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.
Diabetes Metab. 2021 Nov;47(6):101275. doi: 10.1016/j.diabet.2021.101275. Epub 2021 Sep 2.
Dipeptidyl peptidase-4 inhibitors (DPP-4is) and sodium-glucose cotransporter type 2 inhibitors (SGLT2is) offer new options for the oral management of type 2 diabetes mellitus (T2DM), with the advantage in the elderly population to be devoid of a high risk of hypoglycaemia. SGLT2is have also shown benefits regarding cardiovascular (heart failure) and renal protection, including in patients with T2DM aged ≥ 65 years while DPP-4is have only proved cardiovascular and renal safety without superiority compared with placebo. The glucose-lowering efficacy of the two pharmacological classes is almost similar including in older patients with T2DM. However, the tolerance and safety profile may be highly different and overall more favourable with DPP-4is than with SGLT2is. Some adverse events have been reported with SGLT2is which may be more prevalent or severe in older patients than in younger patients. The present comprehensive review focuses on the benefit/risk balance in the elderly population with T2DM by comparing the profile of DPP-4is and SGLT2is regarding the following potential issues: metabolic disorders (hypoglycaemia and diabetic ketoacidosis); cardiac and vascular issues (atheromatous cardiovascular disease, heart failure, volume reduction hypotension, and lower limb amputations); renal endpoints including acute renal injury; risk of infections; digestive disorders; bone and skin adverse events; and cancer risk. Both DPP-4is and SGLT2is have their own advantages and disadvantages. Personalised treatment is recommended based upon the efficacy/safety profile of each drug class and individual patient characteristics that may be markedly different among the heterogeneous population of older individuals with T2DM.
二肽基肽酶-4 抑制剂（DPP-4i）和钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2i）为 2 型糖尿病（T2DM）的口服治疗提供了新的选择，其在老年人群中的优势在于低血糖风险低。SGLT2i 还显示出对心血管（心力衰竭）和肾脏的保护作用，包括年龄≥65 岁的 T2DM 患者，而 DPP-4i 仅在与安慰剂相比具有心血管和肾脏安全性，而没有优越性。两种药物类别的降糖疗效几乎相似，包括年龄较大的 T2DM 患者。然而，耐受性和安全性特征可能有很大的不同，与 SGLT2i 相比，DPP-4i 总体上更有利。SGLT2i 已报告了一些不良反应，这些不良反应在老年患者中可能比年轻患者更常见或更严重。本综合综述通过比较 DPP-4i 和 SGLT2i 在以下潜在问题方面的特征，重点关注老年 T2DM 人群的获益/风险平衡：代谢紊乱（低血糖和糖尿病酮症酸中毒）；心脏和血管问题（动脉粥样硬化性心血管疾病、心力衰竭、容量减少性低血压和下肢截肢）；肾脏终点包括急性肾损伤；感染风险；消化系统疾病；骨骼和皮肤不良事件；以及癌症风险。DPP-4i 和 SGLT2i 各有优缺点。建议根据每种药物类别的疗效/安全性特征和个体患者特征进行个体化治疗，这些特征在异质性的老年 T2DM 人群中可能有很大差异。
