Department of Geriatric Medicine, Rotherham General Hospital, Moorgate Road, Rotherham, UK.
Expert Rev Endocrinol Metab. 2023 Jan;18(1):53-65. doi: 10.1080/17446651.2023.2168644. Epub 2023 Jan 17.
The prevalence of diabetes is increasing in older people. With increasing age, frailty emerges as a new complication leading to disability. Frailty does not only include physical dysfunction but also involves negative impact on cognition and mood. Triad of impairments (TOI) is a new concept that includes physical frailty, dementia and depression to reflect the wider spectrum of frailty.
Little is known about effects of hypoglycaemic agents on frailty syndrome. A literature search was performed on studies, which reported effects of hypoglycaemic agents on the component of the TOI.
It appears that most hypoglycaemic agents have some effects on frailty, although the results of clinical studies are inconsistent. Metformin seems to have a consistent and a positive effect on physical frailty. Its effects on cognitive function, however, are inconclusive but tend to be positive. Metformin appeared to improve depressive symptoms. Other agents such as incretins, thiazolidinediones, and sodium glucose transporter-2 inhibitors have some positive effects on cognition and depression. Sulfonylureas, glinides, or insulin have either negative or neutral effects on TOI components. The negative effects of insulin could be partially explained by the negative psychological factors and the frequent episodes of hypoglycemia associated with such therapy.
随着年龄的增长，糖尿病的患病率在老年人中不断增加。衰弱作为一种新的并发症出现，导致残疾。衰弱不仅包括身体机能障碍，还涉及对认知和情绪的负面影响。三损伤（TOI）是一个新概念，包括身体虚弱、痴呆和抑郁，以反映更广泛的虚弱范围。
关于降糖药物对衰弱综合征的影响知之甚少。对报告了降糖药物对 TOI 组成部分影响的研究进行了文献检索。
似乎大多数降糖药物对衰弱都有一定的影响，尽管临床研究的结果不一致。二甲双胍似乎对身体虚弱有一致的积极影响。然而，其对认知功能的影响尚无定论，但倾向于积极。二甲双胍似乎可以改善抑郁症状。其他药物，如肠促胰岛素、噻唑烷二酮和钠葡萄糖转运蛋白-2 抑制剂，对认知和抑郁有一定的积极影响。磺酰脲类、格列奈类或胰岛素对 TOI 成分有负面或中性影响。胰岛素的负面影响部分可以用这种治疗相关的负面心理因素和频繁的低血糖发作来解释。
