Tomic Dunya, Harding Jessica L, Jenkins Alicia J, Shaw Jonathan E, Magliano Dianna J
School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.
Nat Rev Endocrinol. 2025 Feb;21(2):92-104. doi: 10.1038/s41574-024-01046-z. Epub 2024 Oct 24.
Although type 1 diabetes mellitus (T1DM) is traditionally viewed as a youth-onset disorder, the number of older adults being diagnosed with this disease is growing. Improvements in the average life expectancy of people with T1DM have also contributed to the growing number of older people living with this disease. We summarize the evidence regarding the epidemiology (incidence, prevalence and excess mortality) of T1DM in older adults (ages ≥60 years) as well as the genetics, immunology and diagnostic challenges. Several studies report an incidence peak of T1DM in older adults of a similar size to or exceeding that in children, and population prevalence generally increases with increasing age. Glutamic acid decarboxylase antibody positivity is frequently observed in adult-onset T1DM. Guidelines for differentiating T1DM from type 2 diabetes mellitus in older adults recommend measuring levels of C-peptide and autoantibodies, including glutamic acid decarboxylase antibodies. However, there is no gold standard for differentiating T1DM from type 2 diabetes mellitus in people aged 60 years and over. As such, the global variation observed in T1DM epidemiology might be in part explained by misclassification, which increases with increasing age of diabetes mellitus onset. With a growing global population of older adults with T1DM, improved genetic and immunological evidence is needed to differentiate diabetes mellitus type at older ages so that a clear epidemiological picture can emerge.
尽管1型糖尿病（T1DM）传统上被视为一种青少年发病的疾病，但被诊断出患有这种疾病的老年人数量正在增加。T1DM患者平均预期寿命的提高也导致了患这种疾病的老年人数量不断增加。我们总结了有关老年人（年龄≥60岁）T1DM的流行病学（发病率、患病率和超额死亡率）以及遗传学、免疫学和诊断挑战的证据。几项研究报告称，老年人中T1DM的发病率峰值与儿童相似或超过儿童，且总体人群患病率通常随年龄增长而增加。成人发病的T1DM中经常观察到谷氨酸脱羧酶抗体阳性。在老年人中区分T1DM和2型糖尿病的指南建议测量C肽和自身抗体水平，包括谷氨酸脱羧酶抗体。然而，在60岁及以上人群中区分T1DM和2型糖尿病并没有金标准。因此，T1DM流行病学中观察到的全球差异可能部分是由于错误分类造成的，这种错误分类随着糖尿病发病年龄的增加而增加。随着全球患有T1DM的老年人口不断增加，需要更好的遗传学和免疫学证据来区分老年人的糖尿病类型，以便呈现清晰的流行病学情况。
