doi: 10.1080/14656566.2021.1912735. Epub 2021 Apr 13.
An increasing number of older patients has type 2 diabetes treated with different oral antidiabetic agents whose safety may raise concern considering some particularities of a heterogeneous elderly population.
This article discusses some characteristics of older patients that could increase the risk of adverse events, with a focus on hypoglycemia. It describes the most frequent and/or severe complications reported in the elderly in both randomized controlled trials and observational studies with metformin, sulfonylureas, meglitinides, alpha-glucosidase inhibitors, thiazolidinediones, dipeptidyl peptidase-4 inhibitors (gliptins) and sodium-glucose cotransporter type 2 inhibitors (gliflozins).
Old patients may present comorbidities (renal impairment, vascular disease, heart failure, risk of dehydration, osteoporosis, cognitive dysfunction) that could increase the risk of severe adverse events. Sulfonylureas (and meglitinides) induce hypoglycemia, which may be associated with falls/fractures and cardiovascular events. Medications lacking hypoglycemia should be preferred. Gliptins appear to have the best tolerance/safety profile whereas gliflozins exert a cardiorenal protection. However, data are lacking in very old or frailty old patients so that caution and appropriate supervision of such patients are required. Taking advantage of a large choice of pharmacotherapies, personalized treatment is recommended based upon both drug safety profiles and old patient individual characteristics.
越来越多的老年 2 型糖尿病患者接受不同的口服降糖药物治疗，由于老年人群存在异质性，这些药物的安全性令人担忧。
本文讨论了一些可能增加不良事件风险的老年患者特征，重点关注低血糖。描述了二甲双胍、磺酰脲类、格列奈类、α-葡萄糖苷酶抑制剂、噻唑烷二酮类、二肽基肽酶-4 抑制剂（gliptins）和钠-葡萄糖共转运蛋白 2 抑制剂（gliflozins）在随机对照试验和观察性研究中报告的老年患者最常见和/或最严重的并发症。
老年患者可能存在合并症（肾功能不全、血管疾病、心力衰竭、脱水风险、骨质疏松症、认知功能障碍），这可能增加严重不良事件的风险。磺酰脲类（和格列奈类）可引起低血糖，低血糖可能与跌倒/骨折和心血管事件有关。应首选无低血糖风险的药物。gliptins 似乎具有最佳的耐受性/安全性，而 gliflozins 具有心脏和肾脏保护作用。然而，在非常年老或虚弱的老年患者中缺乏数据，因此需要谨慎并对这些患者进行适当的监测。鉴于有大量的药物治疗选择，建议根据药物安全性和老年患者的个体特征进行个体化治疗。
