Bilal Anika, Pratley Richard
AdventHealth Translational Research Institute, Orlando, Florida, USA.
AdventHealth Diabetes Institute, Orlando, Florida, USA.
Ann N Y Acad Sci. 2025 Jan;1543(1):42-67. doi: 10.1111/nyas.15259. Epub 2024 Dec 12.
An aging population combined with a rapidly increasing prevalence of diabetes foreshadows a global epidemic of cardiovascular and kidney disease that threatens to halt improvements in life and health-span and will have particularly severe consequences in older adults. The management of diabetes has been transformed with the recent development of newer anti-hyperglycemic agents that have demonstrated superior efficacy. However, the utility of these drugs extends beyond glycemic control to benefits for managing obesity, cardiovascular disease (CVD), chronic kidney disease, and heart failure. Numerous cardiovascular and kidney outcomes trials of these drugs have played an instrumental role in shaping current guidelines for the management of diabetes and CVD. Older adults with diabetes are diverse in terms of their comorbidities, diabetic complications, and cognitive and functional status. Therefore, there is an unmet need for personalized management of diabetes and CVD in this population. In this review, we provide an overview of the epidemiological burden and management of diabetes and CVD in older adults. We then focus on randomized cardiovascular and kidney outcome trials with anti-hyperglycemic agents to propose an evidence-based approach to the management of diabetes in older adults with high risk of cardiovascular and kidney disease.
人口老龄化加上糖尿病患病率迅速上升，预示着心血管和肾脏疾病将在全球流行，这可能会阻碍寿命和健康寿命的改善，并将对老年人产生特别严重的后果。随着新型降糖药物的最新发展，糖尿病的管理已经发生了变革，这些药物已证明具有卓越的疗效。然而，这些药物的效用不仅限于血糖控制，还对管理肥胖症、心血管疾病（CVD）、慢性肾脏病和心力衰竭有益。这些药物的众多心血管和肾脏结局试验在制定当前糖尿病和CVD管理指南方面发挥了重要作用。患有糖尿病的老年人在合并症、糖尿病并发症以及认知和功能状态方面存在差异。因此，这一人群对糖尿病和CVD的个性化管理存在未满足的需求。在本综述中，我们概述了老年人糖尿病和CVD的流行病学负担及管理。然后，我们重点关注使用降糖药物的随机心血管和肾脏结局试验，以提出一种基于证据的方法来管理有心血管和肾脏疾病高风险的老年人的糖尿病。
