Department of Diabetes, Endocrinology and Metabolism and Department of Rheumatology and Clinical Immunology, Gifu University Graduate School of Medicine, Gifu, Japan.
Yutaka Seino Distinguished Center for Diabetes Research, Kansai Electric Power Medical Research Institute, Kyoto, Japan.
J Diabetes Investig. 2024 Jan;15(1):63-66. doi: 10.1111/jdi.14097. Epub 2023 Oct 10.
Sodium-glucose cotransporter 2 inhibitors (SGLT2is) have been shown in cardiovascular outcome trials to reduce the risk of heart failure and major adverse cardiovascular as well as renal events in individuals with type 2 diabetes. Moreover, clinical evidence indicates that SGLT2i use reduces heart failure and chronic kidney disease (CKD) in east Asian patients with type 2 diabetes. Thus, SGLT2is might seem to be the preferred treatment for older patients with type 2 diabetes even in the presence of multiple comorbidities. However, older patients with type 2 diabetes may well have impaired physiological function, making the risk of certain adverse events higher than that in the general population. While a randomized clinical trial has been conducted to evaluate changes in skeletal muscle mass and function as well as those in cognitive function with SGLT2i use in older Japanese individuals with type 2 diabetes who are otherwise healthy, the safety of SGLT2is remains to be established among older individuals with type 2 diabetes also having impaired activity of daily living and/or cognitive impairment. Even so, international and domestic consensus reports recommend SGLT2is for patients with type 2 diabetes and heart failure, CKD, and/or cardiovascular diseases, and SGLT2is are being widely prescribed by general practitioners to older individuals with type 2 diabetes with little regard to the patient's comorbidities. We maintain that SGLT2i use in older patients with type 2 diabetes should be prescribed cautiously in consideration of the pathophysiology of the disease and the presence of complications and comorbidities as well as the individual's lifestyle.
钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2is）在心血管结局试验中已被证明可降低 2 型糖尿病患者心力衰竭和主要不良心血管及肾脏事件的风险。此外，临床证据表明，SGLT2i 的使用可降低东亚 2 型糖尿病患者心力衰竭和慢性肾脏病（CKD）的发生风险。因此，SGLT2is 似乎是 2 型糖尿病老年患者的首选治疗药物，即使患者合并多种合并症。然而，2 型糖尿病老年患者的生理功能可能受损，使某些不良事件的风险高于一般人群。虽然已经进行了一项随机临床试验来评估在生理功能正常的情况下，SGLT2i 在日本 2 型糖尿病老年患者中使用对骨骼肌质量和功能以及认知功能的影响，但 SGLT2is 在 2 型糖尿病老年患者中的安全性仍需进一步研究，这些患者的日常生活活动能力和/或认知障碍受损。即便如此，国际和国内的共识报告建议将 SGLT2is 用于心力衰竭、CKD 和/或心血管疾病的 2 型糖尿病患者，全科医生也广泛地为日常生活活动能力和/或认知障碍受损的 2 型糖尿病老年患者开具 SGLT2is 处方。我们认为，在考虑疾病的病理生理学以及并发症和合并症的存在以及个体的生活方式的情况下，应谨慎地为 2 型糖尿病老年患者开具 SGLT2i 处方。
