Abstract：
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: Novel glucose-lowering medications with benefits that outweigh risks should be prioritized for older patients with diabetes.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: Novel glucose-lowering medications with benefits that outweigh risks should be prioritized for older patients with diabetes.
摘要：
背景：2型糖尿病（T2DM）越来越多地被诊断为老年人。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缺陷。
方法：进行了网络荟萃分析，以确定随机对照试验，该试验检查了年龄≥65岁的T2DM成人以患者为中心的结局。我们搜索了PubMed,科克伦中部,和Embase至2023年9月23日。使用CochraneRoB2.0工具评估合格研究的质量。
结果：共纳入22项试验，涉及41654名参与者，掺入钠-葡萄糖协同转运蛋白-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-1RA可降低主要不良心血管事件的风险(风险比[RR]，0.83；95%置信区间[CI]，0.71至0.97)和体重(平均差[MD]，-3.87千克；95%CI，-5.54至-2.21）。SGLT2抑制剂可预防心力衰竭住院（RR，0.66；95%CI，0.57至0.77），肾脏综合结局(RR，0.69；95%CI，0.53至0.89），并减轻体重(MD，-1.85千克；95%CI，-2.42至-1.27）。SU治疗会增加任何低血糖的风险(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）。GLP-1RA,SGLT2抑制剂，二甲双胍,SU和DPP-4抑制剂可有效降低血糖参数。值得注意的是,在大多数情况下，随着年龄的增加，所需的治疗次数减少。
结论：对于老年糖尿病患者，应优先选择效益大于风险的新型降糖药物。
方法：进行了网络荟萃分析，以确定随机对照试验，该试验检查了年龄≥65岁的T2DM成人以患者为中心的结局。我们搜索了PubMed,科克伦中部,和Embase至2023年9月23日。使用CochraneRoB2.0工具评估合格研究的质量。
结果：共纳入22项试验，涉及41654名参与者，掺入钠-葡萄糖协同转运蛋白-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-1RA可降低主要不良心血管事件的风险(风险比[RR]，0.83；95%置信区间[CI]，0.71至0.97)和体重(平均差[MD]，-3.87千克；95%CI，-5.54至-2.21）。SGLT2抑制剂可预防心力衰竭住院（RR，0.66；95%CI，0.57至0.77），肾脏综合结局(RR，0.69；95%CI，0.53至0.89），并减轻体重(MD，-1.85千克；95%CI，-2.42至-1.27）。SU治疗会增加任何低血糖的风险(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）。GLP-1RA,SGLT2抑制剂，二甲双胍,SU和DPP-4抑制剂可有效降低血糖参数。值得注意的是,在大多数情况下，随着年龄的增加，所需的治疗次数减少。
结论：对于老年糖尿病患者，应优先选择效益大于风险的新型降糖药物。
