Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan.
Division of Evidence-based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Age Ageing. 2024 Aug 6;53(8). doi: 10.1093/ageing/afae175.
Type 2 diabetes mellitus (T2DM) is increasingly being diagnosed in older adults. Our objective is to assess the advantages and potential drawbacks of different glucose-lowering medications in this specific population.
A network meta-analysis was conducted to identify randomized controlled trials that examined patient-centered outcomes in adults aged ≥65 years with T2DM. We searched PubMed, Cochrane CENTRAL, and Embase up to September 23, 2023. Quality of eligible studies were assessed using the Cochrane RoB 2.0 tool.
A total of 22 trials that involved 41 654 participants were included, incorporating sodium-glucose cotransporter-2 (SGLT2) inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1RAs), dipeptidyl peptidase-4 (DPP-4) inhibitors, metformin, sulfonylureas (SU) and acarbose. Our findings reveal that GLP-1RAs reduce the risk of major adverse cardiovascular events (risk ratio [RR], 0.83; 95% confidence interval [CI], 0.71 to 0.97) and body weight (mean difference [MD], -3.87 kg; 95% CI, -5.54 to -2.21). SGLT2 inhibitors prevent hospitalization for heart failure (RR, 0.66; 95% CI, 0.57 to 0.77), renal composite outcome (RR, 0.69; 95% CI, 0.53 to 0.89), and reduce body weights (MD, -1.85 kg; 95% CI, -2.42 to -1.27). SU treatment increases the risk of any hypoglycaemia (RR, 4.19; 95% CI, 3.52 to 4.99) and severe hypoglycaemia (RR, 7.06; 95% CI, 3.03 to 16.43). GLP-1RAs, SGLT2 inhibitors, metformin, SU and DPP-4 inhibitors are effective in reducing glycaemic parameters. Notably, the number of treatments needed decreases in most cases as age increases.
Novel glucose-lowering medications with benefits that outweigh risks should be prioritized for older patients with diabetes.
2 型糖尿病（T2DM）在老年人中的诊断率越来越高。我们的目标是评估不同降糖药物在这一特定人群中的优势和潜在弊端。
进行了一项网络荟萃分析，以确定研究年龄≥65 岁的 T2DM 患者以患者为中心结局的随机对照试验。我们检索了 PubMed、Cochrane CENTRAL 和 Embase，检索时间截至 2023 年 9 月 23 日。使用 Cochrane RoB 2.0 工具评估合格研究的质量。
共纳入 22 项试验，涉及 41654 名参与者，包括钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂、胰高血糖素样肽-1 受体激动剂（GLP-1RAs）、二肽基肽酶-4（DPP-4）抑制剂、二甲双胍、磺酰脲类（SU）和阿卡波糖。我们的研究结果表明，GLP-1RAs 降低了主要不良心血管事件（风险比 [RR]，0.83；95%置信区间 [CI]，0.71 至 0.97）和体重（平均差值 [MD]，-3.87kg；95%CI，-5.54 至-2.21）的风险。SGLT2 抑制剂可预防心力衰竭（RR，0.66；95%CI，0.57 至 0.77）、肾脏复合结局（RR，0.69；95%CI，0.53 至 0.89）和体重（MD，-1.85kg；95%CI，-2.42 至-1.27）的住院治疗。SU 治疗增加了任何低血糖（RR，4.19；95%CI，3.52 至 4.99）和严重低血糖（RR，7.06；95%CI，3.03 至 16.43）的风险。GLP-1RAs、SGLT2 抑制剂、二甲双胍、SU 和 DPP-4 抑制剂在降低血糖参数方面均有效。值得注意的是，大多数情况下，随着年龄的增长，所需治疗的次数减少。
对于老年糖尿病患者，应优先选择具有获益大于风险的新型降糖药物。
